Effectiveness of Single-dose Methotrexate in Management of Ectopic Pregnancy
Suvanna Asavapiriyanont MD*,**, Piyanan Tangvenichcharoensuk MD*
Affiliation : * Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand ** College of Medicine, Rangsit University, Bangkok, Thailand
Background : Nowadays, ectopic pregnancies can be diagnosed early, and medical treatment with methotrexate instead of
surgery is being used more often than in the past. No study of the success rates and predictive factors of single-dose
methotrexate in management of ectopic pregnancy have previously been performed in Rajavithi Hospital.
Objective : To determine the success rates and predictive factors of single-dose methotrexate in treatment of ectopic pregnancy.
Material and Method: A retrospective study was conducted of ectopic pregnant women treated with methotrexate at Rajavithi
Hospital between 1st January 2011 and 31st May 2015. Successful treatment was defined as a decrease in serum beta-hCG
levels to less than 5 mIU/ml with no need for further methotrexate or surgical treatment. Data collection and analysis of serum
beta-hCG levels at pre-treatment (day 0) and post-treatment (days 4 and 7) were performed in all the subjects.
Results : In total, 106 ectopic pregnant women were initially treated with single-dose methotrexate, and seventy-two cases
(67.9%) had successful outcomes. There was no association between patient characteristics or clinical presentations with
success rates, with the exception of history of previous ectopic pregnancy (success group 4.2% vs. failure group 17.6%, p =
0.020). Median serum beta-hCG level at day 0 was significantly different between the success and failure groups (1,511
and 2,466 mIU/ml respectively, p = 0.040). A pre-treatment serum beta-hCG level of below 5,000 mIU/ml was the significant
predictive factor for success based on multivariate logistic analysis (adjusted odds ratio 3.33; 95% CI, 1.18 to 9.40;
p = 0.023).
Conclusion : Ectopic pregnant women with pre-treatment serum beta-hCG levels below 5,000 mIU/ml were the best candi-
dates for methotrexate treatment.
Keywords : Beta-hCG, Ectopic pregnancy, Methotrexate, Success rate
