Predictive Factors of Methotrexate Treatment Success in Ectopic Pregnancy: A Single Tertiary Center Study

Abstract

OBJECTIVE:It is controversial whether medical or surgical treatment options have more successful results in ectopic pregnancy treatment. Although high pretreatment serum hCG levels have been known to be the most important predictor, the appropriate treatment modality for a specific range of hCG level remains unclear. Furthermore, the variables that make a patient a bad candidate for single-dose methotrexate treatment is unclear. The aim of this study was to identify predictive factors associated with the success of single-dose methotrexate treatment in women with ectopic pregnancy.METHODS:In this retrospective study, 101 women with tubal ectopic pregnancies who had been treated with single-dose methotrexate were selected. The gestational ages, pretreatment hCG values, ectopic mass size, and fluid presence in the abdomen were compared between the groups.RESULTS:The mean age of the patients was 30.6±5.8 (range, 19–42) years, and the gestational age at first injection was 7.0±2.13 (range, 2.3–13.6) weeks. The overall treatment success rate was 77.2% (n=79). The mean duration of hospital stay was 4.21±1.89 days in the successfully treated group and 6.92±2.13 days in the failure group (p<0.05). The rate of treatment failure in patients with abdominal fluid was 37.8%, and it was 12.7% in the non-fluid group (p=0.03). hCG values on days 1, 4, and 7 were significantly higher in the unsuccessful group (3887–2589 mIU/mL, 2814–1287 mIU/mL, and 1119–285 mIU/mL, respectively; p<0.05). The cutoff hCG value, which determined the failure of methotrexate treatment, was found to be 1362 mIU/mL.CONCLUSION:In present study, patients with hCG value <1362 mIU/mL were found to be good candidates for methotrexate treatment. Although not strictly decisional, this hCG threshold level can be used to decide on the likelihood of methotrexate success or failure. Detection of abdominal fluid on ultrasonography also can be assessed as a bad prognostic factor, but size of ectopic mass does not correlate with methotrexate treatment success.

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

“…Finally, Levin et al advocated that β-hCG increment of less than 17% in the 24 hr pretreatment, and a decrease of more than 22% between day1 and day 4 β-hCG concentations might predict the success of single-dose MTX treatment [26]. In our study, the overall success rate was comparable to the literature with 77.2% [13,24,28,29]. The success rate of single-dose MTX treatment for those whose β-hCG values fell between D0-D4 was 87.3%, and 59.5% in those whose levels rose.…”

“…In the literature, close β-hCG thresholds for MTX treatment success have been reported. Rabischong et al [22] found this value as 1300 IU/L, Markwitz et al [23] reported 1790 IU/L, Pulatoglu et al [24] found 1362 IU/L, and Corsan et al [25] reported 1500 IU/L. In the current study contrary to expectations initial β-hCG value was not found to be an independent factor for the treatment outcome, similar with Levin at al.…”

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

“…23 A recent prospective study reported a high β-HCG level (3887 ±3300 IU/L) on the first day of MTX administration in patients in whom medical treatment failed and relatively low mean levels (2589±1784 IU/L) in the successfully treated group. 24 Studies in literature have reported high pretreatment β-HCG levels in the MTX treatment failure group. 25,26 We observed that the mean ages of patients in treatment success (30.59±5.430years) and treatment failure groups (31.18±4.714 years) were similar.…”

Managing Ectopic Pregnancies by Targeting Chorionic Villi with a Transvaginal Injection of Ethanol into the Lacunar Space

“…Since the level of β-HCG is stipulated to be between > 1500 and ≤ 5000 IU/mL, and cases with FHB are not considered, it can only be used for the treatment of early-stage pregnancy. In a recent retrospective study involving 101 women with tubal ectopic pregnancies, the cutoff β-hCG value, which determined successful methotrexate treatment in single administration, was found to be ≤ 1362 mIU/mL [26]. Furthermore, response to MTX occurs over 5 to 7 days, since MTX works metabolically by causing death of villi, subsequently leading to an initial decrease in the serum β-hCG level.…”