Efficacy and Predictors of Success of Methotrexate Treatment in Women with Unruptured Tubal Ectopic Pregnancies

Rhu, Sang Woo; Lee, Gui Se Ra; In, Kown; Hur, Soo Young; Kim, Sa Jin; Kim, Eun Joong

Abstract

OBJECTIVE
To evaluate the efficacy and predictors of success of methotrexate (MTX) treatment in selected cases of unruptured tubal pregnancies.
METHODS
This study was retrospectively performed in 36 women who had diagnosed unruptured tubal pregnancies. Patients received intramuscular MTX. Serial beta-hCG measurement was performed weekly, and success was defined as the achievement to beta-hCG concentration of 10 mIU/mL without surgical intervention. Surgical intervention was performed for presumed tubal rupture. Pretreatment serum concentration of beta-hCG, the size of tubal mass and gestational sac by transvaginal ultrasonography were measured to evaluate the predictors of MTX therapy.
RESULTS
29 patients (81%) were successfully treated by MTX systematic treatment. There were not significant differences in the patient's age, parity, gestational age and the size of tubal ectopic mass, but significant differences in the gestational sac size and serum beta-hCG concentration between success group and failure group of MTX treatment. The mean time for achieving successful treatment was 33.8 days. The success rate of systemic MTX was significantly decreased and resolution time was prolonged if the initial pretreatment serum beta-hCG was 10,000 mIU/mL or gestational sac size was >or=1 cm.
CONCLUSION
Pretreatment serum beta-hCG concentration and gestational sac size are important predictors of success of MTX treatment in women with unruptured tubal pregnancy.