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Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate
J Elito1, A P Reichmann, M N Uchiyama
1Department of Obstetrics, Federal University of São Paulo, Brazil.
Objective:
To evaluate the efficacy of a predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate in order to select the best cases for the medical treatment.
Method:
Our study included 40 patients. The inclusion criteria were: hemodynamic stability; adnexal mass < or = 3.5 cm; desire of future pregnancy; and a written permission to participate in the study. All patients were treated with a single dose of methotrexate (50 mg/m2 i.m.). A predictive score was elaborated based on four parameters: initial levels of beta-hCG, aspects of the image at ultrasound (hematosalpinx, tubal ring or live embryo), size of the mass, vascular flow of the color Doppler. Each parameter received a grade from 0 to 2. Grade 0 represented an unfavorable situation, grade 1 a borderline situation and grade 2 a favorable situation.
Results:
The success rate with a single dose of methotrexate was 75% (30/40). In the present study the cut off grade was 5, because the majority of patients with grade > or = 5 were treated successfully (29/30 - 97%), while those with grade < 5 failed.
Conclusion:
The predictive score helps us to indicate the best cases for the medical treatment. Therefore, we do not advise it when the grade is < 5. However, we can predict a good evolution of the treatment when the grade is > or = 5. Federation of Gynecology and Obstetrics.