الفهرس 
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Abstract
Background: Ectopic pregnancy is a pregnancy with the fertilized embryo implanted on any tissue other than the uterine lining. 95% of ectopics are in the tube, 1.5% abdominal, 0.5% ovarian and 0.03% are in the cervix. Risk factors of ectopic pregnancy include pelvic inflammatory diseases, in vitro fertilization, previous ectopic pregnancy, pregnancy after tubal ligation, previous tubal surgery, ovulation induction or ovarian stimulation and progestin only contraceptives. Ectopic pregnancy can be diagnosed by serial β-hCG and transvaginal ultrasound. Ectopic pregnancy may be disturbed or undisturbed. Undisturbed ectopic pregnancy can be treated medically by methotrexate intramuscular injection. Methotrexate has demonstrated high success rates (86 to 94%) that are not skill-dependent and has become a standard medical treatment in appropriate patients. It is an anti-cancer drug that has been used for a variety of conditions, such as hydatiform mole, leukemia, and psoriasis. The occurrence of miscarriages or malformed fetuses does not increase after its use. The best candidates for methotrexate therapy for undisturbed ectopic pregnancy are those who are not suffering symptoms, have a blood level of hCG of less than 5000 mIU/ml, tubal size of ≤ 3 cm, no fetal cardiac activity on ultrasonography, and will come in to be followed closely. Objectives: The aim of the work was to evaluate the fate of undisturbed tubal ectopic pregnancy after intramuscular injection of methotrexate Patients and methods: This prospective study was carried out at the Department of Obstetrics and Gynecology, Zagazig University Hospitals on women with undisturbed ectopic pregnancies. The women in the selection criteria were informed regarding the treatment and were consented. However, documentation and obtaining the consent were not universal. We giave single IM dose of methotrexate (50 mg/m2 of body surface area) to the patients. β-hCG were followed on day one (injection day), day four, on day seven. We administered a second dose of methotrexate if the serum hCG concentration on day seven had not declined by at least 25 percent from the day one level and the protocol was repeated. If decrease in hCG between days 4 and 7 was less than 15%, a second dose of methotrexate 50 mg/m2 was given. Weekly measurements were continued until the hCG is undetectable. If hCG falls 15% between weekly measurement after third dose, we perform laparoscopic salpingostomy or salpingectomy. Results: Results showed the level of hCG level of the studied cases pre- and post-injection. The level of hCG in the studied cases pre-injection ranged from 44 to 7500 mIU/ml, its mean was 1932.3 ± 2614. The level of hCG in the studied cases, in the follow-up after injection, ranged in the first day from 39 to 4815 mIU/ml and its mean was 1208.5 ± 1684 mIU/ml. In the second dary post-injection, the level ranged from 21 to 2450 and its mean was 673.1 ± 911 mIU/ml. In the third day, the level ranged from 0 to 955 mIU/ml and its mean was 216.4 ± 292 mIU/ml. In the fourth day, the level ranged from 0 to 300 mIU/ml and its mean was 58.8 ± 99.5 mIU/ml. There were highly significant differences between the cases as regard HCG changes. Conclusion: In women with an undisturbed ectopic pregnancy, the level of serum hCG is the best predictor of successful treatment with intramuscular methotrexate. However, a high success rate was found in patients with hCG levels as high as 15,000 mIU per ml.