title: Second-dose methotrexate in ectopic pregnancies: the role of beta human chorionic gonadotropin.
abstract: OBJECTIVE
  To evaluate the role of β-hCG levels on days 1, 4, and 7 after methotrexate as predictors for second-dose requirement and success.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary university-affiliated hospital.
  
  
  METHODS
  A total of 1,703 patients were admitted because of ectopic pregnancy. Four hundred nine received methotrexate, of whom 73 women required a second dose.
  
  
  METHODS
  The "single-dose" methotrexate protocol with 50 mg/m(2) was administered to patients with progressing ectopic pregnancy. Surgical intervention was performed in cases of methotrexate second-dose treatment failure.
  
  
  METHODS
  Methotrexate second-dose requirement and success according to β-hCG levels on days 1, 4 and 7.
  
  
  RESULTS
  Second-dose methotrexate was successful in 58 patients (79.4%, success group), whereas 15 patients (20.6%) failed treatment and required surgical intervention (failure group). The medians of β-hCG levels on days 1, 4, and 7 were significantly higher in the "failure group" (1,601 vs. 2,844, 2,164 vs. 3,225, and 1,915 vs. 3,745 mIU/mL, respectively). Logistic regression analysis demonstrated that day-1 β-hCG levels were the only significant independent variable for second-dose treatment outcome. The receiver operating characteristic curve for β-hCG levels on day 1 was 0.727, and at a cutoff value of 2,234 mIU/mL the sensitivity and specificity reached the optimum for treatment success (77.5% and 73.3%, respectively).
  
  
  CONCLUSIONS
  Day-1 β-hCG levels were the only predictors for methotrexate second-dose requirement and treatment success. The cutoff value of β-hCG on day 1 with the optimal treatment results was found to be 2,234 mIU/mL.
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: co.aviad@gmail.com.
authors.forename: Aviad
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Bibi
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Benny
authors.initials: B
authors.lastname: Almog
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Tsafrir
authors.affiliation: Department of Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ishai
authors.initials: I
authors.lastname: Levin
mesh_terms: D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage* / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017211:Treatment Failure
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate
keywords: Ectopic pregnancy; beta human chorionic gonadotropin; methotrexate