Cutoff value of human chorionic gonadotropin in relation to the number of methotrexate cycles in the successful treatment of ectopic pregnancy.
OBJECTIVE
To assign cutoff values for human chorionic gonadotropin (beta-hCG) in pretreatment and after one methotrexate (MTX) cycle and determine its correspondence to the number of MTX cycles in successfully treated ectopic pregnancy.


METHODS
Retrospective study.


METHODS
Polish university hospital.


METHODS
68 women with ectopic pregnancies who qualified for medical treatment.


METHODS
A single-dose of MTX (50 mg/m(2)) repeated every 7 days, plus laparoscopy in cases of tubal rupture or increased (>or=50% over 1 week) beta-hCG concentration.


METHODS
Resolution of serum beta-hCG without the necessity of laparoscopy.


RESULTS
Success rate was 78% (53 of 64 women). The medians of pretreatment beta-hCG levels in the groups treated successfully and unsuccessfully (943 vs. 3085 mIU/mL) and after the first dose of MTX (564 vs. 4049 mIU/mL) were statistically significantly different. The decrease in beta-hCG level after one MTX dose differed statistically significantly only in successfully treated women. The receiver operating characteristic (ROC) curve cutoff value in the success group indicated an initial beta-hCG level of 1790 and 1218 mIU/mL after one MTX cycle. The median of beta-hCG titer was not statistically different in patients requiring one or more treatment cycles.


CONCLUSIONS
When the beta-hCG level is >1790 mIU/mL, the MTX treatment of ectopic pregnancy is at risk of failure. However, the initial beta-hCG titer is not a predictor of the number of MTX cycles that can guarantee a successful outcome.
Department of Gynecologic Oncology, Division of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Science, Poznan, Poland. Electronic address: ewamarkwitz@poczta.fm.
Ewa
E
Nowak-Markwitz
Department of Gynecologic Oncology, Division of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Science, Poznan, Poland.
Marcin
M
Michalak
Department of Gynecologic Oncology, Division of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Science, Poznan, Poland.
Mikołaj
M
Olejnik
Department of Gynecologic Oncology, Division of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Science, Poznan, Poland.
Marek
M
Spaczynski
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000328:Adult; D006063:Chorionic Gonadotropin / Q000032:analysis / Q000097:blood* / Q000592:standards; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate