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

Abstract

Objective To study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy. Methods This is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (β-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups. Results The overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (~55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment β-HCG level was 2.3 times higher in Group F than in Group S (1734±1684 vs 4036±2940 IU/L). The data showed a β-HCG level of 3924IU/L as a suitable cut-off value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor. Conclusion The single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment β-HCG level is a significant predictor of the treatment outcome.

Tubal ektopik gebeliklerde çoklu doz metotreksat tedavisinin analizi

“…The β-hCG reduction was significantly higher in the single-dose MTX group (P=0.05). In accordance with the information in the literature 21,23 , the EP patients with low initial β-hCG levels are usually treated with a high treatment efficacy without the need for extra doses of MTX, which may be the reason for this result found in our study. Mavrelos et al 28 reported that the development of tubal abortion or rupture in EP cases reduced the level of β-hCG.…”

“…On the other hand, there was no significant relationship between EP localization and treatment success or failure (Padj>0.05). Sindiani et al 21 reported that the size of the ectopic mass did not affect the medical treatment results. On the contrary, Celik et al 30 reported that the increased size of the ectopic mass decreased the success of the treatment and that the endometrial thickness did not affect the treatment results.…”

“…When the previous studies are examined, it is understood that the success rate of MTX treatment in ectopic pregnancies varies between 65% and 94% [21][22][23] . In this study, the success rate of sequential multi-dose MTX therapy was found to be 71.4% which is rather consistent with the literature.…”

“…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. Similarly, Celik et al 30 reported that the presence of free fluid in Douglas did not increase medical treatment failure.…”

Advances in the Diagnosis and Management of Ovarian Ectopic Pregnancy: A Short Review

“…22 It is recommended to inject a single dose of methotrexate MTX treatment; where a recent study reported an overall success rate of 75.45% after a single MTX dose, and 3.61% required a repeat dose of the drug. 24 Few case reports have described successful methotrexate MTX therapy. 25 Pagidas et al administrated MTX treatment for ovarian ectopic patients' diagnosed using transvaginal USG and were healed.…”