title: Predictors of Success of a Single-Dose Methotrexate in the Treatment of Ectopic Pregnancy.
abstract: BACKGROUND
  Ectopic pregnancy (EP) is the commonest cause of maternal mortality-related death in the first trimester. Methotrexate (MTX) remains the first-line treatment in optimally selected patients.
  
  
  OBJECTIVE
  To evaluate the success rate and predictors of success of a single-dose MTX treatment in EP.
  
  
  METHODS
  We studied retrospectively 109 patients with unruptured EP who were treated with Intramuscular MTX administered in a dose of 50 mg/m(2) on days 0 and in additional doses on day 7 if β-hCG levels did not decrease by 15 % during the follow-up period. The study was conducted at the Maternity and Children Hospital Buraidah, Saudi Arabia from June 2013 to December 2013. Pretreatment β-β-hCG, EP mass diameter, peritoneal fluid, and fetal cardiac activity were evaluated. The main outcome measures were success rate, the predictors of success without surgical treatment.
  
  
  RESULTS
  Under this regime, the overall success rate was 60.6 % of patients. Of the failure group, only 4.7 % of patients experienced rupture of EP. No side effects were reported. The main predictors of failure were initial β-hCG value ≥ 3.500 mIU/mL OR 4.11 (1.646-12.248, 0.043) and EP diameter 3.73 (1.646-12.10, p = 0.003).
  
  
  CONCLUSIONS
  The success rate of MTX in this study was 60.6 %, and the initial β-hCG concentration and EP diameter were the best predictors of successful treatment with MTX. Furthermore, MTX should be offered only to those patients with β-hCG <2,000 mIU/mL and EP mass size <3.5 cm.
authors.affiliation: Department of Obstetrics & Gynecology, College of Medicine, Qassim University, P.O. Box 665, Buraidah, 51452 Kingdom of Saudi Arabia ; Department of Obstetrics & Gynecology, College of Medicine, Bahri University, Khartoum, Sudan.
authors.forename: Mohamed Akhatim
authors.initials: MA
authors.lastname: Alsammani
authors.affiliation: Department of Obstetrics & Gynecology, College of Medicine, Qassim University, P.O. Box 665, Buraidah, 51452 Kingdom of Saudi Arabia.
authors.forename: Neimat Abdalhadi
authors.initials: NA
authors.lastname: Moona
keywords: Ectopic pregnancy; Methotrexate; Predictors of failure complications; Success rate