Ruptured Ectopic Pregnancies Following Methotrexate Treatment: Clinical Course and Predictors for Improving Patient Counseling

Abstract

<h3>Study Objective</h3> To determine the predictors for tubal rupture among women treated with methotrexate (MTX) for ectopic pregnancy. <h3>Design</h3> Retrospective cohort analysis. <h3>Setting</h3> Tertiary university-affiliated medical center. <h3>Patients or Participants</h3> Four-hundred one women who were diagnosed with ectopic pregnancy and were treated with MTX. Forty-one women with ruptured ectopic pregnancy (study group) and 300 women with non-ruptured ectopic pregnancy (control group). <h3>Interventions</h3> Descriptive data and predictive variables for rupture ectopic pregnancy following MTX treatment. <h3>Measurements and Main Results</h3> Out of 122 women who failed MTX treatment, forty-one women had tubal rupture (33.6%). The median time interval from MTX treatment to tubal rupture was 6 days (1-25). β-hCG percentage change in the 48 hours preceding MTX treatment and β-hCG level at day 0 were independent predictors for tubal rupture (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04–1.12, p < 0.001 for every percent change in β-hCG; OR = 1.001, 95% CI = 1.0003–1.002 for every unit change in β-hCG, respectively). In a decision tree analysis model, in women with β-hCG percentage increment >69% in the 48 hours preceding methotrexate the probability for tubal rupture was 85%. <h3>Conclusion</h3> Risk assessment for tubal rupture should be made before methotrexate treatment according to β-hCG dynamics and level. The absolute risk for tubal rupture in women with β-hCG increment<20% is low.