Abstract
Objective: To evaluate the role of β-HCG level changes between days 0 and 1 as an early predictor of methotrexate success in cases of tubal ectopic pregnancy.Methods: A retrospective study included 86 tubal ectopic pregnancies treated with a single-dose methotrexate protocol of 50 mg/m2 of body surface. β-HCG measurements were taken on days 0, 1, 4 and 7 where day 0 is the day of methotrexate injection. Day 0 β-HCG and the percentage change in β-HCG level between days 0 and 1 (HCG index) were calculated and compared between patients who were successfully or unsuccessfully treated. Receiver operator characteristics (ROC) curves were plotted to identify the best cutoff levels.Results: The average level of β-HCG (1416.8 versus 2502.5 IU/L, p=.001) and its increment after 24 hours (12.9 versus 27.1%, p=.001) were significantly lower in the successful treatment group. ROC curves for β-HCG level and its relative increment revealed that cutoff values of ≤1550 IU/L and ≤13% increment showed a sensitivity of 90 and 70% respectively for successful methotrexate treatment.Conclusion: Day 0 β-HCG level ≤1550 IU/L and an increment of ≤13% after 24 hours are early predictors of successful methotrexate treatment for tubal ectopic pregnancy.
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