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Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate
A Tawfiq1, A F Agameya, P Claman
1Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Objective:
To determine variables that predict treatment failure after methotrexate (MTX) treatment of ectopic pregnancy.
Design:
Retrospective cohort study.
Setting:
Canadian teaching hospital.
Patient(S):
Sixty patients diagnosed with and treated for ectopic pregnancy.
Intervention(S):
A single dose of methotrexate (50 mg/m(2)) by i.m. injection.
Main Outcome Measure(S):
Resolution of serum beta-hCG or clinical evidence of treatment failure.
Result(S):
Treatment failure was observed following methotrexate administration in 65% of cases when initial beta-hCG was >4000 IU/L, but in only 7. 5% of patients when serum beta-hCG was <4000 IU/L (OR = 52.06, 95% CI 4.88-555.56). Patients who presented with pelvic pain without tenderness had treatment failure 56% of the time versus only 17% in those without pain (OR = 9.20, 95% CI 1.02-82.60). Treatment failure also occurred in 53% of patients presenting with vaginal bleeding versus 16% without bleeding (OR = 6.18, 95% CI 0.73-51.93).
Conclusion(S):
Methotrexate should not be used to treat ectopic pregnancy when initial beta-hCG is >4000 IU/L. Caution should also be exercised in using methotrexate for ectopic pregnancy when the patient presents with bleeding or pain even without tenderness.