[Prognostic value of early hCG changes after methotrexate injection for ectopic pregnancy]

The purpose of this study was to evaluate the predictive value of early hCG changes on the risk of methotrexate (MTX) therapy failure for ectopic pregnancy.

This monocentric observational study compared the success of single-dose MTX therapy according to early hCG changes. Patients with a decrease of hCG value by at least 20% between day 1 and day 4 were followed up one month later only with an hCG concentration (group A, study protocol). The others patients were followed up with classic protocol, one time a week (group B).

Of the 91 patients treated, there were 29 (31.9%) patients in the group A and 62 (68.1%) in the group B. The overall success rate of MTX treatment was 89%. The success rate of single-dose MTX therapy was significantly increased in group A (29/29 (100%) vs 30/62 (48.4%), P<0.001). The rate of patients requiring surgical treatment was significantly lower in group A (0/29 vs 10/62 (16%), P=0.02) (Table 1).

The 20%-decrease cut-off between day 1 and day 4 appears to be a predictive factor to select patients with low failure rate after one MTX injection, allowing a less stringent follow-up.