Methotrexate-treated ectopic pregnancy: beta human chorionic gonadotropin serum changes as a success predictor using a mathematical model validation.

Autor: Kovaleva A; University Hospital of Tajo, Spain. Electronic address: sasnad_84@hotmail.com., Irishina N; Carlos III University, Madrid, Spain., Pereira A; Department of Obstetrics and Gynecology, University Hospital of Gregorio Marañón, Madrid, Spain., Cuesta-Guardiola T; Department of Obstetrics and Gynecology, University Hospital of Gregorio Marañón, Madrid, Spain., Ortiz-Quintana L; Department of Obstetrics and Gynecology, University Hospital of Gregorio Marañón, Madrid, Spain.
Jazyk: angličtina
Zdroj: European journal of obstetrics, gynecology, and reproductive biology [Eur J Obstet Gynecol Reprod Biol] 2017 Mar; Vol. 210, pp. 35-38. Date of Electronic Publication: 2016 Oct 27.
DOI: 10.1016/j.ejogrb.2016.10.022
Abstrakt: Background: Surgical rescue of methotrexate-treated ectopic pregnancy is necessary when tubal rupture or medical therapy failure is detected during post-therapeutic monitoring. It is known that an increased beta human chorionic gonadotropin (β-hCG) concentration is the most important factor associated with treatment failure. Therefore, we suggested that relative changes in serum β-hCG could predict a successful result of medical treatment, leading to facilitation of the decision to forgo the prospect of possible surgical rescue.
Methods: A retrospective observational study of 115 patients with an ectopic pregnancy who were treated with a single dosage protocol of 50mg/m 2 of methotrexate injected intramuscularly was performed at Puerta de Hierro University Hospital and Gregorio Marañón University General Hospital. Standard statistical tests were applied in order to evaluate the relative changes in β-hCG concentration between the 1st and the 4th days following methotrexate injection.
Results: Methotrexate treatment has a 95% probability to be successful if the relative change of β-hCG from the 1st to the 4th day of monitoring is within the following interval: [-1.02; 0.15]. Moreover, if the values of β-hCG-relative change from 1st to 4th day of monitoring are within [0.54; 1.2], it assures a negative result of treatment with 95% probability. Therefore, the value 0.15 (15%) of β-hCG relative change can be considered a cut-off value for a positive result to treatment.
Conclusions: Our data support that negative β-hCG relative changes on the 4th day of treatment likely predict a successful result of methotrexate therapy, with a cut-off point of 0.15. Expectant management should be carried out in these cases if no clinical indications of surgery are presented.
(Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
Databáze: MEDLINE
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