Outcome prediction of methotrexate treatment in ectopic pregnancies

AIM: To analyze the predictors of success in a novel methotrexate( MTX) protocol of ectopic pregnancies( EPs) and create a cutoff of pretreatment human chorionic gonadotropin( h CG)in the successful MTX treatment of EPs. METHODS: A group of 31 hemodynamicaly stable women,absence of yolk sac and fetal cardiac activity on transvaginal ultrasonography,no desire for surgical treatment,and with no hepatic,hematologic or renal disease,was electively treated with the MTX protocol( overall intramuscular dosage of 1 mg / kg divided to 3 doses at 48-hour intervals given as a course). The diagnosis of EP was made by a nonlaparoscopically algorithm. The size and the volume of the gestational mass,presence of previous EP,total MTX dosage that patients actually accepted and the pretreatment serum h CG levels were accessed,and their prognostic value for primary outcome of MTX treatment of EPs was investigated. RESULTS: 24 cases( 77. 4%) were successfully cured. In these cases,the log-transformed serum h CG levels before MTX administration were lower compared with the levels found in cases of therapeutic failure( 2. 75 ± 0. 38 vs. 3. 14 ± 0. 33,respectively; P = 0. 022). The receiver operating characteristic( ROC) curve analysis showed that a pretreatment serum h CG concentration≤1 603 m IU / m L was a factor indicative of therapeutic success with sensitivity of 87. 5% and specificity of 57. 1%. Logistic regression analysis revealed the initial serum h CG concentration to be the only factor that contributed to the success rate( P = 0. 036). CONCLUSION: In the protocol,the pretreatment serum concentration of h CG is an important prognostic factor associated with MTX success therapy of EP. When the pretreatment h CG level is 1 603 m IU / m L,the MTX treatment of EP is at risk of failure.