Prognostic value of human chorionic gonadotropin changes after methotrexate injection for ectopic pregnancy

Agostini, Aubert; Blanc, Karina; Ronda, Isabelle; Romain, Fanny; Capelle, M.; Blanc, B.

doi:10.1016/j.fertnstert.2006.11.138

Cited by 60 publications

(60 citation statements)

References 13 publications

(14 reference statements)

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“…The overall success rate of single-dose methotrexate therapy in this study was 76.3%, which is similar to that reported in the literature, 65-96% (5-7, 11). Our study mostly confirms the results of previous studies (19,21,22) that noted a rate of treatment success of 88-100% in women with a decline in β-hCG between days 0 and 4, which is similar to our result (88.2%). Taken together, an early decline in serum β-hCG appears to be associated with a very high likelihood of successful treatment outcome.…”

Section: Discussionsupporting

confidence: 93%

“…Undoubtedly, women with a declining trend in the β-hCG level benefited from methotrexate treatment for EP. The results of this study are in accordance with previous reports (11,(19)(20)(21). Stika et al (13) demonstrated that the pretreatment β-hCG concentration was higher in women with treatment failure than those who were successfully treated with a single dose of MTX.…”

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confidence: 93%

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Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Çelik¹,

Türkçüoğlu²,

Karaer³

et al. 2013

J Turkish German Gynecol Assoc

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Objective: To evaluate percentage changes in serum beta-human chorionic gonadotropin (β-hCG) values between days 0-1, 0-4 and 0-7 as an indicator of methotrexate therapy success in extra-uterine pregnancies. Material and Methods:Women with ectopic pregnancy treated with single-dose methotrexate therapy between January 2011 and August 2012 were assessed. Recorded data were reviewed electronically from patient files. All women (n=93) with an ectopic pregnancy treated medically with intramuscular methotrexate (50 mg/m 2 ) were included. The percentage changes in serum β-hCG levels from day 0 to 1, day 0 to 4 and day 0 to 7 were calculated for each case. Results:The median β-hCG values decreased between days 0 and 4 by 55.8%, and 89.6% of these cases were treatment successes. The median initial serum β-hCG values were lower in women with successful treatment, but this was not statistically significant (p=0.11). Conclusion:A decline in serum β-hCG values between days 0 and 4 appears to be the best predictor. It would be beneficial to determine whether a woman with an ectopic pregnancy treated with singledose methotrexate administration will be treated successfully. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Key words: Ectopic pregnancy, human chorionic gonadotrophin, methotrexate.Received: 8 April, 2013 Accepted: 26 May, 2013 Amaç: Ektopik gebeliklerin tedavisinde methotraksat tedavisinin başarısını belirlemede beta-human koryonik gonadotropin (β-hCG) değerlerinin 0-1, 0-4 ve 0-7 günleri arasında yüzde değişimlerini değerlendirmek. Gereç ve Yöntemler:Ocak 2011 ile Agustos 2012 tarihleri arasında ektopik gebelik nedeniyle tanı alan ve tek doz metotreksat tedavisi alan 93 olgu çalışmaya dahil edildi. Elektronik ortamda kaydelilen hastaların dosyalarında bulunan tüm bilgiler incelendi. 0-1, 0-4 ve 0-7 günler arasındaki serum β-hCG seviyelerindeki değişim yüzdeleri her olgu için hesaplandı. Bulgular:Metotreksat tedavisinin başarılı olan olguların %55.8 ve %89.6'da ortanca β-hCG değerleri 0 ve 4. günler arasında azalmış olarak bulundu. Tedavi öncesindeki ortanca β-hCG seviyesi tedavinin başarılı olduğu olgularda daha düşük saptanmasına rağmen iki grup arasında istatistiksel olarak bir fark saptanmadı (p=0.11).Sonuç: Serum β-hCG değerlerindeki 0 ile 4. günler arasındaki düşme olması metoteksat tedavisinin başarısını tahmininde en iyi gösterge olarak ortaya çıkmaktadır, ve tek doz metotreksat ile tedavi edilen ektopik gebeliklerin nihai tedavinin başarısını belirlemek yararlı olacaktır. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Abstract Özet tion of MTX treatment success. The serum β-hCG level before MTX administration has been reported as a particular factor contributing significantly to treatment failure (8). Previously, it has been found that at least a 15% reduction in the β-hCG concentration on the seventh day compared to the fourth day after MTX administration is the best predictor of treatment success, with a positive predictive value of approximately 93.0% (9). A rise in the β-hCG titer on t...

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Section: Discussionsupporting

confidence: 93%

supporting

confidence: 93%

Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Çelik¹,

Türkçüoğlu²,

Karaer³

et al. 2013

J Turkish German Gynecol Assoc

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“…However, the predictor used in their study was a β-hCG level decrease of > 20% between days 0 and 4, and the high probability of success achieved with this predictor can be attributed to the higher percentage of the decrease considered [11].…”

Section: Discussionmentioning

confidence: 99%

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

Celik

Tosun²,

Işık³

et al. 2016

Ginekol Pol

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Objective: 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. Material and methods:A total of 68 women with tubal pregnancy, treated with a single dose of MTX, were selected for this retrospective study. Results: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. Conclusions: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.

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“…2,7 A study by Celik et al 8 evaluated the use of percentage decline of serum β-hCG between days 1 to 4 following administration of methotrexate as an indicator of treatment success. They found that 20% decline was associated with a very high chance of subsequent treatment success, with positive predictive value as high as 97%.…”

Section: Discussionmentioning

confidence: 99%

How important is serum beta-hCG in the management of ectopic pregnancy?

Renukesh

Rai

Hebbar

2015

Int J Reprod Contracept Obstet Gynecol

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Prognostic value of human chorionic gonadotropin changes after methotrexate injection for ectopic pregnancy

Cited by 60 publications

References 13 publications

Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

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

How important is serum beta-hCG in the management of ectopic pregnancy?

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