ROLE OF DAY 4 AND DAY 7 Β-HCG AS AN EARLY PREDICTOR OF SUCCESS AFTER METHOTREXATE THERAPY FOR TUBAL ECTOPIC PREGNANCIES

Abstract

Background: Tubal ectopic pregnancy is potentially life-threatening with an estimated incidence of 1% to 2% of all pregnancies with the wide availability of transvaginal ultrasound and quantitative serum beta human chorionic gonadotropin (β-hCG) assay; ectopic pregnancies can be diagnosed early, leading to successful management without resort to surgery. Objective: Evaluation of β-hCG levels between days 4 and 7 as a predictor of methotrexate therapy success for ectopic pregnancy. Patients and Methods: 50 cases, diagnosed of ectopic pregnancy, This study was carried out on Al-Hussein Hospital during July 2018 and August 2019 All cases were subjected to full history taking, complete clinical examination, ultrasongraphy and Laboratory investigations as Complete blood count, Liver profile (ALT and AST), Serum creatinine, and Serum β-hCG levels on day1, 4, and7 after methotrexate therapy. Results: The mean age was 28 ± 5 years, ranging between 20 and 40 years. The average gestational age was 5 weeks, while the average parity was 1. Of 50 cases, 36 patients (72%) succeeded and 14 failed. The ROC curve for the hCG index identified an hCG index value of 0.192 (19% decrease of hCG value between day 1 and day 4) as the best predictor for ectopic pregnancy treated successfully with a single dose of methotrexate. Sensitivity for the test was 80% and accuracy was 75%. Conclusion: Early serum β-hCG decline is associated with a very high probability of treatment success. However, given that we found an 80% success rate, not 100%, we suggest it is prudent to continue the serial monitoring of serum β-hCG until the complete resolution of the ectopic pregnancy.