Yolk sac on transvaginal ultrasound as a prognostic indicator in the treatment of ectopic pregnancy with single-dose methotrexate.
OBJECTIVE
To determine whether yolk sac on transvaginal ultrasound was an independent predictor for single-dose methotrexate failure for tubal ectopic pregnancies.


METHODS
Seven hundred sixty-six consecutive methotrexate-treated ectopic pregnancy patients were reviewed. After excluding 25 oral and 97 multidose methotrexate patients, 18 cornual, 4 cervical pregnancies, and 63 patients with ectopic cardiac activity, 559 study patients remained. Variables studied included age, gravidity, parity, previous ectopic pregnancy, serum human chorionic gonadotropin and progesterone levels, ectopic size, ectopic volume, body surface area, and yolk sac presence.


RESULTS
Sixteen of 73 (21.9%) patients with yolk sac failed treatment vs 36 of 486 (7.4%) patients without yolk sac (P = .0003). Other significant variables on single factor analysis were previous ectopic (P = .0005), human chorionic gonadotropin (P < .0001), and progesterone (P = .003). Only previous ectopic and human chorionic gonadotropin remained significant on logistic regression analysis.


CONCLUSIONS
The presence of a yolk sac, although a risk factor for failure of single-dose methotrexate in treatment of tubal ectopic pregnancy, is not an independent predictor.
Lipscomb
Gary H
GH
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.
Gomez
Isabel G
IG
Givens
Vanessa M
VM
Meyer
Norman L
NL
Bran
Derita F
DF
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000328:Adult; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014621:Vagina; D015017:Yolk Sac / Q000000981:diagnostic imaging*; D055815:Young Adult
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate