Methotrexate success rates in progressing ectopic pregnancies: a reappraisal

The role of HCG increment in the 48 h prior to methotrexate treatment as a predictor for treatment success

“…The mean HCG percent change prior to methotrexate treatment was significantly higher in the failure group compared to the success group (21% vs. 4% respectively, p < 0.001). Moreover, a subgroup analysis was performed in women that were considered as either "low risk" (HCG level <1000) or "high risk" (HCG level >2500) for treatment failure [7]. Similarly, mean HCG percent change was significantly higher in the failure group, independent of the absolute level of HCG.…”

“…Patients presenting with one of the following conditions were excluded from the study group and referred for immediate surgery: hemodynamic instability, HCG levels >10,000 IU, ectopic pregnancy with cardiac activity, severe abdominal pain or signs of intra-abdominal bleeding. Women who were candidates for medical treatment according to our "watchful waiting protocol" were included in our study [7]. In brief, sequential HCG level follow-ups were used to differentiate spontaneously resolving ectopic pregnancies from progressing ectopic pregnancies.…”

“…Although many factors were proven to correlate with methotrexate treatment outcome, the level of HCG was shown to be the most important predictor for treatment success [6]. The reported success rate of methotrexate treatment in the "single dose protocol" was shown to range between 65 and 96%, based on initial HCG levels [7,8]. Successive HCG level follow up prior to methotrexate treatment was shown to differentiate true progressing ectopic pregnancies from spontaneously resolving ectopic pregnancies [7,9].…”

“…The reported success rate of methotrexate treatment in the "single dose protocol" was shown to range between 65 and 96%, based on initial HCG levels [7,8]. Successive HCG level follow up prior to methotrexate treatment was shown to differentiate true progressing ectopic pregnancies from spontaneously resolving ectopic pregnancies [7,9]. Moreover, sequential HCG level follow up could detect spontaneous resolution of ectopic pregnancies in more than 60% of the women that were primarily candidates for methotrexate treatment [7,9].…”

Some aspects of drug treatment of ectopic pregnancy

“…Медикаментозне лікування трубної вагітності метотрексатом на сучасному етапі є реальною альтернативою ендоскопічній сальпінготомії в пацієнток, які не реалізували свою репродуктивну функцію [6,8]. Основні переваги медикаментозного лікування полягають у відсутності ризику, пов'язаного з оперативним втручанням і загальною анестезією, простоті виконання та нижчій собівартості.…”