Human chorionic gonadotropin value and its change prior to methotrexate treatment can predict the prognosis in ectopic tubal pregnancies

Abstract

PurposeTo investigate the role of beta‐human chorionic gonadotropin (HCG) level and its change prior to methotrexate (MTX) treatment as predictors of treatment success and to access the posttreatment observation period for ectopic tubal pregnancy.MethodsClinical data of 41 females treated with MTX for tubal pregnancies were reviewed and analyzed retrospectively.ResultsAmong 41 patients, 34 achieved complete resolution without surgery. No statistically significant difference was observed in the presence of hemorrhagic ascites, serum progesterone levels, or diameters of adnexal mass between the MTX success and failure groups. Serum HCG levels on the day of MTX administration (day 1) were significantly lower in the MTX success group. Moreover, % HCG change per day, which represents the increment ratio of HCG prior to MTX treatment, was significantly lower in the MTX success group. Receiver operating characteristic (ROC) curves demonstrated that the treatment success was predicted by % HCG change per day less than +12.6% per day with a sensitivity of 87% and a specificity of 71%. The duration from treatment to complete recovery was strongly correlated with day 1 HCG levels.ConclusionsPretreatment HCG change is a significant predictor of therapeutic success of MTX treatment, and the treatment period may be predicted from initial HCG levels.

Predictive value of serum βHCG level in ectopic pregnancy: A cross sectional study

“…In a study conducted by Watanabe et al, 18 ROC analysis showed that prediction of a successful treatment was possible with daily ßHCG changes of <+12.6 with 87% sensivity and 71% specificity and the time interval between the start and the end of treatment was related with first day ßHCG 18 …”

“…increased the success rate (p < 0.07). 17 In a study conducted by Watanabe et al, 18 ROC analysis showed that prediction of a successful treatment was possible with daily ßHCG changes of <+12.6 with 87% sensivity and 71% specificity and the time interval between the start and the end of treatment was related with first day ßHCG. 18 In Cohen et al's 19 study, the success rate with SD MTX treatment was 75% and the mean changes of ßHCG within 48 h before the start of treatment was significant, moreover a less than 12% increase in ßHCG levels within 48 h before the treatment was a good predictor factor for successful treatment.…”

Daily variations and levels of human chorionic gonadotropin before methotrexate treatment as predictors of treatment success

“…However, in the real world, continuous monitoring of serum hCG cannot be performed for most patients. In a study with a sample size of 41 patients, Watanabe et al found that the treatment success was predicted by % HCG change per day <+12.6% per day 22 . Therefore, we applied the concept of serum hCG daily variation to express the serum hCG trend.…”

“…In a study with a sample size of 41 patients, Watanabe et al found that the treatment success was predicted by % HCG change per day <+12.6% per day. 22 Therefore, we applied the concept of serum hCG daily variation to express the serum hCG trend. It was found that MTX success was significantly higher in patients with a daily variation in serum hCG <1.76%/day.…”