Efficacy of methotrexate treatment in extrauterine pregnancies defined by stable or increasing human chorionic gonadotropin concentrations

Ronni Gamzu*, Benny Almog, Yishai Levin, Amiram Avni, Ariel Jaffa, Joseph B. Lessing, Amiram Baram

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Objective: To evaluate the efficacy of methotrexate treatment in selected cases of extrauterine pregnancy (EUP) defined by stable or increasing hCG concentration. Design: Prospective cohort study. Setting: Gynecology department of the Lis Maternity Hospital. Patient(s): Fifty women with EUP diagnosed whenever an intrauterine gestational sac was not seen on transvaginal ultrasonography. Intervention(s): Women received IM methotrexate at a dose of 50 mg/m2 of body surface area. Failure of hCG levels to fall by ≥15% during any successive week resulted in repeated administration of methotrexate. Surgical intervention was performed for presumed tubal rupture. Main Outcome Measure(s): Serial hCG measurement was performed weekly until hCG concentration reached 15 mIU/mL. Success was defined as the achievement of hCG concentration of 25 mIU/mL without surgical intervention. Result(s): Forty-four women (88%) were successfully treated. The mean time from first methotrexate injection to success was 34 ± 2.4 days. Women treated successfully and unsuccessfully differed significantly only with regard to serum hCG levels of 1,876 ± 243 and 3,489 ± 376 mIU/mL, respectively. When the initial hCG levels were lower or higher than 2,000 IU/L, the success rate was 97% and 74%, respectively (significant by Fisher's exact test). Conclusion(s): When methotrexate treatment is administrated in a selected group of EUP defined by stable or increasing hCG, it may fail more frequently (26%) when initial hCG levels are >2,000 mIU/mL.

Original languageEnglish
Pages (from-to)761-765
Number of pages5
JournalFertility and Sterility
Volume77
Issue number4
DOIs
StatePublished - 2002
Externally publishedYes

Keywords

  • Ectopic pregnancy
  • Methotrexate

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