Failure Rate of Methotrexate for Treatment of Ectopic Pregnancy at Lampang Hospital

Main Article Content

Kittipat Tuitemwong
Darin Arora

Abstract

Background: Ectopic pregnancy can be treated non-operatively with methotrexate (MTX) medication. The failure rate of MTX treatment for ectopic pregnancy has not been investigated at Lampang Hospital.
Objectives: To determine the failure rate and factors associated with treatment failure in ectopic pregnancy with MTX at Lampang Hospital.
Material and methods: A descriptive study was conducted on 52 women diagnosed with ectopic pregnancy and treated with MTX at Lampang Hospital between June 2012 and June 2022. Patients were categorized into the failure group and the success group. The data was analyzed using descriptive statistics and compared between the two groups.
Results: There were 44 cases in the success group (84.6%) and 8 cases in the failure group (15.4%). The median value of the initial serum B-hCG level in the failure group was significantly higher than that of the success group (4,892 [IQR 1,946−12,713] vs.1,433 [IQR 638−4,091] mIU/ml, p<0.001). The median duration of treatment until resolution in the success group was 27 days (IQR 20−38.5, range 13−137 days).
Conclusion: The overall failure rate of MTX treatment for ectopic pregnancy was 15.4%. The failure group had a significantly higher initial serum B-hCG level than the success group.

Article Details

How to Cite
Tuitemwong, K., & Arora, D. (2023). Failure Rate of Methotrexate for Treatment of Ectopic Pregnancy at Lampang Hospital. Lampang Medical Journal, 44(2), 21–28. Retrieved from https://he01.tci-thaijo.org/index.php/LMJ/article/view/264217
Section
Original Article

References

Liampongsabhuddhi P. Epidemiological study of ectopic pregnancy in Lampang Hospital. Lampang Med J 2010;31(1):20−7.

Committee on Practice Bulletins-Gynecology. ACOG Practice Bulletin No. 191: tubal ectopic pregnancy. Obstet Gynecol 2018;131(2):e65−77.

Kingsbury B, Sam D, Jeyasudha R, Thomas E, Rebekah G, Lionel J. Ectopic pregnancies: catch them early, treat them wisely!. J Family Med Prim Care 2020;9(9):4911−8.

Cohen A, Zakar L, Gil Y, Amer-Alshiek J, Bibi G, Almog B, et al. Methotrexate success rates in progressing ectopic pregnancies: a reappraisal. Am J Obstet Gynecol 2014;211(2):128.e1−5.

Pulatoglu C, Dogan O, Basbug A, Kaya AE, Yildiz A, Temizkan O. Predictive factors of methotrexate treatment success in ectopic pregnancy: a single-center tertiary study. North Clin Istanb 2018;5(3):227−31.

Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril 2007;87(3):481−4.

Niyomyam P, Tansupswatdikul P. Predictors of success with single-dose methotrexate regimen for the treatment of ectopic pregnancy in Chonburi Hospital. Thai J Obstet Gynaecol 2016;24:273−9.

Eskander M. Single dose methotrexate for treatment of ectopic pregnancy: risk factors for treatment failure. Middle East Fertility Society Journal 2007;12(1):57−62.

Gnisci A, Stefani L, Bottin P, Ohannessian A, Gamerre M, Agostini A. Predictive value of hemoperitoneum for outcome of methotrexate treatment in ectopic pregnancy: an observational

comparative study. Ultrasound Obstet Gynecol 2014;43(6):698−701.

Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril 1982;37(6):851−2.

Practice Committee of American Society of Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 2013;100:638−44.

Var A, Özyurt R, Şık BA, Kumbasar S, Sever E, Deveci M, et al. Retrospective analysis of factors that affect the success of single-dose methotrexate treatment in ectopic pregnancy. Turk J Obstet Gynecol 2015;12(4):215−9.

Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 1999;341(26):1974−8.

Srivichai K, Uttavichai C, Tongsong T. Medical treatment of ectopic pregnancy: a ten-year review of 106 cases at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai 2006;89(10):1567−71.

Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol 2010;115:495−502.

Alur-Gupta S, Cooney LG, Senapati S, Sammel MD, Barnhart KT. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis. Am J Obstet Gynecol 2019;221(2):95−108.e2.

Davenport MJ, Lindquist A, Brownfoot F, Pritchard N, Tong S, Hastie R. Time to resolution of tubal ectopic pregnancy following methotrexate treatment: a retrospective cohort study. PLoS One 2022;17(5):e0268741.