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Morbid obesity and outcome of ectopic pregnancy following capped single-dose regimen methotrexate

  • General Gynecology
  • Published:
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Abstract

Purpose

Evaluate whether morbid obesity influenced resolution, number of doses or ultimately surgical management of tubal ectopic pregnancy (TEP) when treated with single-dose regimen methotrexate (SDR-MTX) capped at 100 mg.

Methods

Retrospective cohort study of patients with a diagnosis of TEP who underwent MTX treatment from 2000 to 2013. Patients were excluded if initial β–hCG <1000 mIU/mL, did not have β–hCG follow-up or were not treated with SDR-MTX. Per protocol, dose was administered at 50 mg/m2 with a capped maximum of 100 mg. Patients were divided based on their BMI (<40 and ≥40 kg/m2). Demographic variables, β–hCG before treatment, maximum diameter of ectopic size, embryonic heart tones, decrease of β–hCG, need for additional MTX doses and surgery despite treatment were recorded and compared among the groups.

Results

151 women were included in the study, 89.4% (135/151) non-morbidly obese and 10.6% (16/151) morbidly obese. No differences in age distribution, ethnicity, pre-treatment presence of embryonic heart tones, maximum diameter of ectopic size ≥35 mm and β–hCG ≥5000 mIU/ml were found. Following treatment, the proportion of patients with at least an 80% decrease in their β–hCG levels or need for surgery were similar, however, morbidly obese patients were significantly more likely [11/134 vs. 5/16, OR 5.1 (1.5–17.3, p = 0.015)] to require an additional MTX dose.

Conclusion

Among patients with TEP, morbidly obese patients were five times more likely to require an additional dose compared to non-morbidly obese when SDR-MTX capped at 100 mg was used for medical management.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA

    Luis R. Hoyos, Mokerrum Malik, Marvin Najjar & Javier Rodriguez-Kovacs

  2. Reproductive Endocrinology and Infertility, Houston Fertility Services, Houston, TX, USA

    Mazen Abdallah

  3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Gustavo Vilchez

  4. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA

    Awoniyi O. Awonuga

Authors
  1. Luis R. Hoyos
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  2. Mokerrum Malik
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  3. Marvin Najjar
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  4. Javier Rodriguez-Kovacs
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  5. Mazen Abdallah
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  6. Gustavo Vilchez
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  7. Awoniyi O. Awonuga
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Corresponding author

Correspondence to Luis R. Hoyos.

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No funding as obtained for this study.

Conflict of interest

LR Hoyos declares that he has no conflict of interest. MF Malik declares that she has on conflict of interest. M Najjar declares that he has no conflict of interest. J Rodriguez-Kovacs declares that he has no conflict of interest. M Abdallah declares that he has no conflict of interest. G Vilchez declares that he has no conflict of interest. AO Awonuga declares that he has no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Hoyos, L.R., Malik, M., Najjar, M. et al. Morbid obesity and outcome of ectopic pregnancy following capped single-dose regimen methotrexate. Arch Gynecol Obstet 295, 375–381 (2017). https://doi.org/10.1007/s00404-016-4229-0

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  • DOI: https://doi.org/10.1007/s00404-016-4229-0

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