Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Abstract

Objective: To evaluate percentage changes in serum beta-human chorionic gonadotropin (β-hCG) values between days 0-1, 0-4 and 0-7 as an indicator of methotrexate therapy success in extra-uterine pregnancies. Material and Methods:Women with ectopic pregnancy treated with single-dose methotrexate therapy between January 2011 and August 2012 were assessed. Recorded data were reviewed electronically from patient files. All women (n=93) with an ectopic pregnancy treated medically with intramuscular methotrexate (50 mg/m 2 ) were included. The percentage changes in serum β-hCG levels from day 0 to 1, day 0 to 4 and day 0 to 7 were calculated for each case. Results:The median β-hCG values decreased between days 0 and 4 by 55.8%, and 89.6% of these cases were treatment successes. The median initial serum β-hCG values were lower in women with successful treatment, but this was not statistically significant (p=0.11). Conclusion:A decline in serum β-hCG values between days 0 and 4 appears to be the best predictor. It would be beneficial to determine whether a woman with an ectopic pregnancy treated with singledose methotrexate administration will be treated successfully. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Key words: Ectopic pregnancy, human chorionic gonadotrophin, methotrexate.Received: 8 April, 2013 Accepted: 26 May, 2013 Amaç: Ektopik gebeliklerin tedavisinde methotraksat tedavisinin başarısını belirlemede beta-human koryonik gonadotropin (β-hCG) değerlerinin 0-1, 0-4 ve 0-7 günleri arasında yüzde değişimlerini değerlendirmek. Gereç ve Yöntemler:Ocak 2011 ile Agustos 2012 tarihleri arasında ektopik gebelik nedeniyle tanı alan ve tek doz metotreksat tedavisi alan 93 olgu çalışmaya dahil edildi. Elektronik ortamda kaydelilen hastaların dosyalarında bulunan tüm bilgiler incelendi. 0-1, 0-4 ve 0-7 günler arasındaki serum β-hCG seviyelerindeki değişim yüzdeleri her olgu için hesaplandı. Bulgular:Metotreksat tedavisinin başarılı olan olguların %55.8 ve %89.6'da ortanca β-hCG değerleri 0 ve 4. günler arasında azalmış olarak bulundu. Tedavi öncesindeki ortanca β-hCG seviyesi tedavinin başarılı olduğu olgularda daha düşük saptanmasına rağmen iki grup arasında istatistiksel olarak bir fark saptanmadı (p=0.11).Sonuç: Serum β-hCG değerlerindeki 0 ile 4. günler arasındaki düşme olması metoteksat tedavisinin başarısını tahmininde en iyi gösterge olarak ortaya çıkmaktadır, ve tek doz metotreksat ile tedavi edilen ektopik gebeliklerin nihai tedavinin başarısını belirlemek yararlı olacaktır. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Abstract Özet tion of MTX treatment success. The serum β-hCG level before MTX administration has been reported as a particular factor contributing significantly to treatment failure (8). Previously, it has been found that at least a 15% reduction in the β-hCG concentration on the seventh day compared to the fourth day after MTX administration is the best predictor of treatment success, with a positive predictive value of approximately 93.0% (9). A rise in the β-hCG titer on t...

How important is serum beta-hCG in the management of ectopic pregnancy?

“…They found that 20% decline was associated with a very high chance of subsequent treatment success, with positive predictive value as high as 97%. 8 However in the present study the mean decline of serum β-hCG more than or equal to 30% was found to have successful outcome. Our study mostly confirms the results of previous studies who reported treatment success of 88-100% in those women with early decline in serum β-hCG between days 0 to 4, however our study had success of 75% this difference in the result may be due to small sample size analyzed.…”

“…2,7 A study by Celik et al 8 evaluated the use of percentage decline of serum β-hCG between days 1 to 4 following administration of methotrexate as an indicator of treatment success. They found that 20% decline was associated with a very high chance of subsequent treatment success, with positive predictive value as high as 97%.…”

“…Our study mostly confirms the results of previous studies who reported treatment success of 88-100% in those women with early decline in serum β-hCG between days 0 to 4, however our study had success of 75% this difference in the result may be due to small sample size analyzed. 8,9 It is important to monitor serial β-hCG values subsequent to methotrexate administration until complete resolution of the ectopic. In the present study we found that very high initial serum β-hCG value of >10000 mIU/ml predicts the site of ectopic pregnancy.…”

Methotrexate treatment in progressive tubal ectopic pregnancies and hCG‐related clinicosurgical implications

“…Similarly, Ustunyurt et al [17] reported that a 22% decrease in b-hCG level predicted treatment success. Celik et al [18] studied 93 patients and reported a 4.94-fold increase in treatment failure associated with at least a 9.08% decrease in b-hCG levels from Day 1 to Day 4. Following methotrexate administration, a slight increase in b-hCG levels is usually expected in the first few days [18].…”

Identifying prognostic factors which affect the success of ectopic pregnancy treatment with a single dose methotrexate

“…Yüksek serum ß-hCG düzeyleri daha önceki iki çalışmada bizimkine benzer tarzda tek etkili prognostik faktör olarak tespit edilirken (6,19) , Kimiaei ve ark. tarafından yapılan çalışmada tek doz metotreksat tedavisinin etkinliğini belirlemede başlangıç ß-hCG değerlerine ek olarak ektopik odak büyüklüğü de önemli olarak tespit edilmiştir (20) bazı çalışmalarda başlangıç ß-hCG değeri yüksekliğine ek olarak başlangıç ve metotreksat sonrası dördüncü gün ß-hCG değerlerindeki düşme düzeyi başarıyı tahminde en önemli gösterge olduğu belirtilmiştir (21,22) . Ayrıca Mungan ve ark.…”