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

Abstract

The 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.

Predictive value of serum βHCG level in ectopic pregnancy: A cross sectional study

“…Similarly, in our study the mean baseline ßHCG levels were lower in the successful group (882.35) than the unsuccessful group (1083.99), but there were no significant differences between the two groups ( p = 0.098). The sample size in our study was greater than Keshta's 11 study (690 vs. 58, respectively). In our study, baseline ßHCG cut off value for successful treatment was 504.5 with 58% sensitivity and 51% specificity.…”

“…In keshta,s 11 study, The mean baseline ßHCG levels were significantly lower in the successful group (1403) compared with the unsuccessful group (2845). The baseline ßHCG cut off value for successful treatment in Keshta's 11 study was 2141 with 72% sensitivity and 75% specificity. Similarly, in our study the mean baseline ßHCG levels were lower in the successful group (882.35) than the unsuccessful group (1083.99), but there were no significant differences between the two groups ( p = 0.098).…”

“…The mean baseline ßHCG levels were significantly lower in the successful group (1403) compared with the unsuccessful group (2845). The baseline ßHCG cut off value for successful treatment in Keshta's 11 study was 2141 with 72% sensitivity and 75% specificity.…”

“…10 The available literature on the medical management of EP is scant and limited to a few parameters related to the management protocols. 11 We investigate the predictive value of serum βHCG level and it's changes from the baseline to the 4th and 7th days after SD MTX treatment in successful treatment of tubal EP.…”

Efficacy of Methotrexate Treatment, Nonsurgical Treatment of Ectopic Pregnancy (EP)

“…Mean age was noted 30.23+5.16 years in successful group and 31.07 +4.33 years in failed treatment group with p value 0.362 in a study conducted by Lee JH et al 24 Another study by Keshta AS et al showed that patients in successful group had parity 2 (0-9) and 1 (0-5) in failure group p value 0.73, not statistically significant comparable with our results. 25 The most predictive variable of success of medical treatment is pretreatment β-hCG level. In our study, the difference between the mean pre-treatment serum β-hCG level in the success and failure groups was statistically significant i.e.,1491.79 ± 1094.69 vs. 2701.50 ± 1417.28 IU/L with p =0.038.…”