Comparison of alternative βhCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy

• Published in: Archives of gynecology and obstetrics 2017-12, Vol.296 (6), p.1161-1165
• Main Authors: Şükür, Yavuz Emre, Koyuncu, Kazibe, Seval, Mehmet Murat, Çetinkaya, Esra, Dökmeci, Fulya
• Format: Article
• Language: English
• Subjects: Abortifacient Agents, Nonsteroidal - administration & dosage; Abortifacient Agents, Nonsteroidal - therapeutic use; Adult; Chorionic Gonadotropin, beta Subunit, Human - blood; Cost-Benefit Analysis; Endocrinology; Female; Follow-Up Studies; General Gynecology; Gynecology; Hospitals, University; Human Genetics; Humans; Medicine; Medicine & Public Health; Methotrexate - administration & dosage; Methotrexate - therapeutic use; Obstetrics/Perinatology/Midwifery; Pregnancy; Pregnancy complications; Pregnancy, Ectopic - drug therapy; Pregnancy, Tubal - drug therapy; Treatment Outcome
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-017-4527-1

Purpose To evaluate the performances of five different βhCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy (EP). Methods Data of patients who received single-dose methotrexate therapy for tubal EP at a university hospital between January 2011 and July 2016 were reviewed. A ‘successful methotrexate treatment’ was defined if the EP treated with no need for surgery. The performances of different protocols were tested by comparing with the currently used ‘15% βhCG decrease between days 4 and 7’ protocol. The tested follow-up protocols were ‘20, 25%, and any βhCG decrease between days 0/1 and 7’ and ‘20% and any βhCG decrease between days 0/1 and 4’. Results Among the 96 patients evaluated, 12 (12.5%) required second dose. Totally, 91 (94.8%) patients treated successfully with no need for surgery. Four patients were operated within 4 days following the second dose. One patient who did not need second dose according to the standard follow-up protocol was operated on the 10th day due to rupture (specificity = 80%). Two protocols, namely ‘20% βhCG decrease between days 0/1 and 7’ and ‘any βhCG decrease between days 0/1 and 7’ did not show statistically significant differences from the index protocol regarding the number of patients who should be assigned to 2nd dose. Conclusions ‘Any βhCG decrease between days 0/1 and 7’ protocol may substitute the currently used one to decide second dose methotrexate in tubal EP management. Omitting 4th day measurement seems to be more convenient and cost effective.