title: Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications.
abstract: Our aim was to evaluate the relationship between the success of methotrexate treatment and β-hCG levels in progressive tubal ectopic pregnancies. We defined a retrospective cohort of 394 progressive tubal ectopic pregnancy patients treated with methotrexate. A single-dose methotrexate protocol using 50 mg/m(2) was administered to patients with progressive tubal ectopic pregnancy. Surgery was performed in patients who exhibited signs of acute abdomen due to tubal rupture. Of 394 patients that received methotrexate treatment, 335 (84.6%) responded to medical treatment, while the remaining 59 (15.36%) underwent surgery due to treatment failure. β-hCG levels in the failure group were significantly higher as compared with the success group at Day 1, Day 4, and Day 7 (2116±3157 vs. 4178±3422, 2062±3551 vs. 4935±4103, and 1532±3007 vs. 3900±4783, respectively). The receiver operating characteristics curve for β-hCG levels at Day 1 was 0.738, with a cutoff value of 1418 mIU/mL, while sensitivity and specificity values reached the optimum for treatment success (83.1% and 59.4%, respectively). Medical treatment with methotrexate achieved an 85.02% success rate for the treatment of progressive tubal ectopic pregnancy, while success rates for medical treatment decreased significantly when initial β-hCG levels were >1418 mIU/mL.
authors.affiliation: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, Izmir, Turkey. Electronic address: askindoganmd@gmail.com.
authors.forename: Askin
authors.initials: A
authors.lastname: Dogan
authors.affiliation: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, Izmir, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Gulhan
authors.affiliation: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, Izmir, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Uyar
authors.affiliation: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, Izmir, Turkey.
authors.forename: Atalay
authors.initials: A
authors.lastname: Ekin
authors.affiliation: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, Izmir, Turkey.
authors.forename: Cenk
authors.initials: C
authors.lastname: Gezer
authors.affiliation: Department of Biostatistics, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Bilgin
authors.affiliation: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, Izmir, Turkey.
authors.forename: Cüneyt E
authors.initials: CE
authors.lastname: Taner
authors.affiliation: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Gaziler Street, Izmir, Turkey.
authors.forename: Ibrahim E
authors.initials: IE
authors.lastname: Ertas
mesh_terms: D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000601:surgery*; D012372:ROC Curve; D017211:Treatment Failure
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate
keywords: Ectopic pregnancy; Failure; Methotrexate; Treatment; β-hCG