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β hCG monitoring after single‐dose methotrexate treatment of tubal ectopic pregnancy: Is the Day 4 β hCG necessary? A retrospective cohort study
Author(s) -
Atkinson Monique,
Gupta Sarika,
Mcgee Therese
Publication year - 2014
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12257
Subject(s) - medicine , methotrexate , regimen , ectopic pregnancy , retrospective cohort study , pregnancy , mcnemar's test , obstetrics , surgery , statistics , genetics , mathematics , biology
Background In ectopic pregnancy ( EP ) management, failure of β hCG to fall more than 15% between Days 4 and 7 after methotrexate administration indicates the need for a second dose. Regimens preferring a 25% fall in β hCG between methotrexate administration and Day 7 have been proposed. Aims Our study analysed these and other regimens' performance in predicting treatment success. Secondarily, we investigated how each regimen guided the prescription of additional methotrexate doses. Methods Medical files of 88 women with ultrasound confirmed tubal EP and pretreatment β hCG <6000 IU /L, unsuitable for expectant management, were retrospectively analysed. The β hCG monitoring regimens studied were (i) 15% fall Day 4–7, (ii) 25% fall Day 0/1–7, (iii) any fall Day 0/1–7, (iv) any fall Day 0/1–4 and (v) 20% fall Day 0/1–4. Treatment success was defined if the EP resolved without surgical intervention. Statistical analysis was performed using McNemar's test. Results Overall, treatment success with methotrexate was 92% ( n = 81/88). Predicting success of methotrexate ( PPV 98–100%) and detecting those needing surgery (specificity 86–100%) were equivalent across all monitoring regimens. However, the 25% Day 0/1–7 fall (and the Day 0/1–4 regimens) over‐selected women for a second dose of methotrexate ( P < 0.05). Conclusion The performance of each regimen is equivalent to the traditional 15% fall Day 4–7 regimen in predicting treatment success. However, a regimen aiming for a 25% fall in β hCG Day 0/1–7 over‐selects patients for a second methotrexate dose. In comparison, any drop in β hCG Day 0/1–7 does not over‐select women and eliminates Day 4 testing.