A new predictive scoring system including shock index for unruptured tubal pregnancy patients.
OBJECTIVE
Shock index (SI) and predictive score grading system including it for predicting medical treatment failure of tubal pregnancies have been studied.


METHODS
Eighty-eight patients were diagnosed as nonruptured tubal pregnancies. Shock index was calculated as the ratio of heart rate to systolic arterial pressure. A predictive score was used based on four parameters including initial level of beta-human chorionic gonadotropin (betahCG), aspect of the image on ultrasound, size of the ectopic mass and shock index value at admission.


RESULTS
Forty patients have undergone to surgery because of tubal gestational sac size > or =4 cm and/or presence of fetal heart activity. Nineteen patients were managed expectantly. Twenty-four patients received single dose methotrexate (MTX) and five patients received second dose MTX. Success rate for single dose MTX therapy was 72% (21/29). The cut-off shock index value for tubal rupture was 0.77 with 89% sensitivity and 61% specifity.


CONCLUSIONS
In this study, we demonstrated that tubal pregnancy patients who were managed with nonsurgical measures at admission and who had SI values lower than 0.77 and predictive score grades greater and equal to 6.5 did not experience tubal rupture and did not need surgical intervention during nonsurgical management.
Kahyaoglu
Serkan
S
Zekai Tahir Burak Women's Health and Research Hospital, Department of Infertility and Reproductive Medicine, Gn. Dr.Tevfik Saglam Cad. Emlakbankasi Evleri C3/32 Etlik, Ankara, Turkey. kralytmer@yahoo.com
Turgay
Inci
I
Gocmen
Muhammed
M
Sut
Necdet
N
Batioglu
Sertac
S
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012769:Shock / Q000175:diagnosis* / Q000503:physiopathology; D014463:Ultrasonography
D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate