title: Morbid obesity and outcome of ectopic pregnancy following capped single-dose regimen methotrexate.
abstract: OBJECTIVE
  Evaluate whether morbid obesity influenced resolution, number of doses or ultimately surgical management of tubal ectopic pregnancy (TEP) when treated with single-dose regimen methotrexate (SDR-MTX) capped at 100 mg.
  
  
  METHODS
  Retrospective cohort study of patients with a diagnosis of TEP who underwent MTX treatment from 2000 to 2013. Patients were excluded if initial β-hCG <1000 mIU/mL, did not have β-hCG follow-up or were not treated with SDR-MTX. Per protocol, dose was administered at 50 mg/m2with a capped maximum of 100 mg. Patients were divided based on their BMI (<40 and ≥40 kg/m2). Demographic variables, β-hCG before treatment, maximum diameter of ectopic size, embryonic heart tones, decrease of β-hCG, need for additional MTX doses and surgery despite treatment were recorded and compared among the groups.
  
  
  RESULTS
  151 women were included in the study, 89.4% (135/151) non-morbidly obese and 10.6% (16/151) morbidly obese. No differences in age distribution, ethnicity, pre-treatment presence of embryonic heart tones, maximum diameter of ectopic size ≥35 mm and β-hCG ≥5000 mIU/ml were found. Following treatment, the proportion of patients with at least an 80% decrease in their β-hCG levels or need for surgery were similar, however, morbidly obese patients were significantly more likely [11/134 vs. 5/16, OR 5.1 (1.5-17.3, p = 0.015)] to require an additional MTX dose.
  
  
  CONCLUSIONS
  Among patients with TEP, morbidly obese patients were five times more likely to require an additional dose compared to non-morbidly obese when SDR-MTX capped at 100 mg was used for medical management.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA. lhoyosma@med.wayne.edu.
authors.forename: Luis R
authors.initials: LR
authors.lastname: Hoyos
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
authors.forename: Mokerrum
authors.initials: M
authors.lastname: Malik
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
authors.forename: Marvin
authors.initials: M
authors.lastname: Najjar
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Rodriguez-Kovacs
authors.affiliation: Reproductive Endocrinology and Infertility, Houston Fertility Services, Houston, TX, USA.
authors.forename: Mazen
authors.initials: M
authors.lastname: Abdallah
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Vilchez
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women's Hospital, Detroit, MI, USA.
authors.forename: Awoniyi O
authors.initials: AO
authors.lastname: Awonuga
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D009767:Obesity, Morbid / Q000150:complications*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate
keywords: Capped dose; Ectopic pregnancy; Methotrexate; Morbid obesity