title: Efficacy of methotrexate therapy in patients with tubal pregnancy and a serum human chorionic gonadotropin level above 10,000 IU/L.
abstract: OBJECTIVE
  To estimate the failure rate of medical treatment and to identify variables associated with treatment failure in patients with tubal pregnancy and an initial serum level of human chorionic gonadotropin (HCG) over 10,000 IU/L.
  
  
  METHODS
  The inclusion criteria were tubal pregnancy diagnosed using ultrasonography, primary treatment of intramuscular methotrexate injection at one of the four institutions between January 2003 and December 2011, a serum HCG level within two days before treatment>10,000 IU/L, and follow-up data to determine treatment success or failure. Exclusion criteria were other primary treatments besides intramuscular methotrexate injection. The clinicopathologic data of 36 patients were collected and analyzed.
  
  
  RESULTS
  Medical treatment failed and surgery was performed in 19 (53%) patients. In univariable analysis, age, parity, and size of the gestational sac were associated with treatment failure, but none of the variables were associated with treatment failure in multivariable analysis. The failure rate in the subgroup with age<33 years and size of gestational sac≥1.1 cm was significantly higher than those of the other subgroups (82% vs. 41% [mean of the other subgroups], respectively).
  
  
  CONCLUSIONS
  Patients with a serum HCG level>10,000 IU/L who received medical treatment had a high failure rate. Among them, patients aged<33 years and with a gestational sac≥1.1 cm had an extremely high failure rate.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Kidong
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Suh
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyun Hoon
authors.initials: HH
authors.lastname: Cheong
authors.affiliation: Department of Obstetrics and Gynecology, Graduate School of Medicine, Dongguk University, Seoul, Korea.
authors.forename: Sang Ho
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea.
authors.forename: Taek-Sang
authors.initials: TS
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jae Hong
authors.initials: JH
authors.lastname: No
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Yong-Beom
authors.initials: YB
authors.lastname: Kim
keywords: Chorionic gonadotropin; Methotrexate; Treatment failure; Tubal pregnancy