ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study

Abstract Objective: To evaluate the diagnostic accuracy of different beta-human chorionic gonadotrophin (ß-hCG) levels measurement, for predicting success of medical treatment in cases diagnosed as tubal ectopic pregnancy (TEP). Design: Five-year prospective observational study. Setting: Prenatal Di...

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Published in:The journal of maternal-fetal & neonatal medicine 2015-04, Vol.28 (6), p.695-699
Main Authors: Orozco, Esteban Mauricio, Sánchez-Durán, Maria Angeles, Bello-Muñoz, Juan Carlos, Sagalá, Juan, Carreras, Elena, Roura, Lluis Cabero
Format: Article
Language:English
Subjects:
Abortifacient Agents, Nonsteroidal - therapeutic use
Adolescent
Adult
Beta-human chorionic gonadotrophin
Chorionic Gonadotropin, beta Subunit, Human - blood
ectopic pregnancy
Female
Follow-Up Studies
Humans
methotrexate
Methotrexate - therapeutic use
Predictive Value of Tests
Pregnancy
Pregnancy, Ectopic - blood
Pregnancy, Ectopic - diagnosis
Pregnancy, Ectopic - drug therapy
Prognosis
Treatment Outcome
Young Adult
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Summary:Abstract Objective: To evaluate the diagnostic accuracy of different beta-human chorionic gonadotrophin (ß-hCG) levels measurement, for predicting success of medical treatment in cases diagnosed as tubal ectopic pregnancy (TEP). Design: Five-year prospective observational study. Setting: Prenatal Diagnosis Unit, Vall d'Hebron University Hospital - Barcelona. Patients: TEP cases fulfilling criteria for medical treatment with Methotrexate. Interventions: ß-hCG levels were measured on d 0, 4 and 7 of treatment. Results were compared by non-parametrical tests. A ROC curve was plotted to define cut-off points. Diagnostic accuracy of the different measurements was evaluated. Main outcome measure: Failure of treatment defined as need for surgical treatment or persistence of high ß-HCG levels despite treatment. Results: 126 women were diagnosed as TEP, eligible for medical treatment. There were no differences in parity, age, previous TEP, or adnexal mass size. Success rate was 88%. ß-HCG decreased significantly more, between days 0-7 and 4-7, in the successful cases. LR for success prediction was 6.2 and 7.8 for ß-HCG levels at days 4 and 7 respectively, 4.02 and 2.47 for decrement between days 0-7 (25%) and 4-7 (20%), respectively. Conclusion: ß-hCG cutoff values have a potential for predicting a successful medical treatment of TEP.
ISSN:1476-7058
1476-4954
DOI:10.3109/14767058.2014.928857