Abstract
INTRODUCTION: A single-dose methotrexate protocol was validated and successfully used to preserve fertility in ectopic pregnancy. A 15% drop in β-hCG between days 4 and 7 had a positive predictive value of 93% in predicting success. However, the drawback of this protocol is there is a waiting period of 7 days before we know whether the methotrexate is effective. Hence, we aim to examine whether a rise or fall in serum β-hCG from days 0–4 confers any prognostic value during methotrexate therapy. METHODS: This is a retrospective study of tubal ectopic pregnancies treated with a single-dose methotrexate protocol at Sultan Quboos University Hospital, Muscat, Oman, for 2 years from 2012 to 2013. We categorized our data into group 1 and group 2 based on whether serum β-hCG rose or fell between days 0 and 4, respectively. We analyzed the data for treatment success or failure. RESULTS: Forty-eight eligible women who received a single-dose methotrexate protocol for ectopic pregnancy were analyzed. The overall treatment success rate was 70.83% (34/48). Of 21 patients in whom serum β-hCG dropped between days 0 and 4 after methotrexate, the ectopic pregnancy was resolved in 95.23% of cases without further treatment. Of 27 women in whom serum β-hCG rose between days 0 and 4, only 51.85% had treatment success. CONCLUSION: A decrease in β-hCG levels between days 0 and 4 after methotrexate for ectopic pregnancy appears to be a reliable indicator of treatment success.
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