Volume 13, Issue 6 (8-2015)                   IJRM 2015, 13(6): 351-354 | Back to browse issues page

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Mirbolouk F, Yousefnezhad A, Ghanbari A. Predicting factors of medical treatment success with single dose methotrexate in tubal ectopic pregnancy: a retrospective study. IJRM. 2015; 13 (6) :351-354
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-657-en.html
1- Department of Obstetrics and Gynecology, Guilan University of Medical Sciences, Rasht, Iran
2- Department of Obstetrics and Gynecology, Guilan University of Medical Sciences, Rasht, Iran , Yousefnezhad59@gmail.com
3- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
Abstract:   (383 Views)
Background: Nowadays, The first step in treatment of ectopic pregnancy (EP) is medical treatment. Medical treatment with methotrexate (MTX) for EP is safe and effective method without the risks associated with the surgical procedure. But there are controversies between studies for which patients will respond better to medical treatment.
Objective: The aim of the present study was to investigate the predictive factors of success or failure of treatment of EP with single dose MTX.
Materials and Methods: In this retrospective study, records of 370 patients who were treated for tubal EP with single dose of MTX were reviewed during four years. Patients were divided into two groups; the first group or “success group” are the patients who were successfully treated with MTX. The second group or “failure group” consist the patients who did not respond to the MTX therapy. The week of gestation, size and location of EP and ß-hCG level were compared between groups.
Results: Of 370 patients, 285 (77.1%) were successfully treated with MTX. 85 patients (22.9%) required surgery after a mean of 5.4 (range 2-15) days. Day-1 beta- human chorionic gonadotropin (ß-hCG) and fall in ß-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial ß-hCG with the success treatment results was found to be 1375 IU/mL there was no statistical difference between groups about week of gestation, size and location of EP.
Conclusion: The results showed that patients who have ß-hCG levels below 1375 and the number of cases with decreasing ß-hCG level on day 4 are the good candidates for medical treatment.
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Type of Study: Original Article |

References
1. Cartwright J, Duncan WC, Critchley HD, Horne AW. Serum biomarkers of tubal ectopic pregnancy: current candidates and future possibilities. Reproduction 2009; 138: 9-22. [DOI:10.1530/REP-09-0060]
2. Thia EH, Loi K, Wang JJ, Siow A. Methotrexate treatment for ectopic pregnancy at the KK Women's and Children's Hospital, Singapore. Singapore Med J 2009; 50: 1058.
3. Vaswani PR. Predictors of success of medical management of ectopic pregnancy in a tertiary care hospital in United Arab Emirates. J Clin Diagn Res 2014; 8: OC04-OC08. [DOI:10.7860/JCDR/2014/8152.4712]
4. Alleyassin A, Khademi A, Aghahosseini M, Safdarian L, Badenoosh B, Hamed EA. Comparison of success rates in the medical management of ectopic pregnancy with single-dose and multiple-dose administration of methotrexate: a prospective, randomized clinical trial. Fertil Steril 2006; 85: 1661-1666. [DOI:10.1016/j.fertnstert.2005.11.055]
5. Bachman EA, Barnhar K. Medical management of ectopic pregnancy: A comparison of regimens.Clin Obstet Gynecol 2012; 55: 440-447. [DOI:10.1097/GRF.0b013e3182510a73]
6. Lipscomb GH, McCord M, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 1999; 341: 1974-1978. [DOI:10.1056/NEJM199912233412604]
7. Medical treatment of ectopic pregnancy: a committee opinion. The practice committee of the American society for reproductive medicine, Birmingham, Alabama. Fertil Steril 2013; 100: 638-644. [DOI:10.1016/j.fertnstert.2013.06.013]
8. Bamhart K, Hummel AC, Sammel MD, Menon S, Jain J, Chakhtoura N. Use of "2-dose" regimen of methotrexate to treat ectopic pregnancy. Fertil Steril 2007; 87: 250-256. [DOI:10.1016/j.fertnstert.2006.06.054]
9. Potter MB, Lepine LA, Jamieson DJ. Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital. Am J Obstet Gynecol 2003; 188: 1192-1194. [DOI:10.1067/mob.2003.310]
10. Ustunyurt E, Duran M, Coskun E, Ustunyurt ÖB, Simşek H. Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single-dose methotrexate treatment in women with tubal ectopic pregnancy. Arch Gynecol Obstet 2013; 288: 1149-1152. [DOI:10.1007/s00404-013-2879-8]
11. Bottin P, Gnisci A, Crochet P, Butzbach P, Cravello L, Gamerre M, Agostini A. Prognostic value of early hCG changes after methotrexate injection for ectopic pregnancy. Gynecol Obstet Fertil 2014; 42: 3-7. [DOI:10.1016/j.gyobfe.2013.08.006]
12. Orozco EM, Sánchez-Durán MA, Bello-Mu-oz JC, Sagalá J, Carreras E, Roura LC. β-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study. J Matern Fetal Neonatal Med 2014; 30: 1-5.
13. Behnamfar F, Yazdani SH, Sakhaee M. Efficacy of single-dose methotrexate in the treatment of ectopic pregnancy: a clinical trial. Tehran Univ Med J 2007; 65: 35-39.
14. Lipscomb GH, Givens VM, Meyer NL, Bran D. Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol 2005; 192: 1844-1848. [DOI:10.1016/j.ajog.2004.12.061]
15. Cohen A, Bibi G, Almog B, Tsafrir Z, Levin I. Second-dose methotrexate in ectopic pregnancies: the role of beta human chorionic gonadotropin. Fertil Steril 2014; 102: 1646-1649. [DOI:10.1016/j.fertnstert.2014.08.019]
16. Nguyen Q, Kapitz M, Downes K, Silva C. Are early human chorionic gonadotropin levels after Methotrexate therapy a predictor of response in ectopic pregnancy? Am J Obstet Gynecol 2010; 202: 630-635. [DOI:10.1016/j.ajog.2010.03.022]
17. Skubisz M, Dutton P, Duncan WC, Horne AW, Tong S. Using a decline in serum hCG between days 0-4 to predict ectopic pregnancy treatment success after single dose methotrexate retrospective cohort study. BMC Pregnancy Childbirth 2013, 13: 30. [DOI:10.1186/1471-2393-13-30]
18. Markwitz EN, Michalak M, Olejnik M, Spaczynski M. Cutoff value of human chorionic gonadotropin in relation to the number of methotrexate cycles in the successful treatment of ectopic pregnancy. Fertil Steril 2009; 92: 1203-1207. [DOI:10.1016/j.fertnstert.2008.07.1775]
19. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol 2003; 101: 778-784. [DOI:10.1097/00006250-200304000-00028]

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