Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience

Stika, Catherine S.; Anderson, Lanetta; Frederiksen, Marilynn C.

doi:10.1016/s0002-9378(96)70219-3

Cited by 112 publications

(64 citation statements)

References 11 publications

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“…In the present study, a 63.4% probability of treatment success was found to be related to a rise in serum β-hCG values between days 0 and 4, which is similar to that indicated by Nguyen et al (11). However, others have noted lower success rates in that population (13). Several studies have attempted to ascertain indicators of success after medical treatment of EP (2,14,15).…”

Section: Discussionsupporting

confidence: 88%

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: 88%

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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“…Despite numerous publications on the use of methotrexate in the treatment of EP, there are no reliable prognostic factors to predict failure of methotrexate treatment [2,3,[19][20][21]. In contrast to our results, Stika et al [14] found pretreatment ß-hCG levels in women responding to single-dose therapy to be significantly lower than those of methotrexate failures. They also suggested that there might be an upper limit of trophoblastic mass that is sensitive to a particular methotrexate dosage.…”

Section: Discussioncontrasting

confidence: 99%

“…Inclusion criteria for group A were (1) hemodynamic stability (evaluated by constant serial hematocrits); (2) an unruptured ectopic mass ^5 cm in the greatest dimension demonstrated in transvaginal ultrasonography; (3) ß-hCG level ^5,000 mIU/ml; (4) no cardiac activity of the extrauterine embryo; (5) wish of future fertility, and (6) informed consent. As Stika et al [14] reported that patients with pretreatment ß-hCG levels 1 5,000 mIU/ml had a greater probability of requiring surgical intervention after methotrexate application, we determined a maximum pretreatment ß-hCG level of 5,000 mIU/ml for group A. We did not exclude patients found to have a small amount of free fluid (less than 100 ml) in their cul-de-sac on ultrasonography when they were hemodynamically stable.…”

Section: Methodsmentioning

confidence: 99%

Could We Treat More Unruptured Ectopic Pregnancies with Intramuscular Methotrexate?

Kucera

Schindl

Klem

et al. 2000

Gynecol Obstet Invest

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The main reason for the restricted use of methotrexate in the treatment of ectopic pregnancy (EP) obviously is the fear of tubal rupture in patients with lower abdominal pain after the administration of methotrexate. Therefore, we wanted to find out if patient characteristics at first presentation, such as age, pretreatment β-hCG level, adnexal mass as visualized by transvaginal ultrasonography, or history of prior EP, would identify patients at risk for tubal rupture if they were hemodynamically stable and showed no signs of peritoneal irritation. We examined whether more patients could have been treated medically with methotrexate, because tubal rupture was unforeseeable at first presentation and inclusion criteria for methotrexate treatment were fulfilled. From January 1996 to August 1998, 122 patients diagnosed as having EP were treated at the Gynecologic Department of the University Hospital of Vienna. Inclusion criteria for medical treatment with intramuscular methotrexate (50 mg/ m² body surface area) were (1) hemodynamic stability, (2) an unruptured ectopic mass ≤5 cm at the greatest dimension demonstrated at transvaginal ultrasonography; (3) β-hCG level ≤5,000 mIU/ml; (4) no cardiac activity of the extrauterine embryo; (5) wish of future fertility, and (6) informed consent. Patients with hemodynamic instability, severe abdominal pain, an ectopic mass ≥5 cm at the greatest dimension, β-hCG levels ≥5,000 mIU/ml, cardiac activity of the extrauterine embryo, and no wish of future fertility, or disagreement with methotrexate treatment, primarily underwent surgery. Despite the fact that none of the above patient characteristics at first presentation identified patients at risk for tubal rupture, only 60/122 patients (49%) actually underwent medical treatment whereas our inclusion criteria would have granted medical treatment in 101/122 patients (83%). We determined the actual and maximal possible percentages of patients with unruptured EP eligible for medical treatment of EP with intramuscular single-dose methotrexate 50 mg/m² body surface area. Our data show that tubal rupture in hemodynamically stable patients is not foreseeable and should not lead to a restricted use of medical treatment in patients preferring methotrexate.

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“…All women in the study by Geum Joon Cho received multiple injections of MTX. In another study by Stika et al, [15], 50 women of ectopic pregnancy were treated with a single dose of MTX and it was concluded that cases with initial serum Beta HCG level > 5000mIU/ml had a greater probability of requiring either multiple doses of MTX or surgical intervention. However exact increase in such risk was not given by Stika et al, They found a success rate of 84.6% with repeated injections of MTX.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Success of Medical Management of Ectopic Pregnancy in a Tertiary Care Hospital in United Arab Emirates

Vaswani¹

2014

JCDR

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Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience

Cited by 112 publications

References 11 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

Could We Treat More Unruptured Ectopic Pregnancies with Intramuscular Methotrexate?

Predictors of Success of Medical Management of Ectopic Pregnancy in a Tertiary Care Hospital in United Arab Emirates

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