Using a decline in serum hCG between days 0–4 to predict ectopic pregnancy treatment success after single-dose methotrexate: a retrospective cohort study

BMC Pregnancy and Childbirth

Stephen Tong²  Andrew W Horne¹  William Colin Duncan¹  Philip Dutton¹  Monika Skubisz³ 

[1] MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, EH16 4TJ, United Kingdom;Translational Obstetrics Group, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria 3084, Australia;The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria 3168, Australia

关键词: Treatment success;    Positive predictive value;    Methotrexate;    Medical management;    Human chorionic gonadotrophin;    Ectopic pregnancy;   

Others  :  1151050
DOI  :  10.1186/1471-2393-13-30

 received in 2012-10-18, accepted in 2013-01-29,  发布年份 2013

【 摘 要 】

Background

The current measure of treatment efficacy of single-dose methotrexate for ectopic pregnancy, is a fall in serum hCG of ≥15% between days 4–7 of treatment, which has a positive predictive value of 93% for treatment success. Two small studies have proposed a fall in serum hCG between days 0–4 after treatment confers similar, earlier prognostic information, with positive predictive values of 100% and 88% for treatment success. We sought to validate this in a large, independent cohort because of the potentially significant clinical implications.

Methods

We conducted a retrospective study of women (n=206) treated with single-dose methotrexate for ectopic pregnancy (pre-treatment serum hCG levels ≤3000 IU/L) at Scottish hospitals between 2006–2011. Women were divided into two cohorts based on whether their serum hCG levels rose or fell between days 0–4 after methotrexate. Treatment outcomes of women in each cohort were compared, and the test performance characteristics calculated. This methodology was repeated for the current measure (≥15% fall in serum hCG between days 4–7 of treatment) and an alternate early measure (<20% fall in serum hCG between days 0–4 of treatment), and all three measures were compared for their ability to predict medical treatment success.

Results

In our cohort, the positive predictive value of the current clinical measure was 89% (95% CI 84-94%) (121/136). A falling serum hCG between days 0–4 predicted treatment success in 85% (95% CI 79-92%) of cases (94/110) and a <20% fall in serum hCG between days 0–4 predicted treatment success in 94% (95% CI 88-100%) of cases (59/63). There was no significant difference in the ability of these tests to predict medical treatment success.

Conclusions

We have verified that a decline in serum hCG between days 0–4 after methotrexate treatment for ectopic pregnancies, with pre-treatment serum hCG levels ≤3000 IU/L, provides an early indication of likelihood of treatment success, and performs just as well as the existing measure, which only provides prognostic information on day 7.

【 授权许可】

   
2013 Skubisz et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM: Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstet Gynecol 2011, 117(4):837-843.
• [2]Stovall TG, Ling FW, Buster JE: Outpatient chemotherapy of unruptured ectopic pregnancy. Fertil Steril 1989, 51(3):435-438.
• [3]Jurkovic D, Wilkinson H: Diagnosis and management of ectopic pregnancy. BMJ 2011, 342:d3397.
• [4]Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW: Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 2011, 37(4):231-240.
• [5]Stovall TG, Ling FW, Gray LA: Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol 1991, 77(5):754-757.
• [6]Kirk E, Condous G, Van Calster B, Haider Z, Van Huffel S, Timmerman D, Bourne T: A validation of the most commonly used protocol to predict the success of single-dose methotrexate in the treatment of ectopic pregnancy. Hum Reprod 2007, 22(3):858-863.
• [7]Nguyen Q, Kapitz M, Downes K, Silva C: Are early human chorionic gonadotropin levels after methotrexate therapy a predictor of response in ectopic pregnancy? Am J Obstet Gynecol 2010, 202(6):630. e631-635
• [8]Skubisz MM, Li J, Wallace EM, Tong S: Decline in betahCG levels between days 0 and 4 after a single dose of methotrexate for ectopic pregnancy predicts treatment success: a retrospective cohort study. BJOG 2011, 118(13):1665-1668.
• [9]Agostini A, Blanc K, Ronda I, Romain F, Capelle M, Blanc B: Prognostic value of human chorionic gonadotropin changes after methotrexate injection for ectopic pregnancy. Fertil Steril 2007, 88(2):504-506.
• [10]Barnhart K, van Mello NM, Bourne T, Kirk E, Van Calster B, Bottomley C, Chung K, Condous G, Goldstein S, Hajenius PJ, et al.: Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil Steril 2011, 95(3):857-866.
• [11]RCOG: The Management of Tubal Pregnancy. In Green-top Guidelines. London, UK: RCOG; 2010:10.