Comparison of alternative beta hCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy

作者：Sukur Yavuz Emre^*; Koyuncu Kazibe; Seval Mehmet Murat; Cetinkaya Esra; Dokmeci Fulya

来源：Archives of Gynecology and Obstetrics, 2017, 296(6): 1161-1165.

DOI：10.1007/s00404-017-4527-1

• Ectopic pregnancy
• Follow-up protocol
• Human chorionic gonadotropin
• Methotrexate

Purpose To evaluate the performances of five different beta hCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy (EP).
Methods Data of patients who received single-dose methotrexate therapy for tubal EP at a university hospital between January 2011 and July 2016 were reviewed. A 'successful methotrexate treatment' was defined if the EP treated with no need for surgery. The performances of different protocols were tested by comparing with the currently used '15% beta hCG decrease between days 4 and 7' protocol. The tested follow-up protocols were '20, 25%, and any beta hCG decrease between days 0/1 and 7' and '20% and any beta hCG decrease between days 0/1 and 4'.
Results Among the 96 patients evaluated, 12 (12.5%) required second dose. Totally, 91 (94.8%) patients treated successfully with no need for surgery. Four patients were operated within 4 days following the second dose. One patient who did not need second dose according to the standard follow-up protocol was operated on the 10th day due to rupture (specificity = 80%). Two protocols, namely '20% beta hCG decrease between days 0/1 and 7' and 'any beta hCG decrease between days 0/1 and 7' did not show statistically significant differences from the index protocol regarding the number of patients who should be assigned to 2nd dose.
Conclusions 'Any beta hCG decrease between days 0/1 and 7' protocol may substitute the currently used one to decide second dose methotrexate in tubal EP management. Omitting 4th day measurement seems to be more convenient and cost effective.

• 出版日期2017-12