The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy.

Abstract

OBJECTIVE:

To evaluate the efficacy of methotrexate treatment for extrauterine pregnancy and define criteria for prediction of success.

METHODS:

Of 829 patients with an ectopic pregnancy admitted to E. Wolfson Medical Center, Holon, Israel, from January 1997 through December 2009, 238 had asymptomatic tubal pregnancies and increasing serum β-human chorionic gonadotropin (βhCG) levels. These patients were treated with a single intramuscular injection of 50mg of methotrexate (MTX) per square meter of body surface. Success was defined as undetectable βhCG levels without the need for a surgical intervention.

RESULTS:

The groups of patients successfully treated (n=167 [70%]) and unsuccessfully treated (n=71 [30%]) were compared. They were similar regarding age and gravidity. The initial serum βhCG level was significantly higher in the latter group than in the former (3798 mIU/mL vs. 1601 mIU/mL, P<0.01). The success rate was 88% when initial βhCG levels were less than 1000 mIU/mL, 71% when they were between 1000 and 2000 mIU/mL, and only 59% when they were between 2000 and 3000 mIU/mL.

CONCLUSION:

Methotrexate treatment is a safe and effective alternative to surgery. However, patients with initial βhCG levels higher than 2000 mIU/mL should only be offered the surgical approach.

• Authors: Ron Sagiv, Abraham Debby, Hagit Feit, Bina Cohen-Sacher, Ran Keidar, Abraham Golan
• Journal: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (Int J Gynaecol Obstet) Vol. 116 Issue 2 Pg. 101-4 (Feb 2012) ISSN: 1879-3479 [Electronic] United States
• PMID: 22093497 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2011. Published by Elsevier Ireland Ltd.

Chemical References

• Abortifacient Agents, Nonsteroidal
• Chorionic Gonadotropin
• Methotrexate

Topics

• Abortifacient Agents, Nonsteroidal (administration & dosage, adverse effects, therapeutic use)
• Adult
• Chorionic Gonadotropin (blood)
• Female
• Follow-Up Studies
• Humans
• Injections, Intramuscular
• Methotrexate (administration & dosage, adverse effects, therapeutic use)
• Pregnancy
• Pregnancy, Tubal (blood, drug therapy)
• Treatment Failure
• Treatment Outcome
• Young Adult