Document Detail


Increment in beta-hCG in the 48-h period prior to treatment: a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate.
MedLine Citation:
PMID:  18274766     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To evaluate the increment in beta-hCG levels (%) in the 48-h interval prior to treatment as a predictor of therapeutic success in the management of ectopic pregnancy with methotrexate. METHODS: A prospective observational study was carried out between April 2002 and November 2006 at the Federal University of São Paulo in 65 patients with an ectopic pregnancy treated with a single dose of 50 mg/m(2) of methotrexate administered intramuscularly. The following predictive factors were evaluated: beta-hCG level on the day of hospital admission and the percent increment in beta-hCG in the 48-h interval prior to treatment. RESULTS: Treatment was successful in 49 cases (75.4%). In these cases, beta-hCG levels at hospitalization were lower when compared to the levels found in cases of therapeutic failure (1,928.9 vs. 4,828.6 mIU/ml, respectively; P<0.01), and the increment in beta-hCG level in the 48-h interval prior to treatment was smaller (13.1 vs. 36.3%, respectively; P=0.01). A beta-hCG measurement <or=2,685 mIU/ml on the day of hospitalization and an increment in beta-hCG level <or=11.1% in the 48 h preceding treatment were factors indicative of therapeutic success with sensitivity of 79.6 and 61.7%, respectively, and specificity of 75 and 81.3%, respectively. CONCLUSIONS: The lower the beta-hCG measurement on the day of hospital admission and the lower its increment in the 48-h interval prior to treatment, the greater the likelihood that treatment of ectopic pregnancy with methotrexate will be successful. The margin of safety for treatment with methotrexate is high when beta-hCG measurement on the day of hospitalization is <or=2,685 mIU/ml and its increment in the 48 h prior to treatment is <or=11.1%.
Authors:
Roberto da Costa Soares; Júlio Elito; Luiz Camano
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Publication Detail:
Type:  Journal Article     Date:  2008-02-15
Journal Detail:
Title:  Archives of gynecology and obstetrics     Volume:  278     ISSN:  0932-0067     ISO Abbreviation:  Arch. Gynecol. Obstet.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-08-20     Completed Date:  2009-01-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710213     Medline TA:  Arch Gynecol Obstet     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  319-24     Citation Subset:  IM    
Affiliation:
Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil. sassarcs@uol.com.br
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MeSH Terms
Descriptor/Qualifier:
Abortifacient Agents, Nonsteroidal / therapeutic use*
Chorionic Gonadotropin, beta Subunit, Human / blood*,  metabolism
Cohort Studies
Female
Humans
Methotrexate / therapeutic use*
Pregnancy
Pregnancy, Ectopic / blood*,  drug therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Abortifacient Agents, Nonsteroidal; 0/Chorionic Gonadotropin, beta Subunit, Human; 59-05-2/Methotrexate

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