Abstract
Objective:The protocol of 15% BhCG decrease between Days four and seven is frequently used for evaluating the success of methotrexate administration in treating ectopic pregnancy. Our objective was to study the usage of hematologic parameters for evaluating the success of methotrexate administration in treating ectopic pregnancy.Method:This study was conducted between February 2014 and December 2016. Data of 434 patients were retrospectively scanned for the study. One hundred sixty-one patients whose Day one, four and seven results were recorded in the hospital information system and who were followed up until their BhCG levels decreased <10 IU/L were enrolled in the study. Three types of complete blood cell count parameters of the patients were used: 1) Neutrophil-to-lymphocyte ratio (NLR). 2) Platelet distribution width (PDW), 3) Platelet count (PLT).Results:Patients were separated into two groups as those who were treated with single-dose methotrexate and those who required surgical treatment. A significant difference was detected between the groups in terms of NLR levels on Days 1, 4, and 7 (p=0.012, p=0.035, and p=0.001, respectively). There was no significant difference detected between the groups for PDW and PLT counts on Days one, four and seven.Conclusions:NLR can also be used as an alternative to BhCG for evaluating the success of single-dose methotrexate administration in treating ectopic pregnancy. However, there is need for further studies on this topic.
Highlights
Ectopic pregnancy constitutes approximately 1%2% of all pregnancies and is observed in 6%–16% of all patients who are admitted to emergency services with vaginal bleeding and inguinal pain.[1,2] A decline in morbidity and mortality rates associated with ectopic pregnancy has been reported following developments in imaging methods and the definition of the BhCG monitoring protocol.[1]Because of more frequent diagnosis of ectopic pregnancies, the use of medical agents for treatment has increased as an alternative to surgical treatment because they are more effective, cost-effective, Pak J Med Sci September - October 2018 Vol 34 No 5 www.pjms.com.pk 1132 and safer
The most commonly used protocol for evaluating the success of methotrexate administration in treating ectopic pregnancy is the protocol with 15% BhCG decrease between Days 4 and 7, which was defined by Kirk E et al.[6]
Our study is a retrospective analysis of patients who were admitted to Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, who were diagnosed with tubal ectopic pregnancy, and received treatment between February 2014 and December 2016
Summary
Because of more frequent diagnosis of ectopic pregnancies, the use of medical agents for treatment has increased as an alternative to surgical treatment because they are more effective, cost-effective, Pak J Med Sci September - October 2018 Vol 34 No 5 www.pjms.com.pk 1132 and safer. The use of methotrexate in the medical treatment of ectopic pregnancy was defined by Stovval TG et al.[3] in 1989. The most commonly used protocol for evaluating the success of methotrexate administration in treating ectopic pregnancy is the protocol with 15% BhCG decrease between Days 4 and 7, which was defined by Kirk E et al.[6] In addition to monitoring BhCG levels, levels of many markers, such as creatine kinase, myoglobulin, progesterone, relaxin, cancer antigen 125 (ca 125), metalloprotease-12, and pregnancy-associated plasma protein A (PAPP-A), were studied for ectopic pregnancy monitoring and treatment success.[7,8]
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