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  • Title: Cutoff value of human chorionic gonadotropin in relation to the number of methotrexate cycles in the successful treatment of ectopic pregnancy.
    Author: Nowak-Markwitz E, Michalak M, Olejnik M, Spaczynski M.
    Journal: Fertil Steril; 2009 Oct; 92(4):1203-1207. PubMed ID: 18851850.
    Abstract:
    OBJECTIVE: To assign cutoff values for human chorionic gonadotropin (beta-hCG) in pretreatment and after one methotrexate (MTX) cycle and determine its correspondence to the number of MTX cycles in successfully treated ectopic pregnancy. DESIGN: Retrospective study. SETTING: Polish university hospital. PATIENT(S): 68 women with ectopic pregnancies who qualified for medical treatment. INTERVENTION(S): A single-dose of MTX (50 mg/m(2)) repeated every 7 days, plus laparoscopy in cases of tubal rupture or increased (>or=50% over 1 week) beta-hCG concentration. MAIN OUTCOME MEASURE(S): Resolution of serum beta-hCG without the necessity of laparoscopy. RESULT(S): Success rate was 78% (53 of 64 women). The medians of pretreatment beta-hCG levels in the groups treated successfully and unsuccessfully (943 vs. 3085 mIU/mL) and after the first dose of MTX (564 vs. 4049 mIU/mL) were statistically significantly different. The decrease in beta-hCG level after one MTX dose differed statistically significantly only in successfully treated women. The receiver operating characteristic (ROC) curve cutoff value in the success group indicated an initial beta-hCG level of 1790 and 1218 mIU/mL after one MTX cycle. The median of beta-hCG titer was not statistically different in patients requiring one or more treatment cycles. CONCLUSION(S): When the beta-hCG level is >1790 mIU/mL, the MTX treatment of ectopic pregnancy is at risk of failure. However, the initial beta-hCG titer is not a predictor of the number of MTX cycles that can guarantee a successful outcome.
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