Predictors of failure of the commonly used single-dose methotrexate protocol for treating tubal ectopic pregnancies.

Autor:	Ozyurek ES; Bagcilar Research and Training Hospital, Gynecology and Obstetrics Department, Istanbul, Turkey. Electronic address: eozyurek@yahoo.com., Akmut E; Bagcilar Research and Training Hospital, Gynecology and Obstetrics Department, Istanbul, Turkey., Kaya E; Bagcilar Research and Training Hospital, Gynecology and Obstetrics Department, Istanbul, Turkey., Akca A; Kanuni Sultan Suleyman Research and Training Hospital, Gynecological and Obstetrics Department, Istanbul, Turkey., Akbayır O; Kanuni Sultan Suleyman Research and Training Hospital, Gynecological and Obstetrics Department, Istanbul, Turkey.
Jazyk:	angličtina
Zdroj:	Taiwanese journal of obstetrics & gynecology [Taiwan J Obstet Gynecol] 2017 Dec; Vol. 56 (6), pp. 755-760.
DOI:	10.1016/j.tjog.2017.10.009
Abstrakt:	Objectives: This study identified patients who would benefit from an earlier additional medical intervention and/or continuing close surveillance even if commonly used parameters indicated sufficient medical treatment to determine markers of treatment failure. Materials and Methods: A retrospective analysis of patients with a preliminary diagnosis of ectopic pregnancy treated with the single-dose methotrexate protocol. Group 1: cases cured with a single dose of methotrexate; Group 2: cases who required more than one dose of methotrexate or surgery following the first dose. Demographics, clinical/sonographic findings, observation period, and β-human chorionic gonadotropin (hCG) levels were compared among the two groups. Thresholds were defined and a regression analysis was performed to define independent predictors of failure. Results: Data from 120 patients were analyzed: Group 1 (n = 92); Group 2 (n = 28). β-hCG levels measured at all time points, and day (0-4) and day (4-7) changes, presence of adnexial masses, and infertility were significantly different among the two groups. Only the day (0-4) and day (4-7) changes in β-hCG levels were independent predictors of failure. Conclusion: Day (0-4) thresholds or newly defined day (4-7) thresholds were not more sensitive than the conventional day (4-7) criteria. Day (0-4) β-hCG levels increased by more than 9.7% in half the patients who required additional methotrexate doses or surgery despite fulfillment of the conventional day (4-7) criteria. In contrast, no cases of treatment failure were observed if the day (0-4) decrease was >26.6%. (Copyright © 2017. Published by Elsevier B.V.)
Databáze:	MEDLINE
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