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

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.

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

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 ß-hCG level were compared between groups.

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 (ß-hCG) and fall in ß-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial ß-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 ß-hCG levels below 1375 and the number of cases with decreasing ß-hCG level on day 4 are the good candidates for medical treatment.