Abstract
Objective
To determine whether the success of treatment with single-dose methotrexate (SD MTX)
for ectopic pregnancy can be predicted using the rate of change in serum β-human chorionic
gonadotropin (β-hCG) level.
Study design
This was a retrospective observational study conducted at a tertiary referral centre.
The study population included women who underwent treatment with SD-MTX for ectopic
pregnancy. We analysed data of 119 women treated with SD-MTX for ectopic pregnancy
at the Galilee Medical Centre between 2012 and 2016. Success was defined as a <15%
decrease in β-hCG level between days 4 and 7, with no need for a second dose of MTX
or surgical intervention.
The dynamics of serum β-hCG levels before treatment were considered as the main outcomes.
Results
SD-MTX administration was successful in 77 (65%) patients. The average baseline β-hCG
level was significantly lower in women with successful outcomes than in those without
successful outcomes (763.1 vs. 1429.63 mIU/L, respectively, p < 0.0048). The hourly change in β-hCG level was significantly lower in those with
successful outcomes than in those without successful outcomes (0.38 vs. 5.73 mIU/mL,
respectively, p < 0.0023). The percentage change in β-hCG level was 13.1%, which was not significantly
different between the groups (p < 0.133). At serum β-hCG level < 946 mIU/mL and sac size < 2.55 cm, the treatment
was successful in 88% of women.
Conclusions
We propose a predictive model of hourly change in β-hCG to achieve successful treatment
using SD-MTX in ectopic pregnancy based on objective and measurable criteria.
Keywords
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Biography
Avishalom Sharon, MD Head of the Gynecology department, a Specialist in Endoscopic Operations and Endometriosis, Galilee Medical Center, Nahariya and Bar Ilan Faculty of Medicine, Zefat, Israel. MD Degree (1993) at Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Specialist in Obstetrics and Gynecology (2000) at Carmel Medical Center, Haifa, Fellowship (2006) at Advanced Gyneco-Laparoscopic Surgeries and Oncology at the Charite' Medical Center, Berlin. His research interests include laparoscopic surgeries and endometriosis. Awarded for Excellence in teaching medical students in years 2008–2020. Executive committee member of The Israeli Society of Gynecological Endoscopy (ISGE).
Biography
Gal Lavie-Shaked Graduated from Tel Aviv university faculties of Biology and Sociology with a BA degrees in 2013 and from Bar Ilan University Faculty of Medicine with an MD degree in 2017. Completed her initial medical training in the Galilee medical center in Naharia and is currently a resident specializing in Internal Medicine in Bnei Zion Hospital in Haifa.
Biography
Renee Tendler, MD Specialist in Obstetrics and Gynecology. Completed MD Degree (1980) at the faculty of medicine of the University of Lasi, Romania. Specialist in Obstetrics and Gynaecology since 1990. Serves as a senior physician in the gynecology department, at the Galilee Medical Center, Nahariya, Israel.
Biography
Mohammed Kais, MD A specialist in Obstetrics and Gynecology, and a senior physician in the Gynecology department, at the Galilee Medical Center, Nahariya, Israel, since 1985. MD Degree (1984) at the faculty of medicine of the University of Jassy, Romania. A member of the Israeli Medical Association, the Israeli Society of Obstetrics and Gynaecology, the European society of genecological endoscopy and the european society of human reproduction & embryology.
Biography
Marwan Odeh MD Clinical Associate Proofessor and specialist in Obstetrics and Gynecology, head of the Ultrasound Unit in Obstetrics and Gynecology, Galilee Medical Center, Nahariya and the Bar Ilan Faculty of Medicine, Zefat, Israel. MD (1986) at the Sackler School of Medicine of the University of Tel-Aviv. A member and treasurer of the Israeli committee of ultrasound in obstetrics and gynecology for the years 2010-2012.
Biography
Jacob Bornstein, MD Past chairman of the Department of Obstetrics and Gynecology at Galilee Medical Center and Full Professor at the Bar-Ilan University, Faculty of Medicine. Past President of the International Society for the Study of Vulvovaginal Disease. Chairman of the terminology committees of the ISSVD and the International Federation of Cervical Pathology and Colposcopy (IFCPC). Authors of books and 180 papers in peer reviewed Journals.
Article info
Publication history
Published online: August 08, 2021
Accepted:
August 5,
2021
Received in revised form:
July 30,
2021
Received:
May 11,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
