The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years’ Experience in a Tertiary Center

• Main Authors: Sindiani AM, Alshdaifat E, Obeidat B, Obeidat R, Rawashdeh H, Yaseen H
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-12-01
• Series: International Journal of Women's Health
• Subjects: ectopic pregnancy; methotrexate; pretreatment β hcg
• Online Access: https://www.dovepress.com/the-use-of-single-dose-methotrexate-in-the-management-of-ectopic-pregn-peer-reviewed-article-IJWH
• ISSN: 1179-1411

Amer Mahmoud Sindiani,1 Eman Alshdaifat,2 Basil Obeidat,1 Rawan Obeidat,1 Hasan Rawashdeh,1 Hashem Yaseen3 1Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Yarmouk University, Irbid, Jordan; 3Department of Obstetrics and Gynecology, Faculty of Medicine, Muta University, Alkarak, JordanCorrespondence: Amer Mahmoud SindianiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box: (3030), Irbid 22110, JordanTel [phone]Fax [phone]Email [e-mail]: To study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy.Methods: This is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (β-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups.Results: The overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (∼ 55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment β-HCG level was 2.3 times higher in Group F than in Group S (1734± 1684 vs 4036± 2940 IU/L). The data showed a β-HCG level of 3924IU/L as a suitable cut-off value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor.Conclusion: The single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment β-HCG level is a significant predictor of the treatment outcome.Keywords: ectopic pregnancy, methotrexate, pretreatment β HCG