Can early βhCG change and baseline progesterone level predict treatment outcome in patients receiving single dose Methotrexate protocol for tubal ectopic pregnancy?
- 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 PrognosisNotes
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.
References
- 1.Stovall TG, Ling FW, Buster JE (1989) Outpatient chemotherapy of unruptured ectopic pregnancy. Fertil Steril. 51(3):435–438CrossRefGoogle Scholar
- 2.Stovall TG, Ling FW, Gray LA (1991) Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol. 77(5):754–757Google Scholar
- 3.Lehner R, Kucera E, Jirecek S, Egarter C, Husslein P (2000) Ectopic pregnancy. Arch Gynecol Obstet. 263(3):87–92CrossRefGoogle Scholar
- 4.Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I (1998) Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases. Fertil Steril. 69(1):62–65CrossRefGoogle Scholar
- 5.Gervaise A (2003) Management of non-surgical treatment of ectopic pregnancy. J Gynecol Obstet Biol Reprod 32(7 Suppl):S64–74Google Scholar
- 6.Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, Van der Veen F, Hemrika DJ et al (1998) Serum human chorionic gonadotropin measurement in the diagnosis of ectopic pregnancy when transvaginal sonography is inconclusive. Fertil Steril. 70(5):972–981CrossRefGoogle Scholar
- 7.Kriebs JM, Fahey JO (2006) Ectopic pregnancy. J Midwifery Women's Health. 51(6):431–439CrossRefGoogle Scholar
- 8.Coste J, Bouyer J, Job-Spira N (1996) Epidemiology of ectopic pregnancy: incidence and risk factors. Contracept Fertil Sex. 24(2):135–139Google Scholar
- 9.Skubisz MM, Li J, Wallace EM, Tong S (2011) Decline in betahCG levels between days 0 and 4 after a single dose of methotrexate for ectopic pregnancy predicts treatment success: a retrospective cohort study. BJOG Int J Obstet Gynaecol. 118(13):1665–1668CrossRefGoogle Scholar
- 10.Celik E, Turkcuoglu I, Karaer A, Kirici P, Eraslan S (2013) Assessment of early decline in the percentage of beta-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for the prediction of treatment success. J Turk Ger Gynecol Assoc. 14(3):125–129CrossRefGoogle Scholar
- 11.Gabbur N, Sherer DM, Hellmann M, Abdelmalek E, Phillip P, Abulafia O (2006) Do serum beta-human chorionic gonadotropin levels on day 4 following methotrexate treatment of patients with ectopic pregnancy predict successful single-dose therapy? Am J Perinatol. 23(3):193–196CrossRefGoogle Scholar
- 12.Nguyen Q, Kapitz M, Downes K, Silva C (2010) Are early human chorionic gonadotropin levels after methotrexate therapy a predictor of response in ectopic pregnancy? Am J Obstet Gynecol. 202(6):630CrossRefGoogle Scholar
- 13.Bottin P, Gnisci A, Crochet P, Butzbach P, Cravello L, Gamerre M et al (2014) Prognostic value of early hCG changes after methotrexate injection for ectopic pregnancy. Gynecologie, Obstetrique and Fertilite. 42(1):3–7CrossRefGoogle Scholar
- 14.Girija S, Manjunath AP, Salahudin A, Jeyaseelan L, Gowri V, Abu-Heija A et al (2017) Role of day 4 HCG as an early predictor of success after methotrexate therapy for ectopic pregnancies. Eur J Obstet Gynecol Reprod Biol. 215:230–233CrossRefGoogle Scholar
- 15.Kirk E, Condous G, Van Calster B, Haider Z, Van Huffel S, Timmerman D et al (2007) A validation of the most commonly used protocol to predict the success of single-dose methotrexate in the treatment of ectopic pregnancy. Hum Reprod. 22(3):858–863CrossRefGoogle Scholar
- 16.Wu J, Ludlow JP, De Vries B, Black K, Beale P (2014) Single-dose methotrexate treatment for ectopic pregnancy and pregnancy of unknown location and progesterone as a predictor of success. Aust N Z J Obstet Gynaecol. 54(5):469–474CrossRefGoogle Scholar
- 17.Stika CS, Anderson L, Frederiksen MC (1996) Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience. Am J Obstet Gynecol. 174(6):1840–1846CrossRefGoogle Scholar
- 18.Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW (1999) Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 341(26):1974–1978CrossRefGoogle Scholar
- 19.Lipscomb GH, Gomez IG, Givens VM, Meyer NL, Bran DF (2009) Yolk sac on transvaginal ultrasound as a prognostic indicator in the treatment of ectopic pregnancy with single-dose methotrexate. Am J Obstet Gynecol. 200(3):338CrossRefGoogle Scholar
- 20.Gamzu R, Almog B, Levin Y, Pauzner D, Lessing JB, Jaffa A et al (2002) The ultrasonographic appearance of tubal pregnancy in patients treated with methotrexate. Hum Reprod. 17(10):2585–2587CrossRefGoogle Scholar
- 21.Helmy S, Koch M, Kolbl H, Grohmann-Izay B, Solomayer E, Bader Y (2015) Correlation of the volume of ectopic pregnancy and MTX therapy outcome: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 184:108–111CrossRefGoogle Scholar