TY - JOUR
T1 - Ruptured ectopic pregnancies following methotrexate treatment
T2 - clinical course and predictors for improving patient counseling
AU - Cohen, Aviad
AU - Bar-on, Shikma
AU - Cohen, Yoni
AU - Sandel, Ori
AU - Fouks, Yuval
AU - Michaan, Nadav
AU - Tzur, Tamar
AU - Levin, Ishai
N1 - Publisher Copyright:
© 2022, Society for Reproductive Investigation.
PY - 2022/4
Y1 - 2022/4
N2 - To determine the predictors for tubal rupture among women treated with methotrexate (MTX) for ectopic pregnancy. We performed a retrospective cohort analysis in a tertiary university-affiliated medical center. Medical records of 401 women who were diagnosed with ectopic pregnancy and were treated with MTX between January 2001 and June 2017 were reviewed. Forty-one women were diagnosed with ruptured ectopic pregnancy (study group) and 360 women with non-ruptured ectopic pregnancy (control group). Descriptive data and predictive variables for rupture ectopic pregnancy following MTX treatment were reviewed. Out of 122 women who failed MTX treatment, forty-one women had tubal rupture (33.6%). The median time interval from MTX treatment to tubal rupture was 6 days (1–25). β-hCG percentage change in the 48 h preceding MTX treatment and β-hCG level at day 0 were independent predictors for tubal rupture (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04–1.12, p < 0.001 for every percent change in β-hCG; OR = 1.001, 95% CI = 1.0003–1.002 for every unit change in β-hCG, respectively). In a decision tree analysis model, in women with β-hCG percentage increment >69% in the 48 h preceding methotrexate the probability for tubal rupture was 85%. Risk assessment for tubal rupture should be made before methotrexate treatment according to β-hCG dynamics and level. The absolute risk for tubal rupture in women with β-hCG increment<20% is low.
AB - To determine the predictors for tubal rupture among women treated with methotrexate (MTX) for ectopic pregnancy. We performed a retrospective cohort analysis in a tertiary university-affiliated medical center. Medical records of 401 women who were diagnosed with ectopic pregnancy and were treated with MTX between January 2001 and June 2017 were reviewed. Forty-one women were diagnosed with ruptured ectopic pregnancy (study group) and 360 women with non-ruptured ectopic pregnancy (control group). Descriptive data and predictive variables for rupture ectopic pregnancy following MTX treatment were reviewed. Out of 122 women who failed MTX treatment, forty-one women had tubal rupture (33.6%). The median time interval from MTX treatment to tubal rupture was 6 days (1–25). β-hCG percentage change in the 48 h preceding MTX treatment and β-hCG level at day 0 were independent predictors for tubal rupture (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04–1.12, p < 0.001 for every percent change in β-hCG; OR = 1.001, 95% CI = 1.0003–1.002 for every unit change in β-hCG, respectively). In a decision tree analysis model, in women with β-hCG percentage increment >69% in the 48 h preceding methotrexate the probability for tubal rupture was 85%. Risk assessment for tubal rupture should be made before methotrexate treatment according to β-hCG dynamics and level. The absolute risk for tubal rupture in women with β-hCG increment<20% is low.
KW - Beta human chorionic gonadotropin
KW - Ectopic pregnancy
KW - Methotrexate
UR - http://www.scopus.com/inward/record.url?scp=85124739598&partnerID=8YFLogxK
U2 - 10.1007/s43032-022-00881-7
DO - 10.1007/s43032-022-00881-7
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C2 - 35157263
AN - SCOPUS:85124739598
SN - 1933-7191
VL - 29
SP - 1209
EP - 1214
JO - Reproductive Sciences
JF - Reproductive Sciences
IS - 4
ER -