Document Detail


Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies.
MedLine Citation:
PMID:  10607814     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The use of methotrexate for the treatment of women with tubal ectopic pregnancies is now common practice. However, the clinical and hormonal determinants of the success of this treatment are not known. METHODS: We studied 350 women with tubal ectopic pregnancies who were treated with methotrexate intramuscularly according to a single-dose protocol. Pretreatment serum concentrations of human chorionic gonadotropin and progesterone, the size and volume of the gestational mass, fetal cardiac activity, and the presence of fluid (presumably blood) in the peritoneal cavity were correlated with the efficacy of therapy, as defined by resolution of the ectopic pregnancy without the need for surgical intervention. RESULTS: There was no relation between the women's age or parity, the size or volume of the conceptus, or the presence of fluid in the peritoneal cavity and the efficacy of treatment. Among the 320 women in whom treatment was successful (91 percent), the mean (+/-SD) serum chorionic gonadotropin and progesterone concentrations were 4019+/-6362 mIU per milliliter and 6.9+/-6.7 ng per milliliter (21.9+/-21.3 nmol per liter), respectively, as compared with 13,420+/-16,590 mIU per milliliter and 10.2+/-5.5 ng per milliliter (32.4+/-17.5 nmol per liter) (P<0.001 and P=0.02) in the 30 women in whom treatment was not successful. Fetal cardiac activity was present in 12 percent of the successfully treated cases and 30 percent of those in which treatment was not successful (P=0.01). Regression analysis revealed the pretreatment serum chorionic gonadotropin concentration to be the only factor that contributed to the failure rate. CONCLUSIONS: Among women with tubal ectopic pregnancies, a high serum chorionic gonadotropin concentration is the most important factor associated with failure of treatment with a single-dose methotrexate protocol.
Authors:
G H Lipscomb; M L McCord; T G Stovall; G Huff; S G Portera; F W Ling
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The New England journal of medicine     Volume:  341     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1999 Dec 
Date Detail:
Created Date:  1999-12-23     Completed Date:  1999-12-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1974-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA. glipscomb@utmem.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Chorionic Gonadotropin / blood*
Female
Fetal Heart / physiology
Humans
Logistic Models
Methotrexate / administration & dosage*
Pregnancy
Pregnancy, Tubal / blood,  drug therapy*
Progesterone / blood
Treatment Failure
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin; 57-83-0/Progesterone; 59-05-2/Methotrexate
Comments/Corrections
Comment In:
N Engl J Med. 2000 Apr 13;342(15):1138   [PMID:  10766587 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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