Predictive Factors for Failure of Methotrexate Treatment of Cervical Pregnancy

Lee, Jae Sung; Gwon, Ja Young; An, Eun Hee; Lim, Jae Hak; Jang, Jin Bum; Kim, Jung Yeon; Bae, Sang Wook; Lee, Gyung Joo

Abstract

OBJECTIVE
The use of methotrexate for the treatment of cervical pregnancy is now common practice. Our study was performed to determine the risk factors when the primary methotrexate treatment of cervical pregnancy was failed.
METHODS
From January 1985 to December 1999, we studied 32 women with cervical pregnancies who were treated with methotrexate intramuscularly according to a repeated intramuscular injections protocol. For evaluation of the efficacy of therapy, pretreatment serum concentrations of human chorionic gonadotropin, the size of the gestational mass, fetal cardiac activity, and the presence of fluid in the peritoneal cavity were measured. This findings were analyzed and compared by means of the chi-square test, Fisher exact test, and student's t-test between the success and failure.
RESULTS
There was no relation between the women's age, parity, the size of the conceptus, or the presence of fluid in the peritoneal cavity and the efficacy of treatment. A cervical pregnancy that presented with a serum human chorionic gonadotropin concentration of >or= 10,000mIU/ml, fetal cardiac activity was considered to be associated with a higher failure rate of primary methotrexate treatment.
CONCLUSION
Among cervical pregnancies, a high serum human chorionic gonadotropin concentration and fetal cardiac activity were the important factors associated with failure of treatment with methotrexate.