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Comparison of alternative βhCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy

  • General Gynecology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the performances of five different βhCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy (EP).

Methods

Data of patients who received single-dose methotrexate therapy for tubal EP at a university hospital between January 2011 and July 2016 were reviewed. A ‘successful methotrexate treatment’ was defined if the EP treated with no need for surgery. The performances of different protocols were tested by comparing with the currently used ‘15% βhCG decrease between days 4 and 7’ protocol. The tested follow-up protocols were ‘20, 25%, and any βhCG decrease between days 0/1 and 7’ and ‘20% and any βhCG decrease between days 0/1 and 4’.

Results

Among the 96 patients evaluated, 12 (12.5%) required second dose. Totally, 91 (94.8%) patients treated successfully with no need for surgery. Four patients were operated within 4 days following the second dose. One patient who did not need second dose according to the standard follow-up protocol was operated on the 10th day due to rupture (specificity = 80%). Two protocols, namely ‘20% βhCG decrease between days 0/1 and 7’ and ‘any βhCG decrease between days 0/1 and 7’ did not show statistically significant differences from the index protocol regarding the number of patients who should be assigned to 2nd dose.

Conclusions

‘Any βhCG decrease between days 0/1 and 7’ protocol may substitute the currently used one to decide second dose methotrexate in tubal EP management. Omitting 4th day measurement seems to be more convenient and cost effective.

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Ankara University School of Medicine, Cebeci Hospital, 06100, Dikimevi/Ankara, Turkey

    Yavuz Emre Şükür, Kazibe Koyuncu, Mehmet Murat Seval, Esra Çetinkaya & Fulya Dökmeci

Authors
  1. Yavuz Emre Şükür
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  2. Kazibe Koyuncu
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  3. Mehmet Murat Seval
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  4. Esra Çetinkaya
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  5. Fulya Dökmeci
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Contributions

YES: Data management, Manuscript writing/editing. KK: Data collection, manuscript writing. MMS: Interpretation. EC: Interpretation. FD: Protocol/project development, Interpretation, Management.

Corresponding author

Correspondence to Yavuz Emre Şükür.

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Conflict of interest statement

The authors of this article report no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional review board and with the Helsinki Declaration or comparable ethical standards.

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Şükür, Y.E., Koyuncu, K., Seval, M.M. et al. Comparison of alternative βhCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy. Arch Gynecol Obstet 296, 1161–1165 (2017). https://doi.org/10.1007/s00404-017-4527-1

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  • DOI: https://doi.org/10.1007/s00404-017-4527-1

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