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Can early βhCG change and baseline progesterone level predict treatment outcome in patients receiving single dose Methotrexate protocol for tubal ectopic pregnancy?

  • Jérémy Brunello
  • Paul Guerby
  • Chloé Cartoux
  • Alexandre Yazigi
  • Martin Baujat
  • Olivier Parant
  • Christophe Vayssière
  • Charlotte Vaysse
  • Elodie Chantalat
  • Fabien VidalEmail author
Maternal-Fetal Medicine
  • 7 Downloads

Abstract

Introduction

We aimed to assess the prognostic significance of early βhCG change and baseline progesterone level on treatment outcome among women receiving single dose Methotrexate protocol for tubal ectopic pregnancy (EP).

Material and methods

Retrospective study involving all consecutive patients diagnosed with EP and receiving Methotrexate therapy form January 2015 to December 2016. Patients were stratified into 2 groups according to treatment outcome: success group (n = 66) involved women who displayed complete resolution of serum βhCG levels following a single course of Methotrexate; failure group (n = 55) included patients who required repeated Methotrexate administration and/or surgical management. Predictive performances of baseline progesterone and ratio“βhCG level on day 4/ βhCG level on day 1″ (d4/d1) on treatment outcome were assessed using Receiving Operating Characteristics curves.

Results

The ratio d4/d1 displayed good performances in predicting treatment outcome (AUC = 0.826). A ratio ≤ 0.7 was associated with a success rate of 94% after 1 course of Methotrexate and 100% after 2 courses. In contrast, a ratio >1.7 was associated with a failure rate of 100%. Conversely, baseline progesterone showed poor performances (AUC = 0.611).

Conclusions

Patients with extreme βhCG changes (n = 33) on day 4 might benefit from a more personalized approach: simplified monitoring in those with a decline ≥30%, anticipated second course of treatment in those with an increase > 70%.

Keywords

Tubal ectopic pregnancy Methotrexate Early βhCG change Baseline progesterone Prognosis 

Notes

Author contribution

JB manuscript writing, statistical analysis. PG data collection, project development. CC data collection, project development. AY data collection. MB data collection, clinical management. OP manuscript reviewing. CV manuscript reviewing. CV manuscript reviewing. EC data collection, project development. FV manuscript writing, statistical analysis, project development.

Funding

None.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jérémy Brunello
    • 1
  • Paul Guerby
    • 1
    • 2
  • Chloé Cartoux
    • 3
  • Alexandre Yazigi
    • 1
  • Martin Baujat
    • 1
  • Olivier Parant
    • 1
    • 2
    • 4
  • Christophe Vayssière
    • 1
    • 2
    • 4
  • Charlotte Vaysse
    • 2
    • 5
  • Elodie Chantalat
    • 2
    • 5
  • Fabien Vidal
    • 1
    • 2
    Email author
  1. 1.CHU Toulouse, Pôle de Gynécologie Obstétrique, Department of Obstetrics and GynecologyHôpital Paule de ViguierToulouseFrance
  2. 2.Université de Toulouse III, UMR1027ToulouseFrance
  3. 3.Department of Obstetrics and GynecologyCHU Saint-PierreGaillonFrance
  4. 4.Inserm, UMR1027ToulouseFrance
  5. 5.CHU Toulouse, Service de Chirurgie gynécologiqueToulouseFrance

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