Predictors of methotrexate treatment failure in ectopic pregnancy.
OBJECTIVE
To determine the possible predictors of methotrexate treatment failure in ectopic pregnancy.


METHODS
Fifty-eight patients diagnosed with ectopic pregnancy were treated with methotrexate (50 mg/m2). Selected variables in the history of the patients, the signs and symptoms at the time of admission, transvaginal ultrasound findings and serum beta-human chorionic gonadotropin (beta-hCG) levels on day 1 and 3 were evaluated in a logistic regression model to predict treatmentfailure, defined as tubal rupture.


RESULTS
Methotrexate treatment failed in 9 cases (15.5 %). Another 9 cases (15.5%) required a second dose of methotrexate, and no treatment failures were observed in these cases. The presence of subchorionic tubal hematoma in the ectopic gestation (OR = 22.9, CI = 2.7-194.7, p = 0.004), the presence of an embryo (OR = 24, CI = 2.1-269, p = 0.01) and day 1 serum beta-hCG level > or = 3,000 mIU/mL (OR = 27.1, CI = 2.1-342.5, p = 0.01) were the main predictors of treatment failure. Follow-up serum beta-hCG levels > or =3,500 mIU/mL (OR = 42.9, CI = 4.3-421) on day 3 were significant predictors of treatment failure. Follow-up risk score was calculated as > 4 on day 3 by adding day 3 serum beta-hCG level to the admission score. Only 1 treatment failure (2.4%) occurred in 42 patients with an admission score of nil. No treatment failure occurred in 39 patients whose follow-up score was nil. The increase in admission risk (OR = 32.1, CI = 3.8-270, p = 0.001) and follow-up risk (OR = 9.2, CI = 2.4-35.2) were significant predictors of treatment failure.


CONCLUSIONS
Transvaginal ultrasound findings are as important as serum beta-hCG level on the first day of methotrexate treatment. In unruptured cases, day 3 serum beta-hCG level is important to reevaluate the decision to continuefollow-up or perform early surgery for increased risk of treatment failure.
Department of Obstetrics and Gynecology, SSK Ankara Maternity and Women's Health Teaching Hospital, Kocaeli University School of Medicine, Ankara, Turkey. sdilbaz@ttnet.net.tr
Serdar
S
Dilbaz
Eray
E
Caliskan
Berna
B
Dilbaz
Ozlem
O
Degirmenci
Ali
A
Haberal
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000097:blood*; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019160:Endosonography / Q000379:methods; D005187:Fallopian Tubes / Q000187:drug effects*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D016015:Logistic Models; D008137:Longitudinal Studies; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011274:Pregnancy, Tubal / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy; D018570:Risk Assessment; D012422:Rupture, Spontaneous / Q000139:chemically induced; D017211:Treatment Failure
D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate