Risk factors for recurrent ectopic pregnancy following single-dose methotrexate treatment

Abstract

Objective: Our study aimed to investigate the predisposing factors for recurrence of an ectopic pregnancy (EP) following single-dose methotrexate (MTX) treatment for a primary EP.

Methods: This was a retrospective cohort study performed in a tertiary care medical centre including all patients diagnosed with primary EP and treated with a single-dose regimen of intramuscular MTX. EPs with future recurrence were compared with first time only EPs, to identify risk factors for recurrent EP. Forward stepwise multivariate logistic regression analyses were subsequently carried out.

Results: The study included 272 women. Of those, 22 (8.1%) had a recurrent EP. Women in the recurrent EP group had a higher rate of abortions (45.5% vs 32.7%; p = 0.02), previous pelvic surgery (45.5% vs 6.5%; p < 0.001) and both pelvic and uterine surgery (4.5% vs 1.6%; p < 0.001). Conception by assisted reproductive technology (ART) was more common among the non-recurrent EP group (23.0% vs 4.5%; p = 0.04). Success of single-dose MTX treatment was lower in the recurrent EP group compared with the non-recurrent EP group (36.4% vs 65.7%; p = 0.006). A history of pelvic surgery was independently associated with recurrent EP (adjusted odds ratio [OR] 17.6; 95% confidence interval [CI] 4.9, 63.2; p = 0.001). Treatment success of single-dose MTX was independently protective for recurrent EP (adjusted OR 0.25; 95% CI 0.08, 0.76; p = 0.02).

Conclusions: Among women with an EP, attention should be paid to those with previous pelvic surgery. Efforts should be made to achieve medical treatment success to prevent recurrent EP.

摘要

目的：探讨甲氨蝶呤 (MTX) 单次给药治疗首次异位妊娠 (EP) 后异位妊娠复发的易感因素。

方法：这是一项在三级医疗中心进行的回顾性队列研究, 包括所有诊断为原发性 EP 并接受单次肌内注射 MTX 治疗的患者。将未来复发的 EP 与仅有首次复发的 EP 进行比较, 以确定复发性 EP 的危险因素。随后进行向前逐步多变量 logistic 回归分析。

结果：研究纳入 272 例女性。其中 22 例 (8.1%) 有复发性 EP。复发性 EP 组的流产率 (45.5%vs 32.7%；p=0.02)、既往盆腔手术率 (45.5%vs 6.5%；p < 0.001) 以及盆腔和子宫手术率 (4.5%vs 1.6%；p < 0.001) 均较高。通过辅助生殖技术 (ART) 受孕在非复发性 EP 组中更常见 (23.0%vs 4.5%；p=0.04)。复发 EP 组的 MTX 单次给药成功率低于未复发 EP 组 (36.4%vs 65.7%；p=0.006)。盆腔手术史与 EP 复发独立相关（校正优势比 [OR] 17.6；95% 置信区间 [CI] 4.9, 63.2；p=0.001）。单次给药 MTX 的治疗成功对复发性 EP 具有独立保护作用（调整后 OR 0.25；95%CI 0.08, 0.76；p=0.02）。

结论：在有 EP 的妇女中, 应该注意那些有盆腔手术史的妇女。应努力取得药物治疗成功, 防止 EP 复发。

Keywords:

• Assisted reproductive technology
• complications
• ectopic pregnancy
• methotrexate
• recurrent ectopic pregnancy

Disclosure statement

No potential conflict of interest was reported by the authors.