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Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

Jing Zhang, Yu Zhang, Lu Gan, Xiao-ying Liu, Shan-ping Du

Abstract

Objective: The aim of this study was to summarize clinical features and identify success predictors of methotrexate (MTX) treatment in ectopic pregnancy. Methods: Retrospective study of 213 ectopic pregnancies (EPs) treated with MTX in the Department of Gynecology of the Shaanxi Provincial People's Hospital from January 2017 to December 2017. Results: Patients were divided into two groups: the successful treatment group (n=166) and the failed treatment group (n=47). The overall success rate of MTX therapy for ectopic pregnancy was 77.93%, and the total cost of MTX therapy ($437.83) was far lower than that of surgical treatment (>$1459.45). The mean initial β-hCG level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 mIU/mL versus 3195.91 mIU/mL, P=0.010). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (61.22%). The β-hCG levels were significantly increased on the 4th day in the failed treatment group (P=0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the ROC curve was 0.863 (95% CI: 0.805-0.920). Conclusions: MTX therapy as a treatment option is safe, effective and economical for asymptomatic, hemodynamically stable patients with EPs who are keen on fertility preservation, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the MTX therapy of ectopic pregnancy.

Keywords
Ectopic pregnancy, MTX therapy, β-hCG

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Preprint: Please note that this article has not completed peer review.

Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

Jing Zhang, Yu Zhang, Lu Gan, Xiao-ying Liu, Shan-ping Du

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Abstract

Objective: The aim of this study was to summarize clinical features and identify success predictors of methotrexate (MTX) treatment in ectopic pregnancy. Methods: Retrospective study of 213 ectopic pregnancies (EPs) treated with MTX in the Department of Gynecology of the Shaanxi Provincial People's Hospital from January 2017 to December 2017. Results: Patients were divided into two groups: the successful treatment group (n=166) and the failed treatment group (n=47). The overall success rate of MTX therapy for ectopic pregnancy was 77.93%, and the total cost of MTX therapy ($437.83) was far lower than that of surgical treatment (>$1459.45). The mean initial β-hCG level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 mIU/mL versus 3195.91 mIU/mL, P=0.010). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (61.22%). The β-hCG levels were significantly increased on the 4th day in the failed treatment group (P=0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the ROC curve was 0.863 (95% CI: 0.805-0.920). Conclusions: MTX therapy as a treatment option is safe, effective and economical for asymptomatic, hemodynamically stable patients with EPs who are keen on fertility preservation, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the MTX therapy of ectopic pregnancy.

Figures

Background

Methods

Results

Discussion

Conclusions

Abbreviations

Declarations

References

Tables

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