Page 86 - Critical Maternity & Newborn Health Nursing

Multi‐dose regimen:

- MTX 1mg/kg IM Days 1, 3, 5, 7. Alternate with folinic acid 0.1mg/kg

IM Days 2, 4, 6, 8.

- Measure serum HCG on MTX dose days; continue dosing until hCG

decreases 15% from previous measurement

- Follow HCG levels until <5 mIU/mL

 To date, no study compares single‐dose and two‐dose regimens head‐

to‐head.

 Two‐dose should be considered if medical management is planned

despite relative contraindications (e.g. HCG >5000 mIU/mL, + ectopic

cardiac activity).

 Multi‐dose should be reserved for extreme cases (e.g. cervical ectopic,

HCG>10,000 in poor surgical candidate); other interventions such as an

u/s‐guided KCl injection should also be considered.

• Other treatment guidelines:

- RhoGAM if Rh negative

- Advise patient to discontinue folic acid supplementation during MTX

treatment

- Avoid pelvic exams and pelvic intercourse during treatment

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