Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy.
OBJECTIVE
To investigate whether a history of previous ectopic pregnancy is an independent risk factor for failure of methotrexate therapy in subsequent ectopic pregnancies and whether the previous treatment method influenced failure.


METHODS
Inner-city teaching hospital.


METHODS
Retrospective case review.


METHODS
Five hundred four consecutive patients treated with "single-dose" methotrexate for ectopic pregnancy. Nine patients electing surgery after beginning medical therapy were excluded from analysis.


METHODS
Systemic methotrexate 50 mg/m(2).


METHODS
Failure of methotrexate therapy.


RESULTS
Twenty-one (18.6%) of 113 of previous ectopic patients and 26 (6.8%) of 382 first-time ectopic patients failed methotrexate therapy (odds ratio, 3.12). The overall success rate was 90.5% (448/495 patients). Univariant analysis showed that treatment hCG and progesterone (P) levels and ectopic cardiac activity were significantly different between successful and failed therapy. Logistic regression analysis for these four variables showed that only hCG and history of previous methotrexate remained significant risk factors for failure of methotrexate therapy. The likelihood of failure in patients with a previous ectopic was not influenced by previous treatment with salpingostomy, salpingectomy, or medical treatment.


CONCLUSIONS
A history of previous ectopic pregnancy appears to be an independent risk factor for failure of systemic methotrexate treatment, but failure is not affected by previous treatment method.
Lipscomb
Gary H
GH
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. glipscomb@utmem.edu
Givens
Vanessa A
VA
Meyer
Norman L
NL
Bran
Derita
D
D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
D008727:Methotrexate