A new scoring system to predict the success of single-dose methotrexate therapy in ectopic pregnancy

Methotrexate remains the most commonly used agent for the medical management of ectopic pregnancy. The aim of this study was to develop a novel scoring system to predict the efficacy of single-dose methotrexate treatment in ectopic pregnancy.

In this retrospective study, information on patients diagnosed with ectopic pregnancy between January 2012 and December 2023 was obtained from the hospital information system. Notably, 156 patients received a single dose of methotrexate for ectopic pregnancy treatment and met the study criteria. Almost 117 of those who were successful in single-dose methotrexate treatment constituted the successful methotrexate treatment group. The other 39 cases who failed single-dose methotrexate treatment constituted the failed methotrexate treatment group. A new scoring system was developed based on six parameters, including serum human chorionic gonadotropin level, gestational week, and ultrasound findings.

According to the scoring system, the total score was significantly higher in the group in which methotrexate treatment failed compared to the group with successful treatment (4 points versus 2 points, respectively, p<0.001). In receiver operating characteristic analysis, the optimal cut-off value for the scoring system was determined as 2.5, with 92% sensitivity and 78% specificity (AUC=0.804, 95%CI 0.731-0.877). The overall success rate of single-dose methotrexate treatment was 75%. However, when only patients with a score below the cut-off value of 2.5 were considered, the success rate of single-dose methotrexate treatment in ectopic pregnancy increased to 90.5%.

This new scoring system significantly enhances the ability to predict outcomes of methotrexate therapy, allowing for faster decision-making regarding surgical intervention.