The predictors of successful methotrexate treatment of tubal ectopic pregnancy
Background The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy remain controversial. This study investigated the outcomes of ectopic pregnancy after one and two MTX doses and their indep...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2024-12-01
|
| Series: | Journal of Obstetrics and Gynaecology |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/01443615.2024.2361456 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841553151920963584 |
|---|---|
| author | Eiman Abdelfattah-Arafa Hager Farag Abdussalam Mohamed Omar Saad Walid El Ansari |
| author_facet | Eiman Abdelfattah-Arafa Hager Farag Abdussalam Mohamed Omar Saad Walid El Ansari |
| author_sort | Eiman Abdelfattah-Arafa |
| collection | DOAJ |
| description | Background The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy remain controversial. This study investigated the outcomes of ectopic pregnancy after one and two MTX doses and their independent predictors.Methods Retrospective cross-sectional study of women who consented to MTX treatment in 2017–2018 at our institution (N = 317). Of these, patients with Caesarean scar pregnancies were excluded because they require different treatment protocols (n = 25). All patients were treated according to our institution’s protocol based on international guidelines and standardised across the three hospitals included in the current study. We retrieved patients’ demographics, laboratory, ultrasonography, and clinical characteristics from our hospital database. Serum β-human chorionic gonadotropin (β-hCG) was measured using electrochemiluminescence immunoassay; ectopic pregnancy was diagnosed using ultrasonography (transvaginal probe).Results Two ninety-two patients were included in the current analysis. Age, pre-treatment β-hCG levels, sonographic presence of yolk sac, presence of foetal cardiac activity, and pelvic pain were significantly different between patients with successful and unsuccessful outcomes. Younger age (adjusted odds ratio [aOR] 2.33, 95% confidence interval (CI) 1.16–4.66, p = .017), no pelvic pain (aOR 2.65, 95%CI 1.03–6.83, p = .043), lower initial β-hCG level (aOR 1.32, 95%CI 1.08–1.59, p = .005), and absence of foetal cardiac activity (aOR 12.63; 95% CI 1.04–153.6; p = .047) were independently associated with success. Treatment failure odds were >2 folds higher for each 10-year age increase (p = .017), 32% higher for each 1000 IU/L increase in initial β-hCG level (p = .005), and >2 folds higher in presence of pelvic pain (p = .043).Conclusions MTX is effective in most patients, averting invasive surgery, which might affect fertility. Pre-treatment β-hCG levels, age, pelvic pain, and foetal cardiac activity was independently associated with outcomes. Research should assess the relationship between the ectopic pregnancy size and treatment outcomes and refine β-hCG titres where treatment would be ineffective. |
| format | Article |
| id | doaj-art-6ca79c4ceb024df8ac7e240aee2617f9 |
| institution | Kabale University |
| issn | 0144-3615 1364-6893 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Obstetrics and Gynaecology |
| spelling | doaj-art-6ca79c4ceb024df8ac7e240aee2617f92025-01-09T12:13:18ZengTaylor & Francis GroupJournal of Obstetrics and Gynaecology0144-36151364-68932024-12-0144110.1080/01443615.2024.2361456The predictors of successful methotrexate treatment of tubal ectopic pregnancyEiman Abdelfattah-Arafa0Hager Farag Abdussalam1Mohamed Omar Saad2Walid El Ansari3Department of Pharmacy, Al Khor Hospital, Al Khor, QatarDepartment of Obstetrics and Gynecology, Al Khor Hospital, Al Khor, QatarDepartment of Pharmacy, Al Wakra Hospital, Al Wakra, QatarDepartment of Surgery, Hamad Medical Corporation, Doha, QatarBackground The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy remain controversial. This study investigated the outcomes of ectopic pregnancy after one and two MTX doses and their independent predictors.Methods Retrospective cross-sectional study of women who consented to MTX treatment in 2017–2018 at our institution (N = 317). Of these, patients with Caesarean scar pregnancies were excluded because they require different treatment protocols (n = 25). All patients were treated according to our institution’s protocol based on international guidelines and standardised across the three hospitals included in the current study. We retrieved patients’ demographics, laboratory, ultrasonography, and clinical characteristics from our hospital database. Serum β-human chorionic gonadotropin (β-hCG) was measured using electrochemiluminescence immunoassay; ectopic pregnancy was diagnosed using ultrasonography (transvaginal probe).Results Two ninety-two patients were included in the current analysis. Age, pre-treatment β-hCG levels, sonographic presence of yolk sac, presence of foetal cardiac activity, and pelvic pain were significantly different between patients with successful and unsuccessful outcomes. Younger age (adjusted odds ratio [aOR] 2.33, 95% confidence interval (CI) 1.16–4.66, p = .017), no pelvic pain (aOR 2.65, 95%CI 1.03–6.83, p = .043), lower initial β-hCG level (aOR 1.32, 95%CI 1.08–1.59, p = .005), and absence of foetal cardiac activity (aOR 12.63; 95% CI 1.04–153.6; p = .047) were independently associated with success. Treatment failure odds were >2 folds higher for each 10-year age increase (p = .017), 32% higher for each 1000 IU/L increase in initial β-hCG level (p = .005), and >2 folds higher in presence of pelvic pain (p = .043).Conclusions MTX is effective in most patients, averting invasive surgery, which might affect fertility. Pre-treatment β-hCG levels, age, pelvic pain, and foetal cardiac activity was independently associated with outcomes. Research should assess the relationship between the ectopic pregnancy size and treatment outcomes and refine β-hCG titres where treatment would be ineffective.https://www.tandfonline.com/doi/10.1080/01443615.2024.2361456Ectopic pregnancymedical managementmethotrexatepregnancy of unknown location |
| spellingShingle | Eiman Abdelfattah-Arafa Hager Farag Abdussalam Mohamed Omar Saad Walid El Ansari The predictors of successful methotrexate treatment of tubal ectopic pregnancy Journal of Obstetrics and Gynaecology Ectopic pregnancy medical management methotrexate pregnancy of unknown location |
| title | The predictors of successful methotrexate treatment of tubal ectopic pregnancy |
| title_full | The predictors of successful methotrexate treatment of tubal ectopic pregnancy |
| title_fullStr | The predictors of successful methotrexate treatment of tubal ectopic pregnancy |
| title_full_unstemmed | The predictors of successful methotrexate treatment of tubal ectopic pregnancy |
| title_short | The predictors of successful methotrexate treatment of tubal ectopic pregnancy |
| title_sort | predictors of successful methotrexate treatment of tubal ectopic pregnancy |
| topic | Ectopic pregnancy medical management methotrexate pregnancy of unknown location |
| url | https://www.tandfonline.com/doi/10.1080/01443615.2024.2361456 |
| work_keys_str_mv | AT eimanabdelfattaharafa thepredictorsofsuccessfulmethotrexatetreatmentoftubalectopicpregnancy AT hagerfaragabdussalam thepredictorsofsuccessfulmethotrexatetreatmentoftubalectopicpregnancy AT mohamedomarsaad thepredictorsofsuccessfulmethotrexatetreatmentoftubalectopicpregnancy AT walidelansari thepredictorsofsuccessfulmethotrexatetreatmentoftubalectopicpregnancy AT eimanabdelfattaharafa predictorsofsuccessfulmethotrexatetreatmentoftubalectopicpregnancy AT hagerfaragabdussalam predictorsofsuccessfulmethotrexatetreatmentoftubalectopicpregnancy AT mohamedomarsaad predictorsofsuccessfulmethotrexatetreatmentoftubalectopicpregnancy AT walidelansari predictorsofsuccessfulmethotrexatetreatmentoftubalectopicpregnancy |