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Trends in serum human chorionic gonadotropin levels 0–4 days after methotrexate administration for predicting tubal ectopic pregnancy treatment success
Author(s) -
Wong Lo,
Fung Linda W.Y.,
Cheung ChunWai,
Lao Terence T.
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12419
Subject(s) - medicine , human chorionic gonadotropin , methotrexate , ectopic pregnancy , confidence interval , pregnancy , gynecology , gonadotropin , retrospective cohort study , receiver operating characteristic , obstetrics , hormone , biology , genetics
Objective To evaluate serum human chorionic gonadotropin ( HCG ) levels 0–4 days after single‐dose methotrexate administration for tubal ectopic pregnancy. Methods The present retrospective study included women with tubal ectopic pregnancy treated by methotrexate at a tertiary hospital in Hong Kong, China, between January 1, 2007, and December 31, 2016. Patients were stratified serum HCG levels rose or fell from day 0–4 post‐administration. Trends in day 0–4 serum HCG to predict treatment success were compared with that of day 4–7 serum HCG . The optimal drop in HCG was identified by receiver operating characteristic curve analysis. Results There were 102 patients included. The positive predictive value ( PPV ) of day 0–4 serum HCG for treatment success was 91% (95% confidence interval [ CI ] 82–96), which is comparable to the current criterion of a 15% drop in day 4–7 serum HCG ( PPV 91%, 95% CI 84–95). A 6% drop in day 0–4 serum HCG was the best predictor of treatment success ( PPV 96%, 95% CI 86–99). Conclusion A drop in day 0–4 serum HCG provided earlier prognostic information and was not inferior to the current criterion.