Abstract
Introduction: Ectopic pregnancy (EP) poses a great threat to pregnant women, and in case of misdiagnosis could lead to catastrophic death of the patients. EP patients tend to be treated with surgical or non-surgical treatments. One of the most common therapies in managing EP is Methotrexate (MTX), which the efficacy of its single- and double-dose treatments will be evaluated in this study. Methods: One-hundred and twenty patients with EP, diagnosed in AL-Zahra hospital in Tabriz, Iran, were involved in the study and were divided, randomly, into two groups of 60 (though 4 of the patients in the second group left the study due to discontent, afterwards). For the first group 50 milligrams (mg) of intramuscular (IM) single-dose MTX was prescribed, while for the second group two doses of 50 mg IM MTX were prescribed. The levels of β-hCG were evaluated before the treatment, in the fourth and seventh days, and second and fourth weeks after the treatment. In addition, sonographic findings, clinical symptoms before the treatment, and side effects after treatment were recorded. Results: Success rate for the single-dose group was 85%, while for the double-dose group was 94.6%. However, there was no statistically significant difference between two groups. In addition, there were no significant relations between 2 groups in endometrial thickness, presence of abdominal free fluid and gestational age with the success rate. Regardless, the initial level of β-hCG was an indicator of treatment success rate. In patients with double-dose MTX, required period of time for β-hCG levels to reduce down to zero was significantly lower than the other group. Cut-off point for success rate with single-dose MTX was 3350, with the sensitivity of 88.9% and specificity of 76.5% and for the other group it was 3894.5, with the sensitivity of 66.7% and specificity of 71.7%. Conclusion: No significant difference was observed between single- and double-dose MTX groups in treating EP. The initial levels of β-hCG and mass size were the only factors to predict the treatment success rate. Double-dose regimen lowered β-hCG down to zero earlier than single-dose. Based on Cut-off points, while the initial β-hCG level was below 3350, single-dose treatment was efficient, whereas, between 3350 and 3894.5, double-dose treatment
Highlights
Ectopic pregnancy (EP) poses a great threat to pregnant women, and in case of misdiagnosis could lead to catastrophic death of the patients
The rising prevalence of EP has been attributed to multiple reasons including assisted reproductive technology (ART) [3], previous history of surgery causing damages to fallopian tubes [4], contraception devices like intrauterine device (IUD) with progesterone [5], etc
In the single-dose group, in 16.3% of the patients, who responded to the treatment, the β-hCG levels declined to zero in the 3rd week, while in 49% of them it happened in the 4th week and in 34.7% of the cases it took more than 4 weeks
Summary
Ectopic pregnancy (EP) poses a great threat to pregnant women, which in case of misdiagnosis could lead to catastrophic mortality of the patients. The mean level of initial β-hCG in all patients was 3321±867, which, separately, was 3174±854 for the single-dose group and 3478±860 for the double-dose group, with no statistical significant difference (p=0.058). In the single-dose group, in 16.3% of the patients, who responded to the treatment, the β-hCG levels declined to zero in the 3rd week, while in 49% of them it happened in the 4th week and in 34.7% of the cases it took more than 4 weeks. ROC curves were implemented in order to determine the cut-off points for predicting the treatment success with single-and double-dose MTX based on β-hCG levels. The cut-off point for β-hCG levels to predict treatment success with double-dose regimen was 3894.5 with 66.7% of sensitivity and 71.7% of specificity (Figure 3)
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