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Methotrexate As the First-Line Treatment of Unruptured Tubular Ectopic Pregnancies With High Initial Human Chorionic Gonadotropin Levels: A Retrospective Cohort Publisher



Keikha F1 ; Ardekani SS2 ; Parsaei M3 ; Zargarzadeh N4 ; Hadizadeh A5 ; Tarafdari A1
Authors
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Authors Affiliations
  1. 1. Department of Obstetrics and Gynecology, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
  4. 4. Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, United States
  5. 5. Female Pelvic Medicine and Reconstructive Surgery Division, University of Chicago, Pritzker School of Medicine, Northshore University, HealthSystem, Skokie, IL, United States

Source: European Journal of Obstetrics and Gynecology and Reproductive Biology: X Published:2024


Abstract

Objectives: To evaluate the effectiveness of the first-line medical management with Methotrexate (MTX) in the treatment of patients with stable tubal Ectopic Pregnancies (EPs) and varying ranges of Beta-Human Chorionic Gonadotropin (β-HCG) levels. Materials and methods: In this retrospective cohort study, we reviewed the medical records of a total of 184 patients with the diagnosis of tubal EP, who received MTX as their first-line treatment. Patients with a baseline β-HCG< 4800 mIU/mL received single-dose MTX (n = 136) and those with an initial β-HCG≥ 4800 mIU/mL underwent the double-dose MTX regimen (n = 48). The treatment success was determined by evaluating the reported weekly β-HCG levels of the patients. Results: Baseline β-HCG and mass size in the single-dose group were 1895.1 ± 1463.4 mIU/mL and 2.2 ± 1.1 cm, respectively, compared to 17,867.6 ± 31,870.5 mIU/mL and 2.3 ± 1.1 cm in the double-dose group. Treatment duration was 30.6 ± 16.9 days for single dose and 41.0 ± 27.0 days for double dose, with additional MTX in 27.2% and 12.5% in respective groups. Single dose achieved a 92.6% success rate, and double dose, 81.3%, without serious adverse effects. No significant effects were seen for either baseline β-HCG and mass size on the treatment success rates of both groups (p-value>0.05). However, the presence of Fetal Heart Rate (FHR) was associated with poorer responses only in the single-dose group (p-value=0.034). Conclusions: Medical management with MTX shows promise as a first-line treatment for tubal EPs with β-HCG> 2000, suggesting a potential reassessment of existing guidelines in light of this emerging evidence. However, further research seems crucial in this field. © 2024 The Authors
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1. The Value of Serum B-Subunit of Human Chorionic Gonadotropin Level in Prediction of Treatment Response to Methotrexate in Management of Ectopic Pregnancy; a Systematic Review and Meta-Analysis, International Journal of Pediatrics (2016)
2. Comparing the Effectiveness of Letrozole Versus Methotrexate for Treatment of Ectopic Pregnancy: A Randomized Controlled Trial, European Journal of Obstetrics and Gynecology and Reproductive Biology (2024)
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