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Failed methotrexate treatment of cervical pregnancy. Predictive factors
Sang Wook Bai1, Jae Sung Lee, Joo Hyun Park
1Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Shinchon-dong 134, Sudaemun-gu, Seoul, Korea, 120-752. swbai@yumc.yonsei.ac.kr
Objective:
To determine the risk factors when primary methotrexate treatment of cervical pregnancy fails.
Study Design:
From January 1985 to December 1999, 32 women with cervical pregnancy were treated with methotrexate intramuscularly according to a repeated intramuscular injection protocol. For evaluation of the efficacy of therapy, pretreatment serum concentrations of human chorionic gonadotropin, size of the gestational mass, fetal cardiac activity and presence of fluid in the peritoneal cavity were measured. These findings were analyzed and compared in terms of success and failure by means of the chi 2 test, Fisher's exact test, receiver operating characteristic curve and Student's t test.
Results:
There was no relation between the women's age, parity, size of the conceptus or presence of fluid in the peritoneal cavity to the efficacy of treatment. In a cervical pregnancy that presented with a serum human chorionic gonadotropin concentration of > or = 10,000 mIU/mL, fetal cardiac activity was associated with a higher failure rate of primary methotrexate treatment.
Conclusion:
In cervical pregnancies, a high serum human chorionic gonadotropin concentration and fetal cardiac activity were the most important factors associated with failure of treatment using methotrexate.