ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study

Orozco, Esteban Mauricio; Sánchez‐Durán, María Ángeles; Bello-Muñoz, J.; Sagalá, Juan; Carreras, Elena; Cabero, L.

doi:10.3109/14767058.2014.928857

Cited by 15 publications

(17 citation statements)

References 18 publications

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“…The number of cases died from disturbed ectopic pregnancy has been decreased, but it still forms about 6% of all maternal fatality [3]. Early diagnosis of ectopic pregnancy allowed a better medical treatment and in addition to liability of avoiding surgery in some cases [4,5]. Using Methotrexate (MTX) as an option for medical treatment of ectopic pregnancies has been suggested by Tanaka et al, since 1982 [6].…”

Section: Introductionmentioning

confidence: 99%

Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Lashin

Alabiad

Abdelsalam

2020

Zagazig University Medical Journal

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Background: Using Methotrexate as an option for medical treatment of ectopic pregnancies has been suggested since 1982. Studies regarding the dose, number of doses of methotrexate and the predictive factors of degree of success of methotrexate in the medical management of ectopic pregnancy are limited. Aim of the present article were; to assess the predictive factors of success and efficacy of methotrexate therapy and to assess the value and efficacy of using lower dose of methotrexate and the suitable number of doses for medical management of ectopic pregnancy. Methods: we included 100 patients with ectopic tubal pregnancy that were given Methotrexate dosage 1 mg/kg which was injected intramuscular. After the first injection we asked the patients to return on the 4 th day then on the 7 th day to test the levels of hCG. In case of reduction of the level of β-hCG less than 15% on 4 th and 7 th days, patients were given the second methotrexate dose of 1 mg/kg which was also injected intramuscular. We followed patients until achieving β-hCG target level (<15 mIU/mL) then completely negative values. We assessed rates and predictive factors for success or failure of methotrexate therapy. Results: of the included 100 patients, 15 patients needed surgical management at the end of treatment, with a success rate of medical Methotrexate therapy of 85%.The pretreatment predictive factors of failure of medical treatment are; presence of a pretreatment adnexal mass (p= 0.040), presence of pain (p= 0.039), metrorrhagia (p= 0.023), or hemoperitoneum (p= 0.002). Base line pretreatment hCG levels was the most important predictive factor of therapy success (p= 0.002). Conclusions: methotrexate in a single dose or two doses could effectively treat ectopic pregnancy with fewer side effects providing that base line hCG level < 5000 IU/L in hemodynamically stable young patients with no liver or kidney problems with a higher success rate.

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Section: Introductionmentioning

confidence: 99%

Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Lashin

Alabiad

Abdelsalam

2020

Zagazig University Medical Journal

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“…[7][8][9][10][11] These studies vary widely in-patient selection and cut offs for HCG values (10,000 or more) and dose protocols (single dose versus multidose). Present study had more strict criteria for patient selection compared to these studies, which may have contributed to better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Success of medical management of tubal ectopic pregnancy with Methotrexate in a tertiary hospital in North India

Juneja

Jain

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Unruptured ectopic pregnancy can be managed with surgery as well as systemic methotrexate. We aimed to study efficacy of medical management and factors affecting success in strictly selected patients.Methods: It was a three-year prospective observational study. 171 patients with ectopic pregnancy were screened and those fulfilling the strict study criteria were given systemic methotrexate. The single dose regimen was followed. Patients were observed for side effects and signs of rupture. Serial measurement of HCG levels was done to determine success or failure. Various factors were studied which had potential bearing on results.Results: Thirty-one patients received methotrexate. We had an overall success rate of 93%. Two of the participants had surgery due to failure. No major side effects were observed.Conclusions: Carefully selected patients of unruptured ectopic pregnancy can be safely and successfully treated with systemic methotrexate.

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“…In the literature, various serum hCG cutoff values have been reported, mostly from single-dose regimen ( Table 5 ) [ 11 12 13 14 17 18 19 20 21 ]. In most of studies, inclusion criteria set by pretreatment serum hCG level or characteristics of enrolled patients were quite different, thus caution is needed for its interpretation.…”

Section: Discussionmentioning

confidence: 99%

“…In most of studies, inclusion criteria set by pretreatment serum hCG level or characteristics of enrolled patients were quite different, thus caution is needed for its interpretation. For example, only patients with hCG levels under 5,000 IU/L were included in two studies [ 13 14 ]. In the study by Wu et al [ 12 ], relatively lower cutoff value was suggested possibly because they included PUL.…”

Section: Discussionmentioning

confidence: 99%

“…High pretreatment serum hCG level has been known to be the most important predictor associated with medical treatment failure [ 2 4 10 11 12 13 14 ]. In a review of 503 women with tubal pregnancy treated with a single-dose of methotrexate, failure rate in patients with serum hCG <5,000 IU/L was <4%, whilst the failure rate in patients with serum hCG 5,000 to 9,999 and ≥10,000 IU/L were 14% and 18%, respectively [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Pretreatment serum human chorionic gonadotropin cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy

et al. 2017

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ObjectiveTo investigate individual pretreatment serum human chorionic gonadotropin (hCG) cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy.MethodsEighty-five women who received methotrexate for the treatment of tubal ectopic pregnancy during 2003 to 2015 were selected. Fifty-three women received a single-dose regimen and 32 women received a multi-dose regimen. Medical treatment failure was defined as necessity of surgical treatment. The medical treatment success rate was estimated in both regimens and the pretreatment serum hCG titer to predict the success was assessed by receiver operating characteristics curve analysis.ResultsPretreatment clinical and laboratory parameters were similar between group of single-dose regimen and multi-dose regimen. Treatment success rate was 64.2% in the single-dose regimen group and 71.9% in the multi-dose regimen group (P>0.05). Pretreatment serum hCG titer was an independent prognostic factor for treatment success in each regimen. Serum hCG cutoff value to predict the treatment success was 3,026 IU/L in single-dose regimen group and 3,711 IU/L in multi-dose regimen group.ConclusionWe recommend use of single-dose regimen when pretreatment serum hCG <3,026 IU/L but multi-dose regimen may be favored when initial serum hCG level between 3,026 and 3,711 IU/L.

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ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study

Abstract: ß-hCG cutoff values have a potential for predicting a successful medical treatment of TEP.

Cited by 15 publications

References 18 publications

Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Success of medical management of tubal ectopic pregnancy with Methotrexate in a tertiary hospital in North India

Pretreatment serum human chorionic gonadotropin cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy

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