Abstract
Ectopic pregnancy (EP) is the commonest cause of maternal mortality-related death in the first trimester. Methotrexate (MTX) remains the first-line treatment in optimally selected patients.
To evaluate the success rate and predictors of success of a single-dose MTX treatment in EP.
We studied retrospectively 109 patients with unruptured EP who were treated with Intramuscular MTX administered in a dose of 50 mg/m2 on days 0 and in additional doses on day 7 if beta-hCG levels did not decrease by 15 % during the follow-up period. The study was conducted at the Maternity and Children Hospital Buraidah, Saudi Arabia from June 2013 to December 2013. Pretreatment beta-beta-hCG, EP mass diameter, peritoneal fluid, and fetal cardiac activity were evaluated. The main outcome measures were success rate, the predictors of success without surgical treatment.
Under this regime, the overall success rate was 60.6 % of patients. Of the failure group, only 4.7 % of patients experienced rupture of EP. No side effects were reported. The main predictors of failure were initial beta-hCG value a parts per thousand yen 3.500 mIU/mL OR 4.11 (1.646-12.248, 0.043) and EP diameter 3.73 (1.646-12.10, p = 0.003).
The success rate of MTX in this study was 60.6 %, and the initial beta-hCG concentration and EP diameter were the best predictors of successful treatment with MTX. Furthermore, MTX should be offered only to those patients with beta-hCG < 2,000 mIU/mL and EP mass size < 3.5 cm.