J Korean Med Sci.  2006 Feb;21(1):86-89. 10.3346/jkms.2006.21.1.86.

Predictors of Success of Repeated Injections of Single-dose Methotrexate Regimen for Tubal Ectopic Pregnancy

• Cho GJ
• Lee SH
• Shin JW
• Lee NW
• Kim T
• Kim HJ
• Lee KW

• KMID: 2157788
• DOI: http://doi.org/10.3346/jkms.2006.21.1.86

Abstract

The purpose of this study is to evaluate predictors of success of repeated injections of methotrexate in the single-dose regimen for the treatment of tubal ectopic pregnancy. All patients who had ectopic tubal pregnancy and were treated with a single dose regimen were retrospectively identified. 126 patients were treated with methotrexate. Among them, 39 patients were adequate for this study. 33 were treated with the 2nd dose and 27 were successfully cured. Additionally, 6 who were injected with the 3rd dose were all cured as well. Therefore, in our study, the success rate for the repeated injections of methotrexate was found to be 84.6% (33/39). The mean initial beta-hCG level was significantly lower in patients who were successfully treated than in patients who failed (3915.3+/-3281.3 vs. 8379.7+/-2604.4 IU/mL, p<0.05). The success rate is 96% when the beta-hCG level is less than 6,000 IU/mL and is 58% when beta-hCG is greater than 6,000 IU/mL (OR=18.57, 95% CI 1.86-185.89). The initial beta-hCG level is the only factor that has significant meaning as predictor of success of repeated injections of methotrexate in the single-dose regimen. Repeated injections of methotrexate may be particularly effective when the initial beta-hCG level is below 6,000 IU/mL.

Keyword

Pregnancy, Ectopic; Methotrexate; Single-dose Regimen; Repeated Injections

MeSH Terms

Abortifacient Agents, Nonsteroidal/administration & dosage/therapeutic use
Chorionic Gonadotropin, beta Subunit, Human/blood
Female
Humans
Injections
Methotrexate/administration & dosage/*therapeutic use
Predictive Value of Tests
Pregnancy
Pregnancy, Tubal/blood/*drug therapy
Retrospective Studies
Time Factors
Treatment Outcome

Figure

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  Fig. 1 Outcome of ectopic pregnancy patients treated with MTX.

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  Fig. 2 β-hCG value profiles in groups 1-a, 1-b, 2.

Reference

1. Ory SJ, Villanueva AL, Sand PK, Tamura RK. Conservative treatment of ectopic pregnancy with methotrexate. Am J Obstet Gynecol. 1986. 154:1299–1306.

2. Sauer MV, Gorrill MJ, Rodi IA, Yeko TR, Greenberg LH, Bustillo M, Gunning JE, Buster JE. Nonsurgical management of unruptured ectopic pregnancy: an extended clinical trial. Fertil Steril. 1987. 48:752–755.

3. Glock JL, Johnson JV, Brumsted JR. Efficacy and safety of single dose systemic methotrexate in the treatment of ectopic pregnancy. Fertil Steril. 1994. 62:716–721.

4. Stovall TG, Ling FW, Gray LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol. 1991. 77:754–757.

5. Stika CS, Anderson L, Frederiksen MC. Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience. Am J Obstet Gynecol. 1996. 174:1840–1848.

6. Lipscomb GH, Bran D, McCord ML, Portera JC, Ling FW. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol. 1998. 178:1354–1358.

7. Stovall TG, Ling FW. Single-dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol. 1993. 168:1759–1762.

8. 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.

9. Lipscomb GH, McCord ML, 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.

10. Tawfiq A, Agameya AF, Claman P. Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate. Fertil Steril. 2000. 74:877–880.

11. Erdem M, Erdem A, Arslan M, Oc A, Biberoglu K, Gursoy R. Single-dose methotrexate for the treatment of unruptured ectopic pregnancy. Arch Gynecol Obstet. 2004. 270:201–204.

12. Groutz A, Luxman D, Cohen JR, David MP. Rising beta-hCG titers following laparoscopic injection of methotrexate into unruptured, viable tubal pregnancies. Br J Obstet Gynaecol. 1993. 100:287–288.

13. Saraj AJ, Wilcox JG, Najmbadi S, Stein SM, Johnson MB, Paulson RJ. Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular methotrexate with salpingostomy. Obstet Gynecol. 1998. 92:989–994.

14. Natale A, Busacca M, Candiani M, Gruft L, Izzo S, Felicetta I, Vignali M. Human chorionic gonadotropin patterns after a single dose of methotrexate for ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2002. 100:227–230.

15. Natale A, Candiani M, Barbieri M, Calia C, Odorizzi MP, Busacca M. Pre- and post-treatment patterns of human chorionic gonadotropin for early detection of persistence after a single dose of methotrexate for ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2004. 117:87–92.

16. DeLoia JA, Stewart-Akers AM, Creinin MD. Effects of methotrexate on trophoblast proliferation and local immune responses. Hum Reprod. 1998. 13:1063–1069.

17. Hajenius PJ, Voigt RR, Engelsbel S, Mol BW, Hemrika DJ, Van der Veen F. Serum human chorionic gonadotropin clearance curves in patients with interstitial pregnancy treated with systemic methotrexate. Fertil Steril. 1996. 66:723–728.

18. Gamzu R, Almog B, Levin Y, Pauzner D, Lessing JB, Jaffa A, Bar-Am A. The ultrasonographic appearance of tubal pregnancy in patients treated with methotrexate. Hum Reprod. 2002. 17:2585–2587.