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Do the change in β-hCG values between the 0th and 4th days in tubal ectopic pregnancy treatment with a single-dose methotrexate (MTX) protocol predict the need for a second dose of MTX?

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Aim

The single-dose methotrexate (MTX) regimen is effective and minimizes side effects but an additional second dose is needed in case of failure in an ectopic pregnancy (EP). We aimed to predict the additional MTX dose by evaluating the change in β-hCG values between day 0 and day 4 in EPs with administered single-dose MTX regimen.

Method

A total of 454 tubal EPs between 2013 and 2019 were evaluated retrospectively. Cases cured with a single dose of MTX without an additional dose were accepted as the control group, and cases under a single-dose regimen were cured by applying a second dose of MTX on the 7th day were accepted as the study group. Obstetric and demographic characteristics and the change in β-hCG values compared in both groups.

Results

Age, body mass index (BMI), gravida, smoking, abdominal surgery, presence of IUDs, initial β-hCG levels (0th day), and EP size were similar in both groups, but the presence of previous EP history was significantly higher in the study group. The change of β-hCG from days 0 and 4 determined that a 20% increase predicts the need for a second dose of MTX with 72.4% sensitivity, and 87.8% negative predictive value (NPV).

Conclusion

The single-dose MTX protocol is successful in 83.3% of convenient cases (as the control group), but an increase of 20% in β-hCG between days 0 and 4 predicts the patients who need to be administered second-dose MTX, and thus, a double-dose MTX protocol will be achieved early.

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Availability of data and materials

The data supporting this study are available through the corresponding author upon reasonable request.

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Acknowledgements

We are grateful to all participants and their families who spent their precious time and participated in this research program. We are also thankful for the tireless efforts of the research team members

Funding

There is no financial disclosure to be made for this study.

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Authors and Affiliations

  1. Obstetrics-Gynecology Department, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey

    Yıldız Akdaş Reis, Arife Akay, Merve Özkan, Fahri Burçin Fıratlıgil, Murat Levent Dereli, Tuğba Kınay & Salim Erkaya

  2. Bingol maternity and children’s hospital, Bingöl, Turkey

    Arife Akay

  3. Ankara Etlik City Hospital, Ankara Etlik City Hospital, Ankara, Türkiye

    Merve Özkan, Fahri Burçin Fıratlıgil & Murat Levent Dereli

  4. Ankara Bilkent City Hospital, Ankara Bilkent City Hospital, Ankara, Türkiye

    Salim Erkaya

Authors
  1. Yıldız Akdaş Reis
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  2. Arife Akay
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  3. Merve Özkan
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Contributions

YAR: Project Development, Data Collection or Management, Manuscript Writing/Editing. AA: Project Development, Data Management, Manuscript Writing/Editing. MÖ: Data Collection and Management, Project Development. TK: Data Management, Data Analysis, Project Development, Manuscript Writing/Editing. FBF, MLD, SE: Supervision, Manuscript Writing/Editing.

Corresponding author

Correspondence to Yıldız Akdaş Reis.

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The authors declare no conflicts of interest.

Ethical approval and human rights

Ethics committee approval was taken for this retrospective study from the Local Ethics Committee. All authors and the study protocol have complied with the World Medical Association Declaration of Helsinki regarding the ethical conduct of research involving human subjects.

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Informed consent was obtained from patients who participated in this study.

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Akdaş Reis, Y., Akay, A., Özkan, M. et al. Do the change in β-hCG values between the 0th and 4th days in tubal ectopic pregnancy treatment with a single-dose methotrexate (MTX) protocol predict the need for a second dose of MTX?. Arch Gynecol Obstet (2023). https://doi.org/10.1007/s00404-023-07116-3

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  • DOI: https://doi.org/10.1007/s00404-023-07116-3

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