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Characterizing ectopic pregnancies that rupture despite treatment with methotrexate
Paul S Dudley1, Michael J Heard, Haleh Sangi-Haghpeykar
1Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Medical Center, Houston, Texas 77030, USA.
Objective:
To identify risk factors for tubal rupture among ectopic pregnancies treated with methotrexate (MTX).
Design:
Retrospective case-control analysis.
Setting:
An urban medical center.
Patient(S):
Eighty-one women diagnosed with an ectopic gestation treated with MTX: 19 patients experienced subsequent tubal rupture, and 62 patients experienced ectopic resolution.
Intervention(S):
None.
Main Outcome Measure(S):
Predictive variables including serial human chorionic gonadotropin (hCG) values.
Result(S):
The hCG incremental rate before as well as after MTX administration was positively associated with tubal rupture. HCG values prior to ectopic diagnosis that increased at least 66% over 48 hours and rising hCG values after treatment with methotrexate were independent predictors of tubal rupture. A disproportionate number (47%) of ectopic pregnancies that ruptured were located in the tubal isthmus.
Conclusion(S):
The hCG incremental rate both before and after MTX represents an independent risk factor for subsequent tubal rupture. Concentrations of hCG before ectopic diagnosis that increased at least 66% over 48 hours, or persistently rising hCG concentrations after treatment with MTX, may lower the threshold for surgical intervention. Implantation site may represent an unidentifiable risk factor for tubal rupture.
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