Korean J Obstet Gynecol.  2007 Sep;50(9):1260-1269.

Therapeutic effect and predictors of failure with single-dose methotrexate injection in ectopic pregnancy

• Ryu KH
• Jung HJ
• Jeon SR
• Cho YS
• Kim YJ
• Choi EK

Abstract

OBJECTIVE
To evaluate the therapeutic effect of single-dose methotrexate injection for ectopic pregnancy and determine the possible predictors of therapeutic failure.
METHODS
We retrospectively reviewed 127 patients' records with methotrexate injection (50 mg/m2) for unruptured ectopic pregnancy from January 2001 to December 2006. The transvaginal sonographic findings in each case were analyzed according to the presence and size of an ectopic mass, endometrial pattern, amount of intraperitoneal fluid, presence of yolk sac and presence of pseudogestational sac. Patient's age, pretreatment beta-hCG levels and clinical symptoms were also recorded. Success of treatment was regarded only when single or another dose of methotrexate injection was needed to lower the beta-hCG levels to non-pregnant state (<5 mIU/ml).
RESULTS
Of 127 patients, 65 cases (51.2%) succeeded with single-dose of methotrexate, 44 cases (34.6%) multi-dose of methotrexate, and ultimately 18 cases (14.2%) surgical procedures. Elevated pretreatment beta-hCG levels, size of an ectopic mass, trilaminar endometrial pattern, presence of yolk sac and vaginal bleeding were the main predictors of single-dose methotrexate treatment failure.
CONCLUSION
Single-dose methotrexate injection was proved to be safe and effective method for ectopic pregnancy. Transvaginal sonographic findings could be important prognostic factors as well as pretreatment beta-hCG levels.

Keyword

Ectopic pregnancy; Methotrexate; Therapeutic effect; Predictors of failure

MeSH Terms

Female
Humans
Methotrexate*
Pregnancy
Pregnancy, Ectopic*
Retrospective Studies
Treatment Failure
Ultrasonography
Uterine Hemorrhage
Yolk Sac
Methotrexate