The evaluation of success and failure of methotrexate treatment in ectopic pregnancy

Abstract

Aim: Regardless of medical advancements, ectopic pregnancy (EP) is still an essential factor in the mortality rate of women of reproductive age. The main aim of this study was to determine predictive factors associated with the success of the response to treatment with single-dose and two-dose methotrexate (MTX) regimens in women with tubal EP. Material and Method: This retrospective study examined the electronic records of 130 patients who underwent treatment due to EP were included in the study. The patients were divided into two groups: the successful MTX treatment group (n: 85) as the case group and the failure of MTX treatment group (n: 45) as the control group. Results: Age-matched (30.62±4.36) and body mass index (BMI)-matched (24.37±2.29) patients diagnosed with EP were treated with MTX. The mean beta-human chorionic gonadotropin (β-hCG) value on the first day of treatment was 1639.84±524.96 mIU/mL in the successful and 5866.76±1875.51 mIU/mL in the unsuccessful group. 85 of 130 (65%) were successfully treated with MTX. Five of 45 (35%) failed medical treatment and required laparoscopic surgery. The longest ectopic mass diameter was significantly higher in the failure of MTX treatment group (p<0.05). There was a statistically significant difference between groups in regard to the β-hCG values on days 1, 4, 7, and 14. The β-hCG values on the first day were significantly higher in the failure of MTX treatment group(p <0.05). There was no statistically significant difference between a single-dose regimen and multi-dose treatments.  Conclusion: We found that an initial β-hCG value was a predictive parameter for MTX’s effective medical care of ectopic pregnancy. Vaginal bleeding was identified as a risk factor for the success of MTX treatment.

Keywords

• Ectopic pregnancy
• methotrexate
• medical treatment

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