Risk factors and human chorionic gonadotropin trends in patients with ruptured tubal ectopic pregnancies despite methotrexate treatment

Abstract

This retrospective cohort study investigates the risk factors and beta-human chorionic gonadotropin (β-hCG) trends in patients with ruptured tubal ectopic pregnancies (EPs) despite methotrexate (MTX) treatment. All patients receiving MTX for sonographically confirmed tubal EPs at our fertility center between 2004 and 2014 were included. Baseline demographics and β-hCG trends of patients with EP rupture after MTX were compared to patients with resolved EPs after MTX. One-hundred-thirty-seven patients with EPs were treated with MTX during the study duration; 27 experienced EP rupture and 110 EP resolution. There was no difference in the baseline demographics or β-hCG levels on the day of MTX between the groups. Patients with ruptured EPs after MTX had higher β-hCG levels on day-4 (1223.9 ± 243.5 vs. 1111.2 ± 179.7 mIU/mL; p < .001) and day-7 (1156.9 ± 206.2 vs. 872.4 ± 690.2 mIU/mL; p < .001). The odds of EP rupture compared to EP resolution was 6.2 (95% CI 2.1–19.1), 13.7 (95% CI 4.8–38.9), and 3.0 (95% CI 1.2–7.2) times higher when the change in β-hCG levels was <5% between day-7 vs. day of MTX, day-7 vs. day-4, and day-4 vs. day of MTX, respectively. Our results demonstrate that ruptured tubal EPs despite MTX have <5% change in β-hCG levels between the day of MTX and day-4 or day-7 after MTX.

摘要

回顾性队列研究探究甲氨蝶呤（MTX）治疗输卵管异位妊娠（EPs）患者的危险因素和β-人绒毛膜促性腺激素（β-hCG）。从2004-2014年期间, 在我们生育中心所有经过超声诊断为输卵管异位妊娠并接受MTX治疗的患者被纳入。经过MTX治疗后EP破裂与MTX治疗后EPs治愈的患者β-hCG的变化趋势与基线人口统计学情况。在研究期间, 137例EPs患者接受MTX治疗, 其中27例EP发生破裂, 110例EP被治愈。各组间予以MTX基线人口统计学数据或β-hCG水平无差异。经过MTX治疗后EPs破裂的患者β-hCG水平在第4天(1223.9 ± 243.5 vs. 1111.2 ± 179.7 mIU/mL; p < .001)和第7天(1156.9 ± 206.2 vs. 872.4 ± 690.2 mIU/mL; p < .001)水平较高。在第7天与给予MTX当天、第7天与第4天、第4天与给予MTX当天β-hCG水平变化 <5%, 输卵管异位妊娠破裂比输卵管异位妊娠治愈的可能性高6.2倍(95% CI 2.1–19.1), 13.7倍(95% CI 4.8–38.9)和3.0 倍(95% CI 1.2–7.2)。我们的研究表明尽管MTX治疗后输卵管异位妊娠破裂, 但在给予MTX当天和给予MTX之后的第4天或者第7天β-hCG的水平变化<5%。

Keywords:

• Ectopic pregnancy
• methotrexate
• failure
• rupture
• salpingectomy
• laparoscopy
• risk factors

Disclosure statement

No potential conflict of interest was reported by the authors.