Beta-Human Chorionic Gonadotropin and Uterine Artery Doppler Measurements for the Prediction of Success of Single Dose Methotrexate Treatment in Tubal Ectopic Pregnancies

Kılıç Çiğdem,Enis Özkaya,Metin Kaplan,Mehmet Metin Altay,Tuğba Kınay,Serap Fırtına Tuncer,Ahmet Okyar Erol,Orhan Gelişen

doi:10.21613/gorm.2016.90

Kılıç Çiğdem, Enis Özkaya + Show 6 more

Open Access

https://doi.org/10.21613/gorm.2016.90

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Abstract

Objectives: To evaluate the impact of the uterine artery Doppler values and the change of β-Human chorionic gonadotropin (β-HCG) levels from day 0 to day 4 for prediction of the success of single dose methotrexate treatment in tubal pregnancy cases. Study Design: 50 patients with tubal pregnancy were included the prospective study. The location and size of ectopic pregnancy, bilateral uterine artery pulsed color doppler imaging was examined by ultrasonography and serum β-HCG levels were measured on day 0, 4, 7 of treatment. Success was defined as decrease of β-HCG level <10 mIU/mL with single dose methotrexate treatment. Multiple dose methotrexate treatment and surgical treatment were considered as treatment failure.Results: 32 patients (64%) treated with single dose methotrexate, 14 patients (28%) treated with multiple dose methotrexate, and 4 patients (8%) treated with surgery. In the group with β-HCG level decrease > 15.04% on day 4, single-dose methotrexate therapy were 3.82 times more successful than the group without > 15.04% β-HCG decrease. However, no significant alteration of uterine artery Doppler measurements was determined on the same days.Conclusion: Reduction rate in the β-HCG level on day 4 of treatment can be used in determination the success of single-dose methotrexate therapy.

Highlights

Ectopic pregnancy is defined as an implantation of the fertilized ovum outside the uterus, often the fallopian tubes.[1]
No significant alteration of uterine artery Doppler measurements was determined on the same days
Reduction rate in the β-Human chorionic gonadotropin (β-Human Chorionic Gonadotropin (HCG)) level on day 4 of treatment can be used in determination the success of single-dose methotrexate therapy

Summary

Introduction

Ectopic pregnancy is defined as an implantation of the fertilized ovum outside the uterus, often the fallopian tubes.[1] Compared to previous years; the incidence of ectopic pregnancy was increased depending on the induction of ovulation, tubal sterilization and increased incidence of pelvic infection.[2] Early diagnosis by the sensitive Human Chorionic Gonadotropin (HCG) measurements, transvaginal ultrasonography, and widespread use of laparoscopic surgical procedures. Address of Correspondence: Submitted for Publication: 18. 2015 play a considerable role in the increased incidence of ectopic pregnancy.[3] Surgical treatment of ectopic pregnancy is still used all over the world as the definitive treatment method. Medical management of unruptured ectopic pregnancy has many advantages; such as low cost, reduced risk of tubal damage and consequent increase in fertility potential.[4,5,6]

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