Cut-off value of initial serum β-hCG level predicting a successful MTX therapy in tubal ectopic pregnancy: a retrospective cohort study

Helmy, S.; Bader, Yvonne; Pablik, Eleonore; Tiringer, Denise; Pils, Sophie; Laml, Thomas; Kölbl, H.; Koch, Marianne

doi:10.1016/j.ejogrb.2014.05.033

Cited by 21 publications

(21 citation statements)

References 21 publications

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“…Methotrexate treatment for ectopic pregnancy is a medical alternative to surgery and has become the mainstay of therapy for properly selected women. The present study showed a success rate of 63.8% for single‐dose methotrexate injection, which is similar to previously reported success rates …”

Section: Discussionsupporting

confidence: 92%

“…The decision on the modality of treatment is a complex one and involves a consideration of future fertility, surgical risk, success rates of the different treatment options, and factors associated with the current gestation . It is important to reduce the failure rate of methotrexate treatment; thus, efforts have been made to evaluate potential predictors of treatment success.…”

Section: Introductionmentioning

confidence: 99%

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Predicting success of methotrexate treatment by pretreatment HCG level and 24‐hour HCG increment

Saleh

Haj-Yahya

Matan

et al. 2017

Intl J Gynecology & Obste

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Predicting success of methotrexate treatment by pretreatment HCG level and 24‐hour HCG increment

Saleh

Haj-Yahya

Matan

et al. 2017

Intl J Gynecology & Obste

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“…[13] suggested a more precise cut‐off value and reported a higher failure rate at > 1790 mIU/mL, while Helmy et al. [14] reported a cut‐off value of 2121 mIU/mL. Natale et al.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Menon et al [12] reviewed the results of 500 patients in five studies and reported a cut-off value of 5000 mIU/mL, and suggested that medical treatment administered to patients with higher values was more likely to be associated with treatment failure. Nowak-Markwitz et al [13] suggested a more precise cut-off value and reported a higher failure rate at > 1790 mIU/mL, while Helmy et al [14] reported a cut-off value of 2121 mIU/mL. Natale et al [15] suggested that changes in b-hCG levels reflected differences in folinic acid metabolism across individuals.…”

Section: Discussionmentioning

confidence: 99%

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

Doğan

Gülhan

Uyar

et al. 2016

The Kaohsiung J of Med Scie

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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.

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“…La dosis única de metotrexato no ha mostrado diferencias en tasas de éxito respecto a la dosis múltiple, pero sí se asocia a menor frecuencia de efectos adversos y una menor necesidad de controles (13)(14)(15)(16)(17).…”

Section: Introductionunclassified

Tratamiento médico del embarazo ectópico no complicado; experiencia del hospital regional de talca

Q²,

et al. 2017

Rev. chil. obstet. ginecol.

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Tratamiento médico del embarazo ectópico no complicado; experiencia del hospital regional de talca 46 RESUMENEl tratamiento médico del embarazo ectópico (EE) no complicado es una alternativa para el manejo de esta patología. Existen distintos criterios para su uso y las tasas de éxito publicadas son variadas.Realizamos una revisión de 34 casos de pacientes con diagnóstico de EE no complicado en el Hospital Regional de Talca, reportándose una tasa de éxito con dosis única de metotrexato de 65%. Un 20,5% de las pacientes requirieron una dosis adicional de metotrexato. La tasa total de éxito con tratamiento médico alcanzó un 73.5%.El manejo médico es una alternativa efectiva a la cirugía en pacientes bien seleccionadas. Se debe evaluar de manera local los criterios de inclusión para el tratamiento médico del EE no complicado.PALABRAS CLAVES: Embarazo ectópico, tratamiento médico, metotrexato. ABSTRACTMedical treatment of non complicated ectopic pregnancy is an alternative for the management of this pathology. There are different criteria for it's use, and published success rates are heterogeneous.We reviewed 34 cases of patients with diagnosis of no complicated ectopic pregnancy in Hospital Regional de Talca, and we reported a success rate of 65% with a single dose of methotrexate. 20,5% of patients needed an additional dose of medication. The global success rate of medical treatment was 73,5%.No surgical management is an effective alternative for well-selected patients. The criteria for medical treatment of no complicated EE must be evaluated locally.

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Cut-off value of initial serum β-hCG level predicting a successful MTX therapy in tubal ectopic pregnancy: a retrospective cohort study

Cited by 21 publications

References 21 publications

Predicting success of methotrexate treatment by pretreatment HCG level and 24‐hour HCG increment

Predicting success of methotrexate treatment by pretreatment HCG level and 24‐hour HCG increment

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

Tratamiento médico del embarazo ectópico no complicado; experiencia del hospital regional de talca

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