Failed methotrexate treatment of cervical pregnancy. Predictive factors.
OBJECTIVE
To determine the risk factors when primary methotrexate treatment of cervical pregnancy fails.


METHODS
From January 1985 to December 1999, 32 women with cervical pregnancy were treated with methotrexate intramuscularly according to a repeated intramuscular injection protocol. For evaluation of the efficacy of therapy, pretreatment serum concentrations of human chorionic gonadotropin, size of the gestational mass, fetal cardiac activity and presence of fluid in the peritoneal cavity were measured. These findings were analyzed and compared in terms of success and failure by means of the chi 2 test, Fisher's exact test, receiver operating characteristic curve and Student's t test.


RESULTS
There was no relation between the women's age, parity, size of the conceptus or presence of fluid in the peritoneal cavity to the efficacy of treatment. In a cervical pregnancy that presented with a serum human chorionic gonadotropin concentration of > or = 10,000 mIU/mL, fetal cardiac activity was associated with a higher failure rate of primary methotrexate treatment.


CONCLUSIONS
In cervical pregnancies, a high serum human chorionic gonadotropin concentration and fetal cardiac activity were the most important factors associated with failure of treatment using methotrexate.
Bai
Sang Wook
SW
Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Shinchon-dong 134, Sudaemun-gu, Seoul, Korea, 120-752. swbai@yumc.yonsei.ac.kr
Lee
Jae Sung
JS
Park
Joo Hyun
JH
Kim
Jeong Yeon
JY
Jung
Kyung A
KA
Kim
Sei Kwang
SK
Park
Ki Hyun
KH
D000020:Abortifacient Agents, Nonsteroidal; D000032:Abortion, Therapeutic / Q000379:methods*; D000328:Adult; D002584:Cervix Uteri; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D005323:Fetal Monitoring; D020073:Gravidity; D006340:Heart Rate, Fetal; D006801:Humans; D008727:Methotrexate; D010298:Parity; D018579:Patient Selection; D011237:Predictive Value of Tests; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate