Endometrial thickness as a predictor of methotrexate treatment success in ectopic pregnancy: A prospective cohort study

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2025-08-23 DOI:10.1111/jog.70043

Shima Hoseini, Sara Ashtari, Mohammad Mahdi Mehrabi, Nafiseh Saedi, Zahra Rezaei

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引用次数: 0

Abstract

Aim

Ectopic pregnancy (EP) remains a significant cause of first-trimester maternal morbidity and mortality. Methotrexate (MTX) is an effective non-surgical treatment for selected early pregnancy cases; however, predicting treatment success remains challenging. Endometrial thickness (ET) has been suggested as a potential predictor, though its clinical utility remains uncertain.

Methods

In this prospective cohort study, 86 women with diagnosed tubal EP and stable hemodynamic status received a single intramuscular dose of MTX (50 mg/m²). Endometrial thickness was measured via transvaginal sonography. Treatment success was defined as a >15% decline in serum β-hCG between days 4 and 7 post-MTX without the need for a second dose or surgery. Logistic regression and ROC analysis were conducted to evaluate predictors of treatment success.

Results

Treatment was successful in 57% of patients. Responders had significantly thinner endometria (mean ET: 8.09 ± 3.53 mm) compared to non-responders (11.54 ± 4.07 mm, p < 0.001). An ET cut-off of 9.5 mm predicted treatment success with 73% sensitivity and 69.6% specificity (AUC = 0.740, p < 0.001). Mass size was also a significant independent predictor, while initial β-hCG and yolk sac presence were not.

Conclusion

Endometrial thickness is a significant predictor of MTX treatment success in unruptured EP. An ET ≤9.5 mm is associated with a higher likelihood of response. ET measurement may aid clinicians in selecting patients and developing effective management strategies.

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子宫内膜厚度作为异位妊娠甲氨蝶呤治疗成功的预测因子：一项前瞻性队列研究

目的异位妊娠（EP）仍然是妊娠早期产妇发病率和死亡率的重要原因。甲氨蝶呤（MTX）是一种有效的非手术治疗选择早期妊娠病例；然而，预测治疗成功仍然具有挑战性。子宫内膜厚度（ET）已被认为是一个潜在的预测指标，尽管其临床应用仍不确定。方法在这项前瞻性队列研究中，86名确诊为输卵管性EP且血流动力学状态稳定的女性接受单次肌内注射MTX （50mg /m2）。经阴道超声测量子宫内膜厚度。治疗成功的定义是甲氨蝶呤治疗后第4至7天血清β-hCG下降15%，无需第二次剂量或手术。采用Logistic回归和ROC分析评估治疗成功的预测因素。结果治疗成功率为57%。应答者子宫内膜明显变薄（平均ET: 8.09±3.53 mm），而无应答者（11.54±4.07 mm, p < 0.001）。ET截止值为9.5 mm，预测治疗成功的敏感性为73%，特异性为69.6% （AUC = 0.740, p < 0.001）。质量大小也是一个显著的独立预测因子，而初始β-hCG和卵黄囊的存在则不是。结论子宫内膜厚度是预测未破裂EP患者MTX治疗成功的重要指标。ET≤9.5 mm与较高的反应可能性相关。ET测量可以帮助临床医生选择患者和制定有效的管理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.