title: Ectopic pregnancy: using the hCG ratio to select women for expectant or medical management.
abstract: OBJECTIVE
  To identify variables that can be used to select women with an ectopic pregnancy for expectant or medical management with systemic methotrexate.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Early Pregnancy Unit of a London teaching hospital.
  
  
  METHODS
  Women with a tubal ectopic pregnancy managed non-surgically.
  
  
  METHODS
  The diagnosis of tubal ectopic pregnancy was made using transvaginal sonography. Human chorionic gonadotrophin (hCG) levels had to be taken at 0 hour and 48 hours pre-treatment. Other recorded variables include presenting complaints, gestational age, progesterone levels, size of the ectopic mass and appearance of the ectopic on transvaginal sonography. Women were followed up until the outcome (success or failure) of management was known.
  
  
  METHODS
  Univariable analysis was performed to identify the variables associated with successful management using area under curves and relative risks.
  
  
  RESULTS
  Thirty-nine women underwent expectant management (overall success rate 71.8%) and 42 had medical management (overall success rate 76.2%). The pre-treatment hCG ratio (hCG 48 hours/hCG 0 hour) was related to the failure of both expectant (area under curve 0.86, 95% CI 0.67-0.94) and medical (area under curve 0.79, 95% CI 0.58-0.90) management. History of ectopic pregnancy was related to failure of expectant management only (relative risk 0.46, 95% CI 0.16-0.92).
  
  
  CONCLUSIONS
  The most important variable for predicting the likelihood of successful non-surgical management was the pre-treatment hCG ratio. New studies are required to validate the use of this variable and of history of ectopic pregnancy to predict the likelihood of successful non-surgical management in clinical practice.
authors.affiliation: Early Pregnancy and Gynaecological Ultrasound Unit, St George's, University of London, UK. ejkirk@hotmail.co.uk
authors.forename: Emma
authors.initials: E
authors.lastname: Kirk
authors.forename: Ben
authors.initials: B
authors.lastname: Van Calster
authors.forename: George
authors.initials: G
authors.lastname: Condous
authors.forename: Aris T
authors.initials: AT
authors.lastname: Papageorghiou
authors.forename: Olivier
authors.initials: O
authors.lastname: Gevaert
authors.forename: Sabine
authors.initials: S
authors.lastname: Van Huffel
authors.forename: Bart
authors.initials: B
authors.lastname: De Moor
authors.forename: Dirk
authors.initials: D
authors.lastname: Timmerman
authors.forename: Tom
authors.initials: T
authors.lastname: Bourne
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D011295:Prenatal Care / Q000379:methods*; D011379:Prognosis; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate