title: Efficacy of methotrexate treatment in extrauterine pregnancies defined by stable or increasing human chorionic gonadotropin concentrations.
abstract: OBJECTIVE
  To evaluate the efficacy of methotrexate treatment in selected cases of extrauterine pregnancy (EUP) defined by stable or increasing hCG concentration.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Gynecology department of the Lis Maternity Hospital.
  
  
  METHODS
  Fifty women with EUP diagnosed whenever an intrauterine gestational sac was not seen on transvaginal ultrasonography.
  
  
  METHODS
  Women received IM methotrexate at a dose of 50 mg/m(2) of body surface area. Failure of hCG levels to fall by >/=15% during any successive week resulted in repeated administration of methotrexate. Surgical intervention was performed for presumed tubal rupture.
  
  
  METHODS
  Serial hCG measurement was performed weekly until hCG concentration reached 15 mIU/mL. Success was defined as the achievement of hCG concentration of 25 mIU/mL without surgical intervention.
  
  
  RESULTS
  Forty-four women (88%) were successfully treated. The mean time from first methotrexate injection to success was 34 +/- 2.4 days. Women treated successfully and unsuccessfully differed significantly only with regard to serum hCG levels of 1,876 +/- 243 and 3,489 +/- 376 mIU/mL, respectively. When the initial hCG levels were lower or higher than 2,000 IU/L, the success rate was 97% and 74%, respectively (significant by Fisher's exact test).
  
  
  CONCLUSIONS
  When methotrexate treatment is administrated in a selected group of EUP defined by stable or increasing hCG, it may fail more frequently (26%) when initial hCG levels are >2,000 mIU/mL.
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. ronn@post.tau.ac.il
authors.forename: Ronni
authors.initials: R
authors.lastname: Gamzu
authors.forename: Benny
authors.initials: B
authors.lastname: Almog
authors.forename: Yishai
authors.initials: Y
authors.lastname: Levin
authors.forename: Amiram
authors.initials: A
authors.lastname: Avni
authors.forename: Ariel
authors.initials: A
authors.lastname: Jaffa
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Lessing
authors.forename: Amiram
authors.initials: A
authors.lastname: Baram
mesh_terms: D006063:Chorionic Gonadotropin / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D006063:Chorionic Gonadotropin; D008727:Methotrexate