Evaluating the role of human chorionic gonadotropin increment in the 48 h prior methotrexate treatment for predicting the treatment success: a retrospective cohort study.

Abstract

Objectives: To evaluate the role of human chorionic gonadotropin (hCG) change in the 48 h prior to methotrexate treatment as a predictor for treatment success of ectopic pregnancy.

Material and methods: This was a retrospective cohort study. A total of 179 women who diagnosed with ectopic pregnancy and given a single dose (50 mg/m²) of methotrexate were included in this study from January 1, 2016 to December 31, 2017. Serum hCG levels and clinical data were collected and compared between the success and failure groups, the percentage increment of hCG levels during the 48 hours prior to methotrexate injection was used to create a receiver operating characteristic (ROC) curve to determine the optimal cut-off value for predicting treatment success.

Results: The success rate of treating ectopic pregnancy with a single dose of methotrexate was 70.9%. The optimal cut-off value for percentage increment of serum hCG levels before methotrexate injection was determined to be 12.56%, with a specificity of 60.66% and sensitivity of 55.69%. The area under the receiver operating characteristic curve (AUC) was 0.646 (p < 0.01).

Conclusions: A lower 2-day hCG percentage increment before methotrexate injection was found to be associated with successful treatment of ectopic pregnancy, with a cut-off value of 12.56%. However, caution should be exercised when deciding on methotrexate treatment versus surgery for ectopic pregnancy patients.