Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate.
OBJECTIVE
To determine variables that predict treatment failure after methotrexate (MTX) treatment of ectopic pregnancy.


METHODS
Retrospective cohort study.


METHODS
Canadian teaching hospital.


METHODS
Sixty patients diagnosed with and treated for ectopic pregnancy.


METHODS
A single dose of methotrexate (50 mg/m(2)) by i.m. injection.


METHODS
Resolution of serum beta-hCG or clinical evidence of treatment failure.


RESULTS
Treatment failure was observed following methotrexate administration in 65% of cases when initial beta-hCG was >4000 IU/L, but in only 7. 5% of patients when serum beta-hCG was <4000 IU/L (OR = 52.06, 95% CI 4.88-555.56). Patients who presented with pelvic pain without tenderness had treatment failure 56% of the time versus only 17% in those without pain (OR = 9.20, 95% CI 1.02-82.60). Treatment failure also occurred in 53% of patients presenting with vaginal bleeding versus 16% without bleeding (OR = 6.18, 95% CI 0.73-51.93).


CONCLUSIONS
Methotrexate should not be used to treat ectopic pregnancy when initial beta-hCG is >4000 IU/L. Caution should also be exercised in using methotrexate for ectopic pregnancy when the patient presents with bleeding or pain even without tenderness.
Tawfiq
A
A
Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Agameya
A F
AF
Claman
P
P
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D015331:Cohort Studies; D000075202:Contraindications; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D017211:Treatment Failure; D014592:Uterine Hemorrhage / Q000209:etiology
D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate