Abstract
BackgroundEctopic pregnancy is a major life- and fertility-threatening women’s health concern. As a result of advances in examination technology, an increasing number of ectopic pregnancies can be diagnosed early and treated with medical methods instead of surgery. The aim of this study was to summarize the clinical features and identify the predictors of success of methotrexate (MTX) treatment of ectopic pregnancy.MethodsThis was a retrospective study of 238 ectopic pregnancies treated with MTX in the Department of Gynecology of Shaanxi Provincial People’s Hospital from January 2017 to December 2017.ResultsPatients were divided into two groups: the successful treatment group (n = 166) and the failed treatment group (n = 72). The overall success rate of MTX therapy for ectopic pregnancy was 69.75%. The mean initial beta-human chorionic gonadotropin (β-hCG) level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 IU/L versus 3533.17 IU/L, P = 0.000). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (54.55%). β-hCG levels were significantly increased on the 4th day in the failed treatment group (P = 0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the receiver operating characteristic (ROC) curve was 0.863 (95% confidence interval (CI): 0.805–0.920).ConclusionsMTX therapy as a treatment option is safe and effective for asymptomatic, hemodynamically stable patients with ectopic pregnancies who are interested in conservative treatment, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the success of MTX therapy for ectopic pregnancy.
Highlights
Ectopic pregnancy is a major life- and fertility-threatening women’s health concern
The protocol suggests that initial beta-human chorionic gonadotropin (β-hCG) level and the size of the adnexal mass should be below certain cutoff values; for example, in China, this treatment is recommended for hemodynamically stable patients with initial Beta-human chorionic gonadotropin (β-hCG) levels less than 2000 IU/L and the adnexal mass less than 4 cm in diameter
A 15% decrease in the β-hCG level from day 4 to day 7 is defined as a factor indicating initial success that can be used as a basis for follow-up treatment decisions
Summary
As a result of advances in examination technology, an increasing number of ectopic pregnancies can be diagnosed early and treated with medical methods instead of surgery. The aim of this study was to summarize the clinical features and identify the predictors of success of methotrexate (MTX) treatment of ectopic pregnancy. With improvements in diagnostic technology, most ectopic pregnancies can be identified early and treated with conservative methods [1]. The β-hCG level on day 4 during the course of treatment might give us some indication of the success of the treatment. The aim of this study was to investigate the factors predictive of therapeutic success and related factors influencing the success rate of conservative treatment
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