Hematological Factors for Predicting Methotrexate Efficacy in Tubal Ectopic Pregnancy: A Retrospective Study

Abstract

Background: Methotrexate (MTX) has emerged as the primary treatment for ectopic pregnancies (EPs), replacing conventional surgical methods. Despite uncertainties regarding its exact mechanism, MTX is thought to induce resorption or tubal abortion of the conceptus. This study aims to identify hematological factors that may predict successful outcomes of MTX in the management of ectopic pregnancy (EP). Methods: In this retrospective cross-sectional study, records of 100 patients diagnosed with tubal EP and treated at the Department of Obstetrics and Gynecology, Health Sciences University Konya City Hospital, between February 2010 and November 2023, were analyzed. Inclusion criteria involved specific conditions for tubal EP diagnosis, along with the administration of a single-dose intramuscular (IM) MTX. Exclusions encompassed other types of EP additional medical conditions, and individuals with smoking habits. Hematological parameters and ratios, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), eosinophil-monocyte ratio (EMR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII), were calculated. Results: Descriptive information revealed significant differences between MTX-effective and MTX-ineffective groups in ectopic focus status, number of pregnancies, number of miscarriages, and β-human chorionic gonadotropin (β-hCG) levels on days 1, 4, and 7 after the IM MTX single-dose. However, hematological parameters did not significantly differ based on MTX effectiveness. NLR (p = 0.9611), PLR (p = 0.815), EMR (p = 0.8101), MLR (p = 0.361), and SIRI (p = 0.6811) values did not show a significant difference between MTX effectiveness and ineffectiveness. Conclusions: The study suggests that hematological markers such as NLR, PLR, EMR, MLR, SIRI, and SII may not effectively predictors of MTX efficacy in tubal EP. Limited by a retrospective design and a small sample size, larger-scale studies are crucial for obtaining comprehensive insights and developing reliable predictive tools in clinical contexts.