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Predicting factors of medical treatment success with single dose methotrexate in tubal ectopic pregnancy: a retrospective study.

Mirbolouk F, Yousefnezhad A, Ghanbari A - Iran J Reprod Med (2015)

Bottom Line: The second group or "failure group" consist the patients who did not respond to the MTX therapy.The cutoff value of initial β-hCG with the success treatment results was found to be 1375 IU/mL there was no statistical difference between groups about week of gestation, size and location of EP.The results showed that patients who have β-hCG levels below 1375 and the number of cases with decreasing β-hCG level on day 4 are the good candidates for medical treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Guilan University of Medical Sciences, Rasht, Iran.

ABSTRACT

Background: Nowadays, The first step in treatment of ectopic pregnancy (EP) is medical treatment. Medical treatment with methotrexate (MTX) for EP is safe and effective method without the risks associated with the surgical procedure. But there are controversies between studies for which patients will respond better to medical treatment.

Objective: The aim of the present study was to investigate the predictive factors of success or failure of treatment of EP with single dose MTX.

Materials and methods: In this retrospective study, records of 370 patients who were treated for tubal EP with single dose of MTX were reviewed during four years. Patients were divided into two groups; the first group or "success group" are the patients who were successfully treated with MTX. The second group or "failure group" consist the patients who did not respond to the MTX therapy. The week of gestation, size and location of EP and β-hCG level were compared between groups.

Results: Of 370 patients, 285 (77.1%) were successfully treated with MTX. 85 patients (22.9%) required surgery after a mean of 5.4 (range 2-15) days. Day-1 beta- human chorionic gonadotropin (β-hCG) and fall in β-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial β-hCG with the success treatment results was found to be 1375 IU/mL there was no statistical difference between groups about week of gestation, size and location of EP.

Conclusion: The results showed that patients who have β-hCG levels below 1375 and the number of cases with decreasing β-hCG level on day 4 are the good candidates for medical treatment.

No MeSH data available.


Related in: MedlinePlus

Receiver operating characteristic (ROC) curves for initial β-hCG concentration on successful outcome
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Figure 1: Receiver operating characteristic (ROC) curves for initial β-hCG concentration on successful outcome

Mentions: There was statistically significant difference between the groups in number of abortion. Frequency of abortion in failure group was higher than success group (0.41 and 0.22 respectively) (p=0.03). The medians of β-hCG levels on days 1, 4, and 7 were significantly higher in the "failure group" (2541 vs. 1167, 2807 vs. 1132, and 2723 vs. 931 mIU/mL, respectively) (p=0.0001). Falling in serum hCG between days 0-4 of treatment in failure and success group were 38.8% and 63.9%, respectively (p=0.0001). 23.5% in success group and 36.5% in failure group required more than one single dose of MTX (p=0.001). With the help of ROC curve analysis, we managed to establish the cutoff point for the β-hCG serum level. At the value of 1375 mIU/mL, sensitivity and specificity for prediction of failure of treatment with MTX reached 70% and 70.5%, respectively (Figure 1). Failure rate among patients with hCG >1375 IU/L was 41.7% vs. 11.1% in patients with a lower level (p=0.01). 48 (13%) patients experienced some side effects. Abdominal pain (6.82%) and GI complication such as vomiting (1.11%), and nausea (5.10%) were the most complication.


Predicting factors of medical treatment success with single dose methotrexate in tubal ectopic pregnancy: a retrospective study.

Mirbolouk F, Yousefnezhad A, Ghanbari A - Iran J Reprod Med (2015)

Receiver operating characteristic (ROC) curves for initial β-hCG concentration on successful outcome
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555054&req=5

Figure 1: Receiver operating characteristic (ROC) curves for initial β-hCG concentration on successful outcome
Mentions: There was statistically significant difference between the groups in number of abortion. Frequency of abortion in failure group was higher than success group (0.41 and 0.22 respectively) (p=0.03). The medians of β-hCG levels on days 1, 4, and 7 were significantly higher in the "failure group" (2541 vs. 1167, 2807 vs. 1132, and 2723 vs. 931 mIU/mL, respectively) (p=0.0001). Falling in serum hCG between days 0-4 of treatment in failure and success group were 38.8% and 63.9%, respectively (p=0.0001). 23.5% in success group and 36.5% in failure group required more than one single dose of MTX (p=0.001). With the help of ROC curve analysis, we managed to establish the cutoff point for the β-hCG serum level. At the value of 1375 mIU/mL, sensitivity and specificity for prediction of failure of treatment with MTX reached 70% and 70.5%, respectively (Figure 1). Failure rate among patients with hCG >1375 IU/L was 41.7% vs. 11.1% in patients with a lower level (p=0.01). 48 (13%) patients experienced some side effects. Abdominal pain (6.82%) and GI complication such as vomiting (1.11%), and nausea (5.10%) were the most complication.

Bottom Line: The second group or "failure group" consist the patients who did not respond to the MTX therapy.The cutoff value of initial β-hCG with the success treatment results was found to be 1375 IU/mL there was no statistical difference between groups about week of gestation, size and location of EP.The results showed that patients who have β-hCG levels below 1375 and the number of cases with decreasing β-hCG level on day 4 are the good candidates for medical treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Guilan University of Medical Sciences, Rasht, Iran.

ABSTRACT

Background: Nowadays, The first step in treatment of ectopic pregnancy (EP) is medical treatment. Medical treatment with methotrexate (MTX) for EP is safe and effective method without the risks associated with the surgical procedure. But there are controversies between studies for which patients will respond better to medical treatment.

Objective: The aim of the present study was to investigate the predictive factors of success or failure of treatment of EP with single dose MTX.

Materials and methods: In this retrospective study, records of 370 patients who were treated for tubal EP with single dose of MTX were reviewed during four years. Patients were divided into two groups; the first group or "success group" are the patients who were successfully treated with MTX. The second group or "failure group" consist the patients who did not respond to the MTX therapy. The week of gestation, size and location of EP and β-hCG level were compared between groups.

Results: Of 370 patients, 285 (77.1%) were successfully treated with MTX. 85 patients (22.9%) required surgery after a mean of 5.4 (range 2-15) days. Day-1 beta- human chorionic gonadotropin (β-hCG) and fall in β-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial β-hCG with the success treatment results was found to be 1375 IU/mL there was no statistical difference between groups about week of gestation, size and location of EP.

Conclusion: The results showed that patients who have β-hCG levels below 1375 and the number of cases with decreasing β-hCG level on day 4 are the good candidates for medical treatment.

No MeSH data available.


Related in: MedlinePlus