Magnitude of hCG drop with MTX for ectopic pregnancy guides follow-up

  • Eur J Obstet Gynecol Reprod Biol

  • International Clinical Digest
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Takeaway

  • In ectopic pregnancy, the magnitude of human chorionic gonadotropin (hCG) decrease with methotrexate (MTX) treatment can help assess patient risk and reduce follow-up time.

Why this matters

  • MTX is used for the treatment of ectopic pregnancy at a rate of up to 27% in the US.

Study design

  • Observational cohort study of MTX (1 mg/kg) for ectopic pregnancy.
  • Day 1 (D1) was day of injection.
    • With hCG drop ≤20% from D1 to D4, women were assigned to high-risk group.
  • Low-risk women (n=151) underwent hCG testing on D28.
  • D28 hCG ≤15 mUI/mL confirmed successful treatment.
  • High-risk women (n=274) tested at D7 and then weekly; decline of hCG from D4 to D7 or weekly was
  • Outcome measures were success rate, proportion of women requiring multiple injections, and mean number of consultations per women and duration of follow-up.
  • Funding: None.

Key results

  • In the low-risk group, success rates were higher, with fewer doses of MTX and follow-up visits needed.
  • Success rate after a single dose was 89.9% in low-risk vs 76% in high-risk group.
  • Failures in low-risk group: 5 surgical treatments between D4 and D7 and 1 at D38.

Limitations

  • This protocol would occasionally delay follow-up for MTX failure.