Single-dose methotrexate for the treatment of ectopic pregnancy: Our experience from 2010 to 2015.

Emre Erdem Taş,Gülin Feykan Feykan Yeğin Akçay,Ayse Filiz Avsar

doi:10.12669/pjms.331.11238

Abstract

Objective:To evaluate the success of systemic single-dose methotrexate (MTX) treatment in patients with ectopic pregnancy (EP) and to investigate factors related to treatment success.Methods:This retrospective study had been performed in Yildirim Beyazit University between January 2010 and December 2015. Demographic and clinical characteristics, ultrasonografic findings, pretreatment serum β–human chorionic gonadotropin (β-hCG) and progesterone levels of 58 patients with EP were retrieved from hospital records retrospectively. The patients were grouped according to MTX treatment success (response vs. failure).Results:Single-dose MTX-treatment was successful in 72.4% (42/58) of patients. The mean pretreatment β-hCG level was significantly lower in responders than in failures (2080 ± 2322 vs. 5707 ± 3885 IU/L, p = 0.001), and 2678 IU/L was the most suitable cutoff to predict success (75% sensitivity, 73.8% specificity). Moreover, failure rate was 8.45 times more in group of patients whose β-hCG values were determined above the cutoff. The presence of fetal cardiac activity adversely affected treatment success (odds ratio = 12, p = 0.004). Treatment success was not affected by past history of ectopic pregnancy, thickness of endometrium, progesterone value or presences of pseudosac and free pelvic fluid.Conclusion:The success rate of single dose MTX in this study was 72.8 %, and we found that failure rate of MTX treatment was 8.45 times more in group of patients whose initial serum β-hCG values were above 2678 IU/L and 12 times more in patients with fetal cardiac activity

Highlights

Blastocyst implantation outside the uterine cavity is defined as ectopic pregnancy (EP)
The rationale of this study is to report our experience with single dose MTX use in patients with EP and to investigate pretreatment Bhcg, preogesterone levels and precense of fetal cardiac activity as there is a limited data especially about the relationship between these factors and treatment success’
Pretreatment β–human chorionic gonadotropin (β-hCG) level differed significantly between the treatment response and failure groups (2080 vs. 5707 mIU/dL; p = 0.001). β-hCG value of 2678 IU/L was the most suitable cutoff for the prediction of treatment success (75% sensitivity, 73.8% specificity)

Summary

Introduction

Blastocyst implantation outside the uterine cavity is defined as ectopic pregnancy (EP). MTX therapy is cost effective and achieves similar results with multidose MTX therapy in terms of success rate and future fertility.[3] drug-based therapy avoids the inherent risks of anesthesia and surgery.[4] Success rates of MTX treatment for EP range from 76% to 100%.5–8. Preliminary reports have cited several factors potentially associated with MTX treatment failure, notably pretreatment β–human chorionic gonadotropin (β-hCG) level and the presence of fetal cardiac activity.[4,5,6] The rationale of this study is to report our experience with single dose MTX use in patients with EP and to investigate pretreatment Bhcg, preogesterone levels and precense of fetal cardiac activity as there is a limited data especially about the relationship between these factors and treatment success’ Success rates of MTX treatment for EP range from 76% to 100%.5–8 Preliminary reports have cited several factors potentially associated with MTX treatment failure, notably pretreatment β–human chorionic gonadotropin (β-hCG) level and the presence of fetal cardiac activity.[4,5,6] The rationale of this study is to report our experience with single dose MTX use in patients with EP and to investigate pretreatment Bhcg, preogesterone levels and precense of fetal cardiac activity as there is a limited data especially about the relationship between these factors and treatment success’

Methods

Results

Discussion

Conclusion