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Efficacy of methotrexate treatment in extrauterine pregnancies defined by stable or increasing human chorionic
Ronni Gamzu1, Benny Almog, Yishai Levin
1Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. ronn@post.tau.ac.il
Objective:
To evaluate the efficacy of methotrexate treatment in selected cases of extrauterine pregnancy (EUP) defined by stable or increasing hCG concentration.
Design:
Prospective cohort study.
Setting:
Gynecology department of the Lis Maternity Hospital.
Patient(S):
Fifty women with EUP diagnosed whenever an intrauterine gestational sac was not seen on transvaginal ultrasonography.
Intervention(S):
Women received IM methotrexate at a dose of 50 mg/m(2) of body surface area. Failure of hCG levels to fall by >/=15% during any successive week resulted in repeated administration of methotrexate. Surgical intervention was performed for presumed tubal rupture.
Main Outcome Measure(S):
Serial hCG measurement was performed weekly until hCG concentration reached 15 mIU/mL. Success was defined as the achievement of hCG concentration of 25 mIU/mL without surgical intervention.
Result(S):
Forty-four women (88%) were successfully treated. The mean time from first methotrexate injection to success was 34 +/- 2.4 days. Women treated successfully and unsuccessfully differed significantly only with regard to serum hCG levels of 1,876 +/- 243 and 3,489 +/- 376 mIU/mL, respectively. When the initial hCG levels were lower or higher than 2,000 IU/L, the success rate was 97% and 74%, respectively (significant by Fisher's exact test).
Conclusion(S):
When methotrexate treatment is administrated in a selected group of EUP defined by stable or increasing hCG, it may fail more frequently (26%) when initial hCG levels are >2,000 mIU/mL.
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