Clinical Outcome of Treatment of Unruptured Tubal Ectopic Pregnancy with Methotrexate: A Study of 60 Patients

Background: Ectopic pregnancy is a life-threatening condition if not managed promptly. Methotrexate (MTX), a folic acid antagonist, has been widely used as a medical management option for unruptured tubal ectopic pregnancies, avoiding surgical intervention and preserving tubal function. Objective: To evaluate the clinical outcomes of single-dose and multi-dose methotrexate regimens in the treatment of unruptured tubal ectopic pregnancy. Methods: A prospective observational study was conducted on 60 patients diagnosed with unruptured tubal ectopic pregnancy at Department of Obstetrics & Gynaecology, Dr. Sirajul Islam Medical College Hospital, Dhaka, Bangladesh & Manikganj Shishu and General Hospital, Manikganj, Bangladesh from January to December 2025. Diagnosis was confirmed via transvaginal ultrasonography and serial ?-hCG measurements. Patients received either single-dose or multi-dose methotrexate therapy according to clinical protocol and ?-hCG levels. Clinical outcomes, including treatment success, need for surgical intervention, ?-hCG resolution time, and complications, were analyzed. Results: Out of 60 patients, 46 (76.7%) responded successfully to methotrexate therapy without requiring surgery. Single-dose therapy was successful in 34 of 40 patients (85%), whereas multi-dose therapy had a success rate of 12 out of 20 patients (60%). The mean time for ?-hCG normalization was 28 ± 6.5 days. Side effects, including mild gastrointestinal upset and transient liver enzyme elevation, were observed in 15% of patients, with no severe adverse events. Treatment failure was significantly associated with initial ?-hCG levels >5000 IU/L and the presence of a gestational sac >3.5 cm. Conclusion: Methotrexate therapy is an effective and safe treatment option for unruptured tubal ectopic pregnancy, with high success rates, minimal side effects, and preservation of fertility. Early diagnosis and careful patient selection improve outcomes.