title: Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases.
abstract: OBJECTIVE
  We sought to evaluate the global success rate of intramuscular methotrexate for the treatment of ectopic pregnancy, identify factors predictive of treatment success or failure, and study methotrexate tolerability in a large patient cohort.
  
  
  METHODS
  For this single-center retrospective observational study, we retrieved the records of all women who had a clinically or echographically confirmed ectopic pregnancy with a Fernandez score <13 and who were treated according to a 1mg/kg intramuscular single-dose methotrexate protocol. Medical treatment failure was defined by an obligation to proceed to laparoscopy. Needing a second injection was not considered to be medical treatment failure.
  
  
  RESULTS
  Between February 2008 and November 2013 (69 months), 400 women received methotrexate for ectopic pregnancy. The medical treatment protocol was effective for 314 patients, i.e., an overall success rate of 78.5%. A single methotrexate dose was sufficient for 63.5% of the women and a second dose was successful for 73.2% of the remaining women. The medical treatment success rate fell as initial hCG levels climbed. The main factors associated with methotrexate failure included day (D) 0, D4 and D7 hCG levels, pretherapeutic blood progesterone, hematosalpinx at D0 and pain at D7. Early favorable kinetics of hCG levels was predictive of success. Methotrexate treatment was successful in 90% of women who had D0 hCG <1000IU/l. Methotrexate tolerability was good, with only 9% of the women reporting non-severe adverse effects. The fertility rate with delivery after medical treatment for ectopic pregnancy was 80.7%.
  
  
  CONCLUSIONS
  In this study, we showed that an initial hCG value <1000IU/l and favorable early HCG kinetics were predictive factors for the successful medical treatment of ectopic pregnancy by methotrexate, and hematosalpinx and pretherapeutic blood progesterone >5ng/ml at diagnosis were predictive of its failure. We also confirmed good tolerability for single-dose methotrexate protocols.
authors.affiliation: Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Bonin
authors.affiliation: Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Pedreiro
authors.affiliation: Clinical Research Associate, Hospices Civils de Lyon, Femme Mère Enfant University Hospital, Department of Obstetrics and Gynecology, Lyon, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Moret
authors.affiliation: Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France.
authors.forename: Gautier
authors.initials: G
authors.lastname: Chene
authors.affiliation: Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Gaucherand
authors.affiliation: Department of Obstetrics and Gynecology Surgery, Femme Mère Enfant Hospital, Lyon, Hospices Civils de Lyon, France. Electronic address: gery.lamblin@chu-lyon.fr.
authors.forename: Géry
authors.initials: G
authors.lastname: Lamblin
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects*; D000032:Abortion, Therapeutic / Q000009:adverse effects*; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006786:Hospitals, Urban; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D007273:Injections, Intramuscular; D010535:Laparoscopy / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D011274:Pregnancy, Tubal / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate
keywords: Ectopic pregnancy; HCG plasmatic; Medical treatment; Methotrexate; Predictive factor