Medical Therapy for Ectopic Pregnancy

Gary H Lipscomb M.D.

Disclosures

Semin Reprod Med. 2007;25(2):93-98. 

In This Article

Predictors Of Success For Single-Dose Methotrexate

Many clinical variables have been suggested as prognostic of success with methotrexate therapy for tubal ectopic pregnancy. The most commonly quoted predictors of success are hCG levels, progesterone levels, ectopic size, the presence of ectopic cardiac activity, and the presence of free peritoneal blood. Unfortunately, there is no consensus on which selection criteria are reliable. Because of the small numbers of treated patients previously available for analysis, it has been difficult to determine the true effect of these parameters on success rates. However, in one review the effect of ectopic size, mass volume, initial serum hCG levels, initial serum progesterone levels, and the presence or absence of ectopic fetal cardiac activity or free peritoneal blood were evaluated with respect to their effect on success with single-dose methotrexate treatment of 350 consecutive tubal ectopic pregnancies.[6] Preliminary univariate analysis showed only initial hCG level, initial progesterone, and the presence of ectopic cardiac activity to be statistically significant. Interestingly, ectopic size, hematoma volume, or the presence of free peritoneal blood confined to the pelvis was not a significant risk factor for treatment failure. Logistic regression on these three statistically significant variables showed hCG to be the only significant contributing factor to the failure rate, with a marked increase in the failure rate seen after 15,000 mIU/mL. This would seem to indicate that many previous relative contraindications for medical therapy are invalid, and that only hCG is predictive. Failure rates by hCG levels based on this study are presented in Table 4 . These failure rates can be used to counsel patients on their relative chance of success with single-dose methotrexate for ectopic pregnancy.

Additional data have suggested that a history of previous ectopic pregnancy may also be an independent risk factor for failure of methotrexate therapy. This appears to be unrelated to the previous method of treatment for the prior ectopic pregnancy.[14]

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