Methotrexate Treatment Of Ectopic Pregnancy Research Articles

Is it necessary to check β-hCG levels on day 4 after single-dose methotrexate treatment of ectopic pregnancy? A retrospective cohort study

Aim: This study aimed to investigate the usefulness of the percentage change in serum β-hCG levels from days 1 to 7 for predicting treatment success in patients treated with a single dose of methotrexate for tubal ectopic pregnancy. Materials and Method: This retrospective observational study investigated 74 patients treated with a single-dose methotrexate regimen for tubal ectopic pregnancy at a tertiary hospital between January 2020 and December 2023. Patients were subdivided into two groups based on reduction in serum β-hCG levels between days 4 and 7:

AKT question relating to methotrexate treatment for ectopic pregnancy

AKT question relating to methotrexate treatment for ectopic pregnancy

AKT answer relating to methotrexate treatment for ectopic pregnancy

AKT answer relating to methotrexate treatment for ectopic pregnancy

The evaluation of success and failure of methotrexate treatment in ectopic pregnancy

Aim: Regardless of medical advancements, ectopic pregnancy (EP) is still an essential factor in the mortality rate of women of reproductive age. The main aim of this study was to determine predictive factors associated with the success of the response to treatment with single-dose and two-dose methotrexate (MTX) regimens in women with tubal EP. 
 Material and Method: This retrospective study examined the electronic records of 130 patients who underwent treatment due to EP were included in the study. The patients were divided into two groups: the successful MTX treatment group (n: 85) as the case group and the failure of MTX treatment group (n: 45) as the control group. 
 Results: Age-matched (30.62±4.36) and body mass index (BMI)-matched (24.37±2.29) patients diagnosed with EP were treated with MTX. The mean beta-human chorionic gonadotropin (β-hCG) value on the first day of treatment was 1639.84±524.96 mIU/mL in the successful and 5866.76±1875.51 mIU/mL in the unsuccessful group. 85 of 130 (65%) were successfully treated with MTX. Five of 45 (35%) failed medical treatment and required laparoscopic surgery. The longest ectopic mass diameter was significantly higher in the failure of MTX treatment group (p

A 10-Year Review of Methotrexate Treatment for Ectopic Pregnancy in a Malaysian Tertiary Referral Hospital.

Background Ectopic pregnancy was recorded as the fourth principal cause of maternal death in Malaysia in 2019. Early diagnosis and use of methotrexate treatment proved to be safe and effective alternatives to surgical treatment. This study investigates the success rate of methotrexate treatment for ectopic pregnancy in a tertiary hospital in Malaysia. Methods This was a retrospective review of 73 patients with ectopic pregnancies treated with methotrexate according to a single-dose protocol from January 2009 until November 2019. The diagnosis of ectopic pregnancy was made using a combination of transvaginal scan and serial serum β-hCG levels. Their clinical and demographic data were reviewed. Serum β-hCG levels were measured at pre- and post-treatment to determine the rate of successful resolution. Results The overall success rate was 87.7% (64/73 patients) with methotrexate treatment. Fifty-six patients (76.7%) were successfully treated with a single dose of methotrexate, and eight patients (11.0%) required a second dose of methotrexate. There was no relation between socio-demographic, pre-treatment β-hCG levels, ectopic mass size, and treatment efficacy. Smaller size of ectopic pregnancy (adjusted OR=29.23; 95% CI: 2.69, 317.90; P=0.006) and absence of free fluid at the pouch of Douglas (POD) (adjusted OR=27.31; 95% CI: 2.84, 262.32; P=0.004) was found to increase the likelihood of overall treatment success. Absence of fetal cardiac activities was found to increase the likelihood of first-dose methotrexate treatment success (OR=10.20; 95% CI: 1.93, 53.79; P=0.006). Conclusions Early diagnosis of ectopic pregnancy may reduce morbidity and mortality. In carefully selected cases, methotrexate treatment has been proven to be cost-effective and avoided risks associated with surgery and anaesthesia.

The Efficacy and Success Rate of Methotrexate in the Management of Ectopic Pregnancy.

BackgroundEctopic pregnancy is a life-threatening medical condition wherein pregnancy occurs outside the uterus. This study primarily aimed to evaluate the efficacy of methotrexate (MTX) in treating patients diagnosed with early ectopic pregnancy between 2016 and 2021. Second, it aimed to investigate the clinical outcomes of subsequent pregnancies following ectopic pregnancy treatment.MethodsA retrospective cohort study was carried out at a tertiary care centre in Jeddah, Saudi Arabia. The sample for this study comprised 59 patients who were diagnosed with ectopic pregnancy and treated with MTX at King Abdulaziz Medical City, Jeddah, between 2016 and 2021. The data were stored in the Microsoft Office Excel format and analyzed using the SPSS software.ResultsThere were 10 reported cases of ruptured ectopic pregnancy; seven of these underwent surgery, while three were successfully treated conservatively using MTX. Success rates of 55.9% and 93.8% were recorded after administering the first and second dose of MTX, respectively, based on beta-human chorionic gonadotrophin (β-hCG) drop between day 4 and day 7. Among those treated with MTX, 37.3% of the patients reported a successful subsequent pregnancy, of which 54.5% delivered a live, healthy infant and 13.6% had a second ectopic pregnancy.ConclusionMTX proved effective in treating ectopic pregnancy, with a β-hCG drop of more than 15%. Patients who received a second dose of MTX showed a higher drop in β-hCG level, indicating greater success as a cumulative effect. The clinical outcome after MTX treatment of ectopic pregnancy was shown to be significant with a p-value <0.05.

The Use of Beta-Human Chorionic Gonadotropin (β-hCG) Levels as a Predictor of Successful Medical Management of Ectopic Pregnancy.

ObjectivesThe early diagnosis of ectopic pregnancy is essential in determining the appropriate therapeutic approach. This study demonstrates the important factors considered in the prediction of a successful medical treatment, which will, in turn, improve the quality of patient counseling and guidance prior to the initiation of the treatment.MethodsThis was a retrospective cohort study of 58 ectopic pregnancies that were treated medically with methotrexate in Bahrain Defense Force (BDF) Hospital from January 2016 to January 2021. All patients that were offered medical treatment of ectopic pregnancy and completed the follow-up were included in the study. StatsDirect software was used to analyze the baseline characteristics of the successful and failed medical treatment of ectopic groups. Simple linear regression was used to correlate initial beta-human chorionic gonadotropin (β-hCG) levels and the drop of β-hCG levels after one week of medical treatment.ResultsPatients were divided into two outcomes: the primary outcome represented in the successful treatment group, 68.9% (40/58), and the secondary outcome represented in the unsuccessful treatment group 31% (18/58). The mean β-hCG level in the successful group was significantly lower than that of the unsuccessful treatment group (1403.6±1421 IU/L versus 2845.1±1705 IU/L, p=0.001). There were no differences between the two groups with regards to the size of the adnexal mass, presence of gestational sac, or size of the gestational sac. The cut-off value of the initial β-hCG level for successful medical treatment was 2,141 IU/L, with 72% sensitivity, 75% specificity, and receiver operator curve (ROC) of 0.76 [95% confidence interval (CI) = 0.63 to 0.89)]. The cut-off value of β-hCG fell between day four and day seven and was 37.2%, with 78% sensitivity, 68% specificity, and a ROC curve of 0.72 (95% CI = 0.55 to 0.89).ConclusionThis study found that low initial β-hCG levels can be used to predict successful methotrexate treatment of ectopic pregnancy. In this cohort of patients, the cut-off level of initial β-hCG for successful treatment was 2141 IU/L.

Methotrexate Treatment of Ectopic Pregnancy: Prognosis at Senlis Hospital

Introduction: Ectopic pregnancy is dreadful and can lead to the death of the patient if it is ignored. Diagnosed early, it offers the possibility of medical treatment with methotrexate. Objective: To describe the prognosis of ectopic pregnancies treated methotrexate. Patients and Methods: Retrospective study of the management of ectopic pregnancy by Methotrexate at Senlis hospital from June 2020 to May 2021 were included in the study, patients with a Fernandez score of less than 13, and having received Methotrexate as first-line treatment. Data were collected using gynecological emergency admission registers, and telephone interviews. Results: 35 cases were identified. The average age of the patients was 32 years old. Forty-nine percent were smokers. The mean gestational age was 5 weeks + 2 days. The diagnosis was made in all of our patients with the combination of the kinetics of ß-hcg and vaginal ultrasound. The size of adnexal mass was less than 4 cm with an average size of 20 mm. The average value of ß-hcg was 1405 IU/L. All patients had received a single dose of methotrexate 1 mg/kg intramuscularly. A second dose was administered to 17.1% of patients for stagnation or re-ascension of the ß-hcg level. The success rate was 91.4%. Thirty percent were obtained spontaneous intra uterine pregnancy, the first year following methotrexate treatment. Conclusion: The success rate of medical treatment for ectopic pregnancy is high in terms of meeting the eligibility criteria for treatment. The subsequent prognosis of fertility is generally preserved.

A detailed study of methotrexate treatment in ectopic pregnancy

Methotrexate is a folic acid antagonist, it works by inhibiting the dihydrofolate by interfering with the DNA synthesis. Ectopic pregnancy is a life threatening condition that may cause maternal mortality. The main aim of this review to show the efficacy of systemic methotrexate and shows the importance of methotrexate treatment in management of ectopic pregnancy with surgical treatment and dosage regimen with protocol treatment. The selection criteria of candidates in this review is pregnant women with &lt;5000miu/ml, adrenal mass &lt;4cm, presence of peritoneum &lt;100mland no sign of cardiac activity. Data collections are made from most relevant article between the periods of 1987-2020. Ectopic pregnancy is an emergency condition if not timely diagnosed and most of the cases where identified in first trimester.

The role of day 0 and day 4 β-human chorionic gonadotropin values and initial ultrasound findings in predicting the success of methotrexate treatment in ectopic pregnancy.

To determine the role of baseline ultrasound findings and the changes between β- human chorionic gonadotropin (hCG) values on day 0 to day 4 in patients receiving single-dose methotrexate (MTX) therapy for tubal ectopic pregnancy. One hundred fourteen patients who were hospitalized with a diagnosis of ectopic pregnancy and treated with single-dose methotrexate were included in this retrospective study. The successful treatment group (n = 88) comprised patients in whom serum β-hCG levels were resolved with single-dose methotrexate treatment, and the failed treatment group (n = 26) included patients who received second dose methotrexate and/or surgery. Ultrasound findings, laboratory findings, and serum β-hCG values at the time of admission and D4 and D7 β-hCG values were compared. The success rate of single-dose methotrexate treatment was 77.2%. In the successful treatment group, the initial β-hCG values of the patients were lower than the unsuccessful treatment group (1479.14 ± 1253.49, 4442.88 ± 3392.58, respectively) (p = 0.0001). A decrease of more than 35% between D0-D4 increased the probability of successful treatment (p = 0.017). Although ectopic focus size and abdominal free fluid showed no significant difference between the two groups, endometrial stripe thickness was significantly higher in the unsuccessful treatment group (12.61 ± 5.79, 9.28 ± 3.53) (p = 0.002). In addition to the basal β-hCG value, endometrial stripe thickness of ultrasound findings should also be considered in determining patients with a high chance of success in single-dose MTX treatment.β-hCG changes between D0-D4 may be advantageous in the clinical management of ectopic pregnancy for earlier evaluation.

Pregnancy of Unknown Location in a Cohort of Patients Treated With Methotrexate [17I

INTRODUCTION: To determine the prevalence of pregnancy of unknown location (PUL) in patients treated with Methotrexate (MTX) for nonsurgical diagnosis of ectopic pregnancy (EP). To determine the beta-hCG treatment outcomes. METHODS: IRB approved retrospective cohort study of patients who received MTX for treatment of EP over a 10-year period in an urban-based healthcare system. Wilcox test was used for statistical analysis. RESULTS: A total of 150 pregnancies were identified as treated with MTX over a 10-year period. Pregnancies were classified based on reviews of ultrasound as pregnancy of unknown location (PUL), ectopic pregnancy (EP), or Intrauterine pregnancy (IUP). 47 were classified as PUL, 101 EP, 2 IUP. Approximately 1/3 of patients treated with MTX were PULs. The average baseline beta-hCG was 2960 MIU/ML and the average B-hCG at treatment was 4188 MIU/ML for the entire cohort. Resolution of beta-hCG levels with one dose of MTX differed between pregnancy types with PULs prescribed MTX at a lower B-hCG level on day of treatment (56% vs 27% at beta-hCG of less than 1000 MIU/ML) compared to EP. Additionally, 61% of the entire cohort were treated with 2 data points or less. 38% of PUL were treated with 1 to 2 beta-hCG values and 82% PUL were treated at beta-hCG <2000 MIU/ML. Of the two IUPs, beta-hCG level at treatment was 6267 MIU/ML and 13353 MIU/ML. CONCLUSION: There may be an underappreciated risk of inadvertent administration of Methotrexate to patients with early IUP. A minimum of three beta-hCG assays over seven days in the diagnostic algorithm for EP would decrease treatment of PUL.

Predicting success of methotrexate treatment by pretreatment HCG level and 24-hour HCG increment.

To evaluate β-human chorionic gonadotropin (β-HCG) level and its 24-hour increment as predictors of successful methotrexate treatment for ectopic pregnancy. Data were retrospectively reviewed from women with ectopic pregnancy who were treated by single-dose methotrexate (50mg/m2 ) at a university hospital in Jerusalem, Israel, between January 1, 2000, and June 30, 2015. Serum β-HCG before treatment and its percentage increment in the 24hours before treatment were compared between treatment success and failure groups. Sixty-nine women were included in the study. Single-dose methotrexate treatment was successful for 44 (63.8%) women. Both mean β-HCG level and its 24-hour increment were lower for women with successful treatment than for those with failed treatment (respectively, 1224IU\L vs 2362IU\L, P=0.018; and 13.5% vs 29.6%, P=0.009). Receiver operator characteristic curve analysis yielded cutoff values of 1600IU\L and 14% increment with a positive predictive value of 75% and 82%, respectively, for treatment success. β-HCG level and its 24-hour increment were independent predictors of treatment outcome by logistic regression (both P<0.01). A β-HCG increment of less than 14% in the 24hours before single-dose methotrexate and serum β-HCG of less than 1600IU\L were found to be good predictors of treatment success.

Methotrexate treatment of ectopic pregnancy does not impact ovarian reserve or clinical outcome, regardless of the duration of time since exposure

Methotrexate (MTX) is a minimally invasive treatment for ectopic pregnancy. As it targets rapidly dividing cells, there is concern it may affect proliferating germinal cells in the ovary, ovarian reserve. Most centers recommend patients wait 2-3 months before attempting subsequent fertility treatment, It is not known whether recent MTX exposure increases the incidence of meiotic error within oocytes, contributing to embryonic aneuploidy. We sought to investigate the effect of MTX treatment and the interval of time from its administration to subsequent fertility treatment on ovarian reserve and IVF outcome.

The role of early determination of β-human chorionic gonadotropin levels in predicting the success of single-dose methotrexate treatment in ectopic pregnancy.

The aim of the study was to determine the importance of β-hCG level on day 4 following methotrexate (MTX) administration, and the difference between β-hCG levels assessed on day 0 and day 4 in predicting treatment success. A total of 68 women with tubal pregnancy, treated with a single dose of MTX, were selected for this retrospective study. The success rate of single-dose MTX treatment in our clinic was 75% (51/68). Among 51 patients in whom MTX treatment was successful, 25 (36.8%) showed a decrease in β-hCG level of > 15% on days 0 and 4, and 44 (64.7%) showed a β-hCG level decrease of > 15% on days 4 and 7. For subjects with β-hCG decrease of > 15% on days 4 and 7, the standard error was 6.5%, and the area under the ROC curve was 81.7%, while the corresponding values for days 0 and 4 were 7.2% and 64%, respectively. A decrease of > 15 % in β-hCG levels between days 0 and 4 does not seem to be a better predictor for success of single-dose MTX treatment for ectopic pregnancy than between days 4 and 7. A statistically significant difference was observed only in β-hCG levels on day 7 in both, successful and unsuccessful single-dose MTX groups.

Methotrexate treatment for ectopic pregnancy after assisted reproductive technology: A case-control study

ObjectivesEctopic pregnancy (EP) occurs in 2% to 5.6% of pregnancies achieved by assisted reproductive technology (ART). EP treatment options include medical treatment by uses of methotrexate (MTX) systemic injection. The objective of this study was to compare MTX treatment effectiveness for EP occurring spontaneously or following ART. MethodsA case-control study performed in the department of obstetrics and gynecology at a tertiary health care center in France. Twenty EP achieved by ART (ART group) and 60 spontaneous EP (SEP group) received MTX treatment between January 2002 and May 2012. The main outcome measures were MTX treatment failure rates, number of MTX injections administered and recovery time. ResultsMTX treatment failure rates observed in ART and SEP groups were similar (3/20 [15%] versus 10/60 [17%]: OR=0.88 [0.22–3.58]). Mean duration of recovery time in patients with successful MTX treatment did not differ between ART and SEP groups (33±14 days versus 28±13 days, P=0.39). A second MTX injection was required more frequently in ART group than in SEP group (10/20 [50%] versus 10/60 [17%]: OR=5 [1.65–15.15]). ConclusionsIt is concluded that MTX treatment is equally effective for spontaneous EP and EP achieved by ART, two injections of MTX being more frequently required in case of ART.

Retrospective analysis of factors that affect the success of single-dose methotrexate treatment in ectopic pregnancy.

Objective:Detection of factors that affect the success of single-dose methotrexate treatment in ectopic pregnancy.Materials and Methods:We investigated 99 patients who had been treated with single-dose methotrexate for ectopic pregnancy in our clinic between January 2009 and June 2014. Demographic, clinical, and laboratory results of possible factors that affect treatment success were retrospectively analyzed. Successfully and unsuccessfully treated patients were compared based on their pre-treatment results.Results:The success rate of single-dose methotrexate treatment was found to be 70.7%. No significant difference was found between succesfully and unsuccessfully treated patients before treatment in terms of factors such as gestational weeks, mass size, presence of yolk sac, and presence of free fluid (p=0.224, p=0.201, p=0.200, p=0.200). Serum β-hCG values in patients whose treatment was unsuccessful was found to be higher compared with the successfully treated group (mean β-hCG value of unsuccessful group: 4412±3501 mIU/mL; mean β-hCG value of successful group: 1079±942 mIU/mL; p<0.001).Conclusion:Single-dose methotrexate treatment is an effective and reliable method in the treatment of ectopic pregnancy. Elevation of serum β-hCG value stands as the main prognostic factor that affects the success of single-dose methotrexate treatment.

Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis.

Does previous methotrexate (MTX) treatment for ectopic pregnancy (EP) have an effect on ovarian response in women receiving fertility treatment? MTX treatment for EP does not seem to affect subsequent fertility treatment. MTX is commonly used to treat EPs that are diagnosed early. Previous studies have reported conflicting results about its effect on subsequent fertility treatments. This systematic review and meta-analysis included a total of 329 patients who had participated in 7 observational studies. A search of the MEDLINE, EMBASE and PUBMED databases was conducted to identify studies about fertility treatments after MTX treatment for EP, published in English or French up to December 2013. Studies were eligible for inclusion only if they compared indicators of ovarian responsiveness during ART in the cycles before and after an injection of MTX for EP. The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the basal serum FSH level, duration of stimulation, total gonadotrophin dose and serum E2 level on the day of hCG triggering. The mean number of oocytes retrieved during the cycles before and after the MTX treatment did not differ significantly (P = 0.4). The comparisons before and after MTX treatment of the basal plasma FSH level, the duration of stimulation, the total gonadotrophin dose used for stimulation and the estradiol level on the day ovulation was triggered did not find any significant differences. The literature on this topic is sparse, with few studies and even fewer of high methodological quality. These results indicate that MTX to treat EP in infertile patients does not have any negative effect on their subsequent fertility treatment, but further studies should be performed before this result can be considered definitive. This work received support from the Department of Gynecology and Obstetrics, La Conception Hospital, Marseille, France. The authors have no competing interests to declare. N/A.

Mifepristone combined with methotrexate in treatment of ectopic pregnancy

Objective To explore the clinical efficacy of mifepristone combined with methotrexate in the treatment of ectopic pregnancy.Methods The data of patients with ectopic pregnancy were analyzed retrospectively.60 cases treated with methotrexate were set as a control group,and 60 cases treated with mifepristone combined with methotrexate as a treatment group.The β-HCG values,the size of mass,the hospital stays,and therapeutic efficacies were compared between the two groups after the therapy.Results The β-HCG values of the treatment group and the control group were (768.5 ± 79.3) mIU/mL and (918.0 ± 82.3) mIU/mL,respectively.The mass of the treatment group and the control group were (1.4 ± 0.8) cm and (2.8 ± 1.3) cm,respectively.The hospital stays of the treatmnent group and the control group were (8.3 ± 5.9) d and (13.1 ± 7.8) d,respectively.The β-HCG value,the size of mass,and the hospital stays of the treatment group are greatly lower than those of the control group,with statistical differences (P ＜ 0.05).The therapeutic efficiency of the treatment group and the control group were 93.3％ and 75.0％,respectively.The therapeutic efficiency of the treatment group was significantly higher than that of the control group.Conclusions Mifepristone combined with methotrexate in the treatment of ectopic pregnancy can be popularized in clinic,which has higher therapeutic efficiency than methotrexate alone. Key words: Ectopic pregnancy; Mifepristone; Methotrexate; Clinical efficacy

Predictive value of hemoperitoneum for outcome of methotrexate treatment in ectopic pregnancy: an observational comparative study

To assess the predictive value of hemoperitoneum for the outcome of methotrexate (MTX) treatment of ectopic pregnancy (EP). This observational prospective single-center study included women presenting with EP treated with MTX from November 2007 to November 2009. The percentage of women with hemoperitoneum at the beginning of MTX treatment was compared between two groups: those whose treatment was successful and those whose treatment failed. The rate of hemoperitoneum in each group and its value in predicting the outcome of MTX treatment of EP were assessed. MTX treatment was successful in 69 of 93 (74%) cases. The percentage of women with hemoperitoneum at the beginning of treatment was significantly higher in women in whom MTX treatment failed as compared to those in whom it was successful (15/24 (62.5%) vs 17/69 (24.6%); P = 0.001). The likelihood of requiring surgery following treatment with MTX was higher in women with hemoperitoneum (odds ratio, 5.1; 95% CI, 1.74-15.14). Study of the diagnostic performance of hemoperitoneum in predicting the need for surgical treatment after MTX treatment revealed a sensitivity of 0.63, a specificity of 0.76, a positive predictive value of 0.47 and a negative predictive value of 0.85. The presence of hemoperitoneum appears to be a risk factor for MTX treatment failure. It is important to inform women as fully as possible about the risk of such failure. Nonetheless, the predictive value of this sign is insufficient for either routinely excluding women with hemoperitoneum from MTX treatment or omitting post-treatment monitoring.

Ovarian reserve and subsequent assisted reproduction outcomes after methotrexate therapy for ectopic pregnancy or pregnancy of unknown location

To assess ovarian reserve after methotrexate treatment for ectopic pregnancy or pregnancy of unknown location after assisted reproductive technology (ART). Retrospective cohort study. Large ART practice. Women receiving methotrexate or surgery after ART. None. Follicle-stimulating hormone (FSH), antral follicle count (AFC), and oocyte yield compared between women treated with methotrexate or surgery, with secondary outcomes of clinical pregnancy and live birth. There were 153 patients in the methotrexate group and 36 patients in the surgery group. Neither group demonstrated differences in ovarian reserve or oocyte yield in a comparison of the before and after treatment values. The change in ovarian reserve and oocyte yield after treatment were similar between the two groups. The number of doses of methotrexate was not correlated with changes in ovarian reserve, indicating no dose-dependent effect. Time between treatment and repeat ART was not correlated with outcomes. Live birth in subsequent cycles was similar in the two groups. Ovarian reserve and subsequent ART cycle outcomes were reassuring after methotrexate or surgical management of ectopic pregnancy. No adverse impact of methotrexate was detected in this large fertility cohort as has been previously described elsewhere.