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

Var, Altan; Özyurt, Ramazan; Şık, Bulat Aytek; Kumbasar, Serkan; Sever, Erman; Deveci̇, Mustafa; Çöt, Özgür; Salman, Süleyman; Güzel, Yılmaz

doi:10.4274/tjod.10576

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…Methotrexate treatment for ectopic pregnancy is a medical alternative to surgery and has become the mainstay of therapy for properly selected women. The present study showed a success rate of 63.8% for single‐dose methotrexate injection, which is similar to previously reported success rates …”

Section: Discussionsupporting

confidence: 92%

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

Saleh

Haj-Yahya

Matan

et al. 2017

Intl J Gynecology & Obste

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Section: Discussionsupporting

confidence: 92%

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

Saleh

Haj-Yahya

Matan

et al. 2017

Intl J Gynecology & Obste

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“…However, this is not a reliable indicator of EP rupture 31,32 . Var et al 33 concluded that the presence of intraperitoneal fluid did not affect the success of the treatment. Sindiani et al 21 reported that free fluid in the pelvis was not an important risk factor for medical treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Tubal ektopik gebeliklerde çoklu doz metotreksat tedavisinin analizi

ÇETİN¹,

TEPE

Sucu

et al. 2022

Cukurova Medical Journal

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Öz Purpose: The study aimed at determining the success rate of sequential multi-dose methotrexate treatment in tubal ectopic pregnancy (EP) patients and the prognostic factors affecting the treatment success. Materials and Methods: Clinical, laboratory, and demographic data of 63 patients -hospitalized with the diagnosis of EP in our tertiary center between 2017-2020 and administered sequential multiple-dose methotrexate treatment protocol-were analyzed in this retrospective study. Results: Based on research findings, medical treatment was successful in 45 of the patients. It was found that 16 out of 18-patient, 88.8% of the patients in the failed group with methotrexate treatment, were operated on due to tubal rupture during follow-up. The mean of sonographic free fluid in Douglas of the successful group with methotrexate treatment was found to be 2.40±0.70 mm (Mean±SE), while it was 10.38±3.05 mm (Mean±SE) in the failed group at the first consultation. The initial β-hCG value of the successful group with methotrexate treatment was measured 3668.55±440.55 IU/L (Mean±SE), while it was 4929.72±752.65 IU/L (Mean±SE) in the failed group. Conclusion: The success rate of the sequential multiple-dose methotrexate protocol was 71.4%. Both the initial serum β-hCG level and the amount of sonographic free fluid in the pouch of Douglas were found high in the failed group with medical treatment at the first consultation. Amaç: Tubal ektopik gebelik hastalarında ardışık çoklu doz metotreksat tedavisinin başarı oranı ile tedavi başarısına etki eden prognostik faktörlerin belirlenmesi hedeflenmiştir. Gereç ve Yöntem: Bu retrospektif çalışmada 2017-2020 yılları arasında tersiyer merkezimizde ektopik gebelik tanısı ile hospitalize edilmiş ve ardışık çoklu doz metotreksat tedavi protokolü uygulanmış 63 hastanın klinik, labaratuvar ve demografik verileri analiz edilmiştir. Bulgular: Hastaların 45'inde medikal tedavi ile başarılı olunmuştur. Metotreksat protokolü ile başarısız olunan hastaların %88.8'inde (n=16) takip sırasında tubal rüptür nedeni ile cerrahi operasyon ihtiyacı gelişmiştir. Medikal tedavi ile başarılı olunan grupta başvuru anında Douglas'ta serbest mayi ortalaması 2.40±0.70 mm (Ort.±SH); başarısız olunan grupta 10.38±3.05 mm (Ort.±SH) bulunmuştur. Medikal tedavi ile başarılı olunan grubun başvuru β-hCG düzeyi 3668.55±440.55 IU/L (Ort.±SH); başarısız olunan grubunki 4929.72±752.65 IU/L (Ort.±SH) bulunmuştur. Sonuç: Ardışık çoklu doz metotreksat protokolünün başarı oranı %71.4 olarak saptanmıştır. Medikal tedavi ile başarısız olunan grupta başlangıç serum β-hCG düzeyinin yüksek olduğu, yine ilk başvuruda Douglas'ta sonografik olarak ölçülen serbest sıvı miktarının yüksek olduğu tespit edilmiştir.

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“…In our study, we found that the initial levels of β-hCG above 2000 mIU / ml were associated with failure of single dose MTX treatment. As with β-hCG, there is no consensus on the size of the ectopic focus that affects success rate of medical treatment [22,23]. Some authors use the 25 mm ectopic focus size as the threshold while others use 35 mm to predict the success rate of medical treatment with single dose of MTX.…”

Section: Discussionmentioning

confidence: 99%

Anrüptüre tubal ektopik gebeliklerde ayaktan metotreksat tedavi stratejileri

Başbuğ

Kaya

Çağlar

et al. 2018

Archives of Clinical and Experimental Medicine

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Atıf yazım şekli: How to cite: Başbuğ A, Kaya AE, Çağlar M, Yavuzcan A. Outpatient methotrexate treatment strategies for unruptured tubal ectopic pregnancy. Arch Clin Exp Med. 2018;3(2):41-44. Abstract Aim: To evaluate the selection criteria for outpatient treatment of unruptured ectopic pregnancy. Methods: A total of 124 unruptured ectopic pregnancies that had been treated with single-dose intramuscular methotrexate injections during the period from 2012 to 2017 at Duzce University Faculty of Medicine, Training and Research Hospital were evaluated. Results: Success rate of the medical treatment with single dose methotraxate was 76.61% (n = 95) of 124 patient. The mean duration of hospital stay was shorter in successful medical treatment group (p=0.030). Combining β-hCG level at the first day of methotrexate treatment with size of ectopic focus and/or the presence of fluid in the abdomen significantly increased the sensitivity, specificity and positive predictivity for successfully treated with methotrexate (sensitivity = 70.3%, specificity =86.3%, positive predictive value =80%). Conclusions: We can choose patients that will be good responder to methotrexate treatment of ectopic pregnancy without hospitalization by initial serum β-hCG values, size of ectopic focus and the presence of fluid in the abdomen. Amaç: Rüptüre olmamış ektopik gebeliğin ayaktan tedavisi için seçim kriterlerini değerlendirmek. Yöntemler: Düzce Üniversitesi Tıp Fakültesi, Eğitim ve Araştırma Hastanesi'nde 2012-2017 yılları arasında tek doz intramusküler metotreksat enjeksiyonları ile tedavi edilen toplam 124 rüptüre olmamış ektopik gebelik retrospektif olarak değerlendirildi. Bulgular: Tek doz metotreksat ile medikal tedavi 124 hastanın % 76,61'inde (n = 95) başarılı bulundu. Başarılı olarak tedavi edilen grupta ortalama hastanede kalış süreleri daha kısa idi (p=0,030). Metotreksat enjeksiyonunun 1.günü β-hCG düzeyinin ektopik odak büyüklüğü ve / veya batın içinde sıvı varlığı ile birleşmesi metotreksat ile başarılı bir şekilde tedavi edilmek üzere duyarlılık, özgüllük ve pozitif öngörüyü anlamlı olarak arttırmıştır (duyarlılık= %70,3, özgüllük= %86,3, pozitif kestirim değeri= %80). Sonuç: Başlangıç serum β-hCG seviyeleri, ektopik odak büyüklüğü ve batında sıvı varlığı ile metotreksat tedavisine iyi yanıt verecek hastaları, hastane yatışı gerektirmeden seçebiliriz.

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

Cited by 4 publications

References 11 publications

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

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

Tubal ektopik gebeliklerde çoklu doz metotreksat tedavisinin analizi

Anrüptüre tubal ektopik gebeliklerde ayaktan metotreksat tedavi stratejileri

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