Using a decline in serum hCG between days 0-4 to predict ectopic pregnancy treatment success after single-dose methotrexate: a retrospective cohort study

• Published in: BMC pregnancy and childbirth Vol. 13; no. 1; p. 30
• Main Authors: Skubisz, Monika, Dutton, Philip, Duncan, William Colin, Horne, Andrew W, Tong, Stephen
• Format: Journal Article
• Language: English
• Published: England BioMed Central 01.02.2013; BioMed Central Ltd; BMC
• Subjects: Abortifacient Agents, Nonsteroidal - administration & dosage; Adult; Chorionic Gonadotropin - blood; Chorionic Gonadotropin - metabolism; Cohort Studies; Drug therapy; Ectopic pregnancy; Female; Human chorionic gonadotrophin; Humans; Medical management; Methotrexate; Methotrexate - administration & dosage; Positive predictive value; Predictive Value of Tests; Pregnancy; Pregnancy, Ectopic - blood; Pregnancy, Ectopic - drug therapy; Retrospective Studies; Studies; Treatment Outcome; Treatment success; Womens health
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/1471-2393-13-30

The current measure of treatment efficacy of single-dose methotrexate for ectopic pregnancy, is a fall in serum hCG of ≥15% between days 4-7 of treatment, which has a positive predictive value of 93% for treatment success. Two small studies have proposed a fall in serum hCG between days 0-4 after treatment confers similar, earlier prognostic information, with positive predictive values of 100% and 88% for treatment success. We sought to validate this in a large, independent cohort because of the potentially significant clinical implications. We conducted a retrospective study of women (n=206) treated with single-dose methotrexate for ectopic pregnancy (pre-treatment serum hCG levels ≤3000 IU/L) at Scottish hospitals between 2006-2011. Women were divided into two cohorts based on whether their serum hCG levels rose or fell between days 0-4 after methotrexate. Treatment outcomes of women in each cohort were compared, and the test performance characteristics calculated. This methodology was repeated for the current measure (≥15% fall in serum hCG between days 4-7 of treatment) and an alternate early measure (<20% fall in serum hCG between days 0-4 of treatment), and all three measures were compared for their ability to predict medical treatment success. In our cohort, the positive predictive value of the current clinical measure was 89% (95% CI 84-94%) (121/136). A falling serum hCG between days 0-4 predicted treatment success in 85% (95% CI 79-92%) of cases (94/110) and a <20% fall in serum hCG between days 0-4 predicted treatment success in 94% (95% CI 88-100%) of cases (59/63). There was no significant difference in the ability of these tests to predict medical treatment success. We have verified that a decline in serum hCG between days 0-4 after methotrexate treatment for ectopic pregnancies, with pre-treatment serum hCG levels ≤3000 IU/L, provides an early indication of likelihood of treatment success, and performs just as well as the existing measure, which only provides prognostic information on day 7.