title: Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy.
abstract: Single-dose methotrexate is an alternative to surgery in treating ectopic pregnancy. Because success rates vary, we sought to identify factors which predict treatment outcome. A total of 44 women with ectopic gestation were treated. The non-laparoscopic diagnosis of ectopic pregnancy was made following history, physical examination, ultrasound, endometrial biopsy and the measurement of serial beta-human chorionic gonadotrophin (HCG) and progesterone concentrations. Methotrexate (50 mg/m2 i.m.) was administered, with a second dose given 1 week later in patients with plateauing or rising beta-HCG concentrations. Of 44 patients, 23 (52.3%) were successfully treated with one dose. An additional 10 women (22.7%) were also successfully managed but required a second dose, giving an overall success rate of 75.0%. In all, 11 women (25.0%) required surgery, four of whom experienced tubal rupture. Receiver operator curves were constructed to optimally select pretreatment beta-HCG and progesterone cut-off concentrations for successful treatment. Using beta-HCG < 1500 IU/l or progesterone < 7.0 ng/ml (22.3 nmol/l) as a cut-off concentration produced a diagnostic test with a sensitivity of 87.5%, a specificity of 90.0%, a positive predictive value of 96.6% and a negative predictive value of 69.2%. Conversely, this model predicts that patients with serum beta-HCG concentrations > or = 1500 IU/l and progesterone concentrations > or = 7.0 ng/ml are at far greater risk of failing single-dose methotrexate therapy.
authors.affiliation: UMDNJ--New Jersey's University of the Health Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Brunswick, USA.
authors.forename: G H
authors.initials: GH
authors.lastname: Corsan
authors.forename: M
authors.initials: M
authors.lastname: Karacan
authors.forename: S
authors.initials: S
authors.lastname: Qasim
authors.forename: M K
authors.initials: MK
authors.lastname: Bohrer
authors.forename: M X
authors.initials: MX
authors.lastname: Ransom
authors.forename: E
authors.initials: E
authors.lastname: Kemmann
mesh_terms: D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D004624:Embryo Transfer; D005184:Fallopian Tube Diseases; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D010062:Ovulation Induction; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D011374:Progesterone / Q000097:blood*; D012422:Rupture, Spontaneous
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D011374:Progesterone; D008727:Methotrexate