Tubal Ectopic Pregnancy: Effect of ß-hCG Change in Treatment

Abstract

Objective: To evaluate the effect of β-hCG of treating prediction in tubal ectopic pregnancies (TEP). Materials and Methods: 758 patients receiving only one dose of methotrexate (mtx) treatment protocol for CAP were included in the study between January 2009 and December 2017. Patients' age, gravity, parity, ultrasonography findings, β-hCG values, and factors that may affect treatming process were recorded. Results: It was determined that medical treatment success was predicted with 77%, 81% sensitivity and 61% and 68% specificity when the initial β-hCG value was 1435 mIU / mL and the β-hCG level on the 4th day was 1539 mIU / mL cut off value. In our study, when β-hCG values decreased by 7% between 0-4 days were taken as cut off value, medical treatment with 84% sensitivity and 77% specificity was shown to be successful. The mean β-hCG levels on the 4th and 7th days were significantly lower in the medical treatment group than in the unsuccessful group. Conclusion: We found that patients with lower β-hCG values at baseline and day 4 had higher chances of success, and when cut off values were taken as 1435 mIU / mL and 1539 mIU / mL, success rate was significantly decreased. According to β-hCG level on day 0, day 4, and β-hCG change level between 0-4 days, we think ectopic pregnancy approach will decrease the unnecessary hospital stay.

The importance of β-hCG values in prediction of the effectiveness of single dose methotrexate therapy in tubal ectopic pregnancy

“…Nowak-Markwitz et al (68 cases), it was shown that the chance of success is higher in patients with lower initial β-hCG values, and when the cut off value is taken as 1790 mIU/mL, the success rate in the treatment of ectopic pregnancy with MTX [17]. In another study involving 758 patients, the cut-off value of β-hCG was found to be 1435 to predict MTX success [3]. In addition, another study conducted (2016) emphasized that a single level of β-hCG is not diagnostic for ectopic pregnancy and that serial levels may show atypical trends in some cases [7].…”

“…There are many studies indicating that the higher the pre-treatment β-hCG level, the lower the success rate [14][15][16][17]. In Menon et al 's review (503 patients treated with MTX), there was a significant and statistically significant increase in failure rates in patients with baseline β-hCG level > 5,000 mIU/mL compared to < 5,000 mIU/mL [3,14].…”

“…An ectopic pregnancy is an implanted pregnancy outside of the uterine cavity, and most occurs in the fallopian tube (96%) [1]. Ectopic pregnancies, whose incidence has increased in recent years, are still one of the most important causes of maternal mortality and morbidity in the first trimester [2,3].…”