Abstract
Objective To compare the results of expectant management, single and multidose methotrexate (MTX) and surgical management of ectopic pregnancy (EP). Materials and Methods In this retrospective cohort study, the original files of 233 patients who were treated for EP between May 2009 and December 2016 were analyzed. The patients were assigned to the following groups based on the applied treatment methods: Group 1, expectant management (n = 24), Group 2, single-dose MTX (n = 144), Group 3, multiple-dose MTX (n = 25), and Group 4, surgical intervention (n = 40). The following parameters were recorded and assessed: sociodemographic characteristics, pelvic ultrasonography findings (gestational sac, ectopic mass appearance, positive fetal cardiac activity), serum beta-human chorionic gonadotropin (β-hCG) levels on Day 0, Day 4, and Day 7, and surgical procedures in women that underwent surgical interventions. Results The sociodemographic characteristics were similar in all four groups. The percentage of ectopic mass and positive fetal cardiac activity was greater and the diameter of the mass was larger in Group 4 than in the other groups. The β-hCG values on Day 0, Day 4, and Day 7 were statistically different between the groups (p < 0.001). The cutoff value for the β-hCG change for EP resolution was 18% between Day 0 and Day 4 (AUC = 0.726, p < 0.001) and 15% between Day 4 and Day 7 (AUC = 0.874, p < 0.001). The probability of the requirement for an additional dose of MTX was 0.78 (95% CI 0.71 – 0.87; p < 0.001) times lower in patients who had a > 18% decrease in β-hCG levels from Day 0 to Day 4 in comparison to those who had a decrease < 18% from Day 0 to Day 4. The probability of the requirement for an additional dose of MTX was 1.64 (95% CI 1.25 – 2.16; p < 0.001) times greater in patients whose reduction in β-hCG levels from Day 4 to Day 7 was < 15% in comparison to those who had > 15% reduction from Day 4 to Day 7. Conclusions Additional dose requirements for patients with EP may be predicted early in the changes in β-hCG levels between Day 0 and Day 4. Further prospective studies are required to elucidate this issue.
Highlights
Ectopic pregnancy (EP), defined as the implantation of a fertilized ovum outside of the endometrial cavity, accounts for approximately 1.3–2 % of all pregnancies, and it is the most important cause of morbidity and mortality in the first trimester [1, 2]
The current study investigated the results of ectopic pregnancy (EP) treatment
Initial β‐hCG values < 1500 mIU/L appear to benefit from expectant management, while β‐hCG values 1500–2000 mIU/L appear to benefit from single-dose MTX therapy, and β‐hCG values > 2000 mIU/L appear to benefit from multiple-dose MTX therapy
Summary
Ectopic pregnancy (EP), defined as the implantation of a fertilized ovum outside of the endometrial cavity, accounts for approximately 1.3–2 % of all pregnancies, and it is the most important cause of morbidity and mortality in the first trimester [1, 2]. While several mechanisms have been proposed in the etiopathogenesis of EP, the main reasons for it are the partial obstruction of and defective ciliar movements in fallopian tubes [3]. It is important to remember that the risk factors of EP include a history of pelvic inflammatory disease, intrauterine device use (especially with progesterone), advanced maternal age, smoking, a history of tubal surgery, and a history of infertility, endometriosis and assisted reproductive technology therapy; it is important to note that risk factors can be undetected in more than half of all EP cases [4, 5]. Vaginal bleeding, and amenorrhea are the most common symptoms in EP, which most often occurs in the fallopian tubes [3, 6]. The goal of EP treatment is to save a mothers life; it should aim to preserve fertility and reduce the cost of infertility treatment [10]
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