When patients raise issues, we should listen
We are disappointed to note that instead of believing what an woman with an ectopic pregnancy revealed to us, i.e. that her treatment had been delayed by 48 hours because an application for use of methotrexate needed to be approved as an exceptional treatment, Doctors for Life have criticized our organization for spreading mis-information. It turns out the woman in question was spot on in her assessment of the situation. Even worse, this very same organization that claims that life should be protected from the moment of conception, issues a statement that (aren’t we fortunate!), no pregnant woman has died in pregnancy in the past 10 years. Apparently, in their eyes, high quality care can be equated to “not dying in pregnancy.” One of the members of this organization has also stated in an online comment that “in Malta we have also preferred to use surgery because methotrexate may leave the woman with a damaged tube, this putting her at risk of a recurrent ectopic”. Sadly this too a mis-representation of the facts. The medical management by methotrexate offers several benefits over surgical treatment. It is less invasive, less expensive, can be given on an outpatient basis and does not need special expertise like laparoscopy. Future reproductive expectations are better with methotrexate, with higher intrauterine pregnancy rates and lower ectopic rates subsequently.
Not only does methotrexate offer a safe and effective non-surgical method of treating selected patients, but another important advantage of medical therapy is the potential for considerable savings in treatment costs. Finally, a few studies of tubal patency after methotrexate have shown that more than 75% have no evidence of scarring, contrary to what has been alleged by Doctors for Life.
Moreover, there is no way of knowing whether the tubal defects identified after methotrexate treatment of an ectopic pregnancy are a consequence of the treatment or were already present before the pregnancy, and were thus the cause of the ectopic pregnancy. The National Institute of Care and Excellence (NICE) would not issue guidelines that included the use of methotrexate if there was any sound evidence of frequent complications from this treatment. Doctors for Life, please stop spreading mis-information.