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Increment in β-hCG in the 48-h period prior to treatment: a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate

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Abstract

Background

To evaluate the increment in β-hCG levels (%) in the 48-h interval prior to treatment as a predictor of therapeutic success in the management of ectopic pregnancy with methotrexate.

Methods

A prospective observational study was carried out between April 2002 and November 2006 at the Federal University of São Paulo in 65 patients with an ectopic pregnancy treated with a single dose of 50 mg/m2 of methotrexate administered intramuscularly. The following predictive factors were evaluated: β-hCG level on the day of hospital admission and the percent increment in β-hCG in the 48-h interval prior to treatment.

Results

Treatment was successful in 49 cases (75.4%). In these cases, β-hCG levels at hospitalization were lower when compared to the levels found in cases of therapeutic failure (1,928.9 vs. 4,828.6 mIU/ml, respectively; P < 0.01), and the increment in β-hCG level in the 48-h interval prior to treatment was smaller (13.1 vs. 36.3%, respectively; P = 0.01). A β-hCG measurement ≤2,685 mIU/ml on the day of hospitalization and an increment in β-hCG level ≤11.1% in the 48 h preceding treatment were factors indicative of therapeutic success with sensitivity of 79.6 and 61.7%, respectively, and specificity of 75 and 81.3%, respectively.

Conclusions

The lower the β-hCG measurement on the day of hospital admission and the lower its increment in the 48-h interval prior to treatment, the greater the likelihood that treatment of ectopic pregnancy with methotrexate will be successful. The margin of safety for treatment with methotrexate is high when β-hCG measurement on the day of hospitalization is ≤2,685 mIU/ml and its increment in the 48 h prior to treatment is ≤11.1%.

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Acknowledgments

The authors would like to express their gratitude to Professors Rita de Cássia Ribeiro Silva (School of Nutrition, Federal University of Bahia, UFBA) and Kleber Pimentel Santos (Bahia State School of Sciences) for their collaboration in the statistical analysis of this study.

Conflict of interest statement

Regarding the article, there is not any potential conflict of interest involving the manuscript authors.

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Authors and Affiliations

  1. Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil

    Roberto da Costa Soares, Júlio Elito Junior & Luiz Camano

  2. Department of Obstetrics and Gynecology, University of Technology and Sciences (FTC), Salvador, Bahia, Brazil

    Roberto da Costa Soares

  3. Avenida Miguel Navarro y Canizares 466 apt. 602, Edifício Villa Nobre, Pituba, 41810-215, Salvador, BA, Brazil

    Roberto da Costa Soares

Authors
  1. Roberto da Costa Soares
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  2. Júlio Elito Junior
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  3. Luiz Camano
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Correspondence to Roberto da Costa Soares.

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da Costa Soares, R., Junior, J.E. & Camano, L. Increment in β-hCG in the 48-h period prior to treatment: a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate. Arch Gynecol Obstet 278, 319–324 (2008). https://doi.org/10.1007/s00404-008-0589-4

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  • DOI: https://doi.org/10.1007/s00404-008-0589-4

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