The evaluation of success and failure of methotrexate treatment in ectopic pregnancy

Year 2022, Volume: 4 Issue: 4, 449 - 454, 22.10.2022

Asena Ayar Madenli , Halime Çalı Öztürk

https://doi.org/10.38053/acmj.1179420

Cited By: 1

Abstract

Aim: Regardless of medical advancements, ectopic pregnancy (EP) is still an essential factor in the mortality rate of women of reproductive age. The main aim of this study was to determine predictive factors associated with the success of the response to treatment with single-dose and two-dose methotrexate (MTX) regimens in women with tubal EP.
Material and Method: This retrospective study examined the electronic records of 130 patients who underwent treatment due to EP were included in the study. The patients were divided into two groups: the successful MTX treatment group (n: 85) as the case group and the failure of MTX treatment group (n: 45) as the control group.
Results: Age-matched (30.62±4.36) and body mass index (BMI)-matched (24.37±2.29) patients diagnosed with EP were treated with MTX. The mean beta-human chorionic gonadotropin (β-hCG) value on the first day of treatment was 1639.84±524.96 mIU/mL in the successful and 5866.76±1875.51 mIU/mL in the unsuccessful group. 85 of 130 (65%) were successfully treated with MTX. Five of 45 (35%) failed medical treatment and required laparoscopic surgery. The longest ectopic mass diameter was significantly higher in the failure of MTX treatment group (p<0.05). There was a statistically significant difference between groups in regard to the β-hCG values on days 1, 4, 7, and 14. The β-hCG values on the first day were significantly higher in the failure of MTX treatment group(p <0.05). There was no statistically significant difference between a single-dose regimen and multi-dose treatments. 
Conclusion: We found that an initial β-hCG value was a predictive parameter for MTX’s effective medical care of ectopic pregnancy. Vaginal bleeding was identified as a risk factor for the success of MTX treatment.

Keywords

Ectopic pregnancy, methotrexate, medical treatment

References

• Gerema U, Alemayehu T, Chane G, Desta D, Diriba A. Determinants of ectopic pregnancy among pregnant women attending referral hospitals in southwestern part of Oromia regional state, Southwest Ethiopia: a multi-center case control study. BMC Pregnancy Childbirth 2021; 21: 130.
• Guo Q, Li Z, Jia S, Tong F, Ma L. Mechanism of Human Tubal Ectopic Pregnancy Caused by Cigarette Smoking. Reprod Sci 2022; 2-8.
• Dokuzeylul Gungor N, Gurbuz T, Ture T. Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through in vitro fertilization. An Bras Dermatol 2021; 96: 171-5.
• 4.Rombauts L, McMaster R, Motteram C, Fernando S. Risk of ectopic pregnancy is linked to endometrial thickness in a retrospective cohort study of 8120 assisted reproduction technology cycles. Hum Reprod 2015; 30: 2846-52.
• Olooto WE, Amballi AA, Banjo TA. A review of Female Infertility; important etiological factors and management. J Microbiol Biotech Res 2012; 2: 379-85.
• Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS. Williams obstetrics, 24e: Mcgraw-hill New York, NY, USA; 2014.
• Güngör Nd, Gürbüz T, Yurci A. Hysteroscopic Evaluation of Chronic Endometritis Incidence in Unexplained Infertile Women with Recurrent Implantation Failure: Six Years Experience. Ahi Evran Med J 2021; 6: 64-70.
• Kaya C, Aslan Ö, Gürsoy B. Laparoscopic management of a broad ligament ectopic pregnancy with a literature review. J Obstet Gynaecol 2022; 42: 710-2.
• Bangsgaard N, Lund CO, Ottesen B, Nilas L. Improved fertility following conservative surgical treatment of ectopic pregnancy. BJOG 2003; 110: 765-70.
• Panchal D, Vaishnav G, Solanki K. Study of management in patient with ectopic pregnancy. Infection 2011; 33: 55.
• Yeasmin MS, Uddin MJ, Hasan E. A clinical study of ectopic pregnancies in a tertiary care hospital of Chittagong, Bangladesh. Chattagram Maa-O-Shishu Hospital Medical College J 2014; 13: 1-4.
• C Chemerinski A, Lubin D, Holder S, Shah D. Appendiceal Endometriosis and Ectopic Pregnancy Occurring Simultaneously. Obstet Gynecol 2018; 131: 572-4.
• Mummert T, Gnugnoli DM. Ectopic pregnancy. StatPearls [Internet], 2022.
• Karaman O, Yaralı ZB. Determination of minimum serum concentration to develop scaffold free micro-tissue. EuRJ 2018; 4: 145-51.
• Madoue G, Lhagadang F, Daniel D, Abdelsalam S. Diagnose and management of ectopic complete molar pregnancy. J Med Sci 2018; 38: 85.
• Mausner Geffen E, Slywotzky C, Bennett G. Pitfalls and tips in the diagnosis of ectopic pregnancy. Abdom Radiol (NY) 2017; 42: 1524-42.
• Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 2013; 100: 638-44.
• Mol F, Mol BW, Ankum WM, van der Veen F, Hajenius PJ. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod Update 2008; 14: 309-19.
• Tanaka K, Baartz D, Khoo SK. Management of interstitial ectopic pregnancy with intravenous methotrexate: An extended study of a standardised regimen. Aust N Z J Obstet Gynaecol 2015; 55: 176-80.
• Erdem M, Erdem A, Arslan M, Oç A, Biberoğlu K, Gürsoy R. Single-dose methotrexate for the treatment of unruptured ectopic pregnancy. Arch Gynecol Obstet 2004; 270: 201-4.
• Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009; 41: 1149-60.
• Davenport MJ, Lindquist A, Brownfoot F, Pritchard N, Tong S, Hastie R. Time to resolution of tubal ectopic pregnancy following methotrexate treatment: A retrospective cohort study. PLoS One 2022; 17: e0268741.
• Bonin L, Pedreiro C, Moret S, Chene G, Gaucherand P, Lamblin G. Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases. Eur J Obstet Gynecol Reprod Biol 2017; 208: 23-30.
• 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: 1844-7.
• Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG 2001; 108: 192-203.
• Lim JE, Kim T, Lee NW, et al. Ultrasonographic endometrial features in tubal pregnancy: are they predictive factors of successful medical treatment? Ultrasound Med Biol 2007; 33: 714-9.
• Lipscomb GH, Givens VA, Meyer NL, Bran D. Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy. Fertil Steril 2004; 81: 1221-4.
• Grigoriu C, Bohiltea RE, Mihai BM, et al. Success rate of methotrexate in the conservative treatment of tubal ectopic pregnancies. Exp Ther Med 2022; 23: 150.
• 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: 1974-8.
• Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril 2007; 87: 481-4.