Indian Journal of Medical Biochemistry

Register      Login

VOLUME 25 , ISSUE 3 ( September-December, 2021 ) > List of Articles

ORIGINAL RESEARCH ARTICLE

Initial and Day Four β-hCG Levels as Predictors of Outcome of Single-dose Methotrexate Therapy in Medical Management of Tubal Ectopic Gestation

Anuradha Kumari, Ratna Biswas, Neeraj Yadav, Ekta Debnath

Keywords : Drugs, Ectopic, β-hCG, Pregnancy

Citation Information : Kumari A, Biswas R, Yadav N, Debnath E. Initial and Day Four β-hCG Levels as Predictors of Outcome of Single-dose Methotrexate Therapy in Medical Management of Tubal Ectopic Gestation. Indian J Med Biochem 2021; 25 (3):91-95.

DOI: 10.5005/jp-journals-10054-0195

License: CC BY-NC 4.0

Published Online: 11-03-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: Ectopic pregnancy is defined as the implantation of a fertilized ovum outside the endometrial cavity. The most common site is the fallopian tube. The incidence of ectopic pregnancy is 1–2% of all pregnancies. Methotrexate is the most commonly used drug for the medical management of ectopic pregnancy. It is a folic acid antagonist that prevents the growth of rapidly dividing cells including trophoblasts and fetal cells by interfering with DNA synthesis. Aim and objective: To study initial and day 4 β-hCG levels as predictors of outcome of single-dose methotrexate therapy in the medical management of ectopic pregnancy. Materials and methods: Thirty patients after confirmed diagnoses of tubal ectopic pregnancy were enrolled in the study. β-hCG was estimated using a sequential two-step immunoenzymatic (sandwich) assay. Results: Out of 30 women who received inj MTX on day 0, 19 (63.3%) women were treated successfully with a single dose of methotrexate (group I), 8 (26.6%) women required a second dose of methotrexate, and 3 (10%) women required surgery. Women who required a second dose or surgery were treatment failure (group II) (36.6%) with a single-dose methotrexate regimen. The mean initial β-hCG β-hCG level was 2294.92 ± 1162.93 mIU/mL in group I and 3831.18 ± 1066.83 mIU/mL in group II. The difference of mean was statistically significant between group I and group II on day 0, day 4, and day 7. Conclusion: Results in the present study favor therapeutic intervention with a second dose of methotrexate on day 4 against day 7 as in the current protocol in women with a rising trend of β-hCG between day 0 and day 4. However, due to the small sample size, further studies are needed to validate these findings.


HTML PDF Share
  1. Coste J, Bouyer J, Job-Spira N. Epidemiology of ectopic pregnancy: incidence and risk factors. Fertil Contracept Sex 1996;24(2):135–139.
  2. Calabressi P, Chabner BA. Antineoplastic agents. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. New York: Macmillan 8th ed., 1990. pp. 1275–1276.
  3. Ectopic pregnancy and miscarriage: diagnosis and initial management. NICE Clinical guidelines 2012. p. 154.
  4. Stovall TG, Ling FW. Single dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol 1993;168(6 Pt 1):1759–1765. DOI: 10.1016/0002-9378(93)90687-e.
  5. Shaamash AH, Alshabrani MS, Awadalla NJ, et al. Falling in serum human chorionic gonadotropin levels between days 1 and 7 as a new protocol to predict successful single-dose of methotrexate therapy for ectopic pregnancy. Middle East Fer Soc J 2014. 77.
  6. Cohen A, Bibi G, Almog B, et al. Second dose methotrexate in ectopic pregnancies: the role of beta human chorionic gonadotropin. Fertil Steril 2014;102(6):1646–1649. DOI: 10.1016/j.fertnstert.2014.08.019.
  7. Elito J, Reichmann AP, Uchiyama MN, et al. Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate. Int J Gynecol Obstet 1999;67(2):75–79. DOI: 10.1016/s0020-7292(99)00114-9.
  8. Eskander M. Single dose methotrexate for treatment of ectopic pregnancy: risk factors for treatment failure. Middle East Fertil Soc J 2007;12:57–62.
  9. Mirbolouk F, Yousefnezhad A, Ghanbari A. Predicting factors of medical treatment success with single dose methotrexate in tubal ectopic pregnancy: a retrospective study. Iran J Reprod Med 2015;13(6):351–354.
  10. Ustunyart E, Duran M, Coskum E, et al. Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single dose methotrexate treatment in women with tubal ectopic pregnancy. Arch Gynecol Obstet 2013;288(5):1149–1152. DOI: 10.1007/s00404-013-2879-8.
  11. Sagiv R, Debby A, Feit H, et al. The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy. Int J Gynecol Obstet 2012;116(2):101–104. DOI: 10.1016/j.ijgo.2011.09.023.
  12. Skubisz M, Duncan P, Duncan WC, et al. Using a decline in serum hCG between days 0–4 to predict ectopic pregnancy treatment success after single dose methotrexate. BMC Preg Childbirth 2013;13(1):30. DOI: 10.1186/1471-2393-13-30.
  13. Renukesh SM, Rai L, Hebbar S. How important is serum β-hCG in the management of ectopic pregnancy? Int J Reprod Contracept Obstet Gynecol 2015;4(2):360–365. DOI: 10.5455/2320-1770.ijrcog 20150414.
  14. Wang Y, Xie X, Shi X, et al. Predictors for clinical in patients with ectopic pregnancy after conservative treatment. Sci Res Essays 2010;5:4028–4033.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.