Outcome prediction for treatment of tubal pregnancy using an intramuscular methotrexate protocol.
OBJECTIVE
The purpose of this study was to determine the outcome predictors of intramuscular methotrexate therapy for tubal pregnancy.


METHODS
This retrospective study was approved by our Institutional Review Board. Fifty-five consecutive women (mean age, 31 years; range, 18-45 years) who were treated with intramuscular methotrexate therapy for tubal pregnancy were retrospectively reviewed. Clinical data (maternal age, gestational age, and serum beta-human chorionic gonadotropin [beta-hCG] level) and transvaginal sonographic findings (size, gross appearance, presence of a gestational product or heartbeat, and amount of the fluid collection) were assessed as potential predictors of the treatment outcome. The Fisher exact test was used for categorical variables, and the Wilcoxon signed rank sum test was used for continuous variables. Treatment failure was defined as the need for surgical intervention.


RESULTS
Women with successful treatment differed from women with unsuccessful treatment with respect to the serum beta-hCG level, the gross appearance of tubal pregnancy, and the presence of a gestational product such as a yolk sac or embryo (P <.001; P = .01; and P =.008, respectively). All of the tubal pregnancies with a gestational product appeared as a tubal ring on transvaginal sonography. A high serum beta-hCG level of greater than 2390 mIU/mL and a transvaginal sonographic appearance of a tubal ring were the important predictors associated with failure of intramuscular methotrexate therapy for tubal pregnancy.


CONCLUSIONS
Measurement of the serum beta-hCG level and evaluation of the transvaginal sonographic appearance of tubal pregnancy are helpful for predicting treatment outcomes in women who receive intramuscular methotrexate therapy for tubal pregnancy.
Moon
Min Hoan
MH
Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Jung-gu, Seoul 100-380, Korea. mmhoan@cgh.co.kr
Lee
Young Ho
YH
Lim
Kyung Taek
KT
Yang
Jae Hyug
JH
Park
Seong Ho
SH
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate