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Expectant management versus systemic methotrexate in the management of persistent pregnancy of unknown location, a seven-year retrospective analysis

  • General Gynecology
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Abstract

Purpose

To compare Expectant management to systemic methotrexate in the management of persistent pregnancy of unknown location with beta-hCG levels below the discrimination zone.

Methods

A retrospective cohort study was conducted on 71 women with persistent pregnancy of unknown location. They were divided into two groups according to the applied management; Group 1, (n = 40) who were managed expectantly and Group 2 (n = 31) who were given a single dose of methotrexate. Data variables were collected and analyzed to evaluate whether expectant management was as effective as methotrexate.

Results

There was no significant difference between the two groups regarding age, parity, gestational age, body mass index and day seven beta-hCG. Success rates were (32 patients (80%) and 28 patients (90.3%) in expectant management and methotrexate groups, respectively (P > 0.05). The mean values for day zero and day four beta-hCG were significantly higher and the mean duration for complete recovery was statistically shorter in the methotrexate group (P < 0.05). There were no significant differences between the two groups regarding prior ectopic, percentage of beta-hCG level drop on day four and day seven, success rate, occurrence of sequelae and patient satisfaction that area under the curve (AUC) for group 1 (expectant management) is 0.566 at 95% Confidence Interval of (0.388: 0.745).

Conclusion

Expectant management is an effective and safe alternative to single-dose methotrexate for persistent PUL with beta-hCG levels below the discrimination zone.

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Data availability

Data are available with the corresponding author upon relevant request.

Code availability

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Acknowledgements

The authors would like to acknowledge the contribution of the Record keeping and Bio-statistics personnel at King Abdul-Aziz Airbase Hospital for their logistic support.

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Contributions

EE: Project development, Manuscript writing and editing and plagiarism check. YZ: Project development, data collection and revision. FA: Project development, data collection and revision. and MF: Project development, Data collection and data analysis and manuscript editing.

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Correspondence to Elsayed Elshamy.

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Elshamy, E., Zakaria, Y., Alajami, F. et al. Expectant management versus systemic methotrexate in the management of persistent pregnancy of unknown location, a seven-year retrospective analysis. Arch Gynecol Obstet 309, 1035–1041 (2024). https://doi.org/10.1007/s00404-023-07332-x

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