title: Success rates of single-dose methotrexate and additional dose requirements among women with first and previous ectopic pregnancies.
abstract: OBJECTIVE
  To compare the success of the single-dose methotrexate regimen and the requirement for a second or third dose of methotrexate between women with their first ectopic pregnancy (EP) and those with previous EP.
  
  
  METHODS
  In a retrospective cohort study, data were analyzed from women treated for EP by single-dose methotrexate at a Turkish tertiary referral center between January 2010 and December 2013. Data were compared between women with at least one previous EP and those with their first EP.
  
  
  RESULTS
  The success rate of the protocol in the first and previous EP groups was similar: 93.0% (320/344) and 87.3% (48/55), respectively. History of previous EP was not a predictor of treatment failure. However, the requirement for additional methotrexate doses was significantly higher in the previous EP group (16/48 [33.4%]) than in the first EP group (55/320 [17.2%]; P=0.03). Multivariate analysis showed that history of tubal surgery (P=0.006) and initial levels of the β-subunit of human chorionic gonadotropin (P=0.001) were significant predictors of treatment failure.
  
  
  CONCLUSIONS
  Although the single-dose regimen had similar success rates in the previous EP and first EP groups, additional doses of methotrexate were more frequently required in the previous EP group.
authors.affiliation: Early Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey. Electronic address: deryaakdag@yahoo.com.
authors.forename: Derya Akdag
authors.initials: DA
authors.lastname: Cirik
authors.affiliation: Early Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Tugba
authors.initials: T
authors.lastname: Kinay
authors.affiliation: Department of Obstetrics and Gynecology, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Keskin
authors.affiliation: Early Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Eda
authors.initials: E
authors.lastname: Ozden
authors.affiliation: Early Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Altay
authors.affiliation: Early Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Gelisen
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D015999:Multivariate Analysis; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*; D012189:Retrospective Studies; D014421:Turkey; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate
keywords: Additional doses of methotrexate; Ectopic pregnancy; Methotrexate treatment success; Previous ectopic pregnancy