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  • Title: Routine β-Human Chorionic Gonadotropin Monitoring for Single-Dose Methotrexate Treatment in Ectopic Pregnancy.
    Author: Dai Y, Zhang G, Zhu L, Lang J, Liu Z.
    Journal: J Minim Invasive Gynecol; 2017; 24(7):1195-1199. PubMed ID: 28800968.
    Abstract:
    STUDY OBJECTIVE: To evaluate an alternative monitoring protocol without day 4 β-human chorionic gonadotropin (β-hCG) measurement for predicting the need for a repeated methotrexate (MTX) dose in patients undergoing single-dose MTX therapy for ectopic pregnancy (EP). DESIGN: Single-center retrospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Included in the study were 184 EP patients treated with MTX between January 2009 and December 2016. INTERVENTIONS: Single-dose MTX treatment (50 mg/m2). MEASUREMENTS AND MAIN RESULTS: The patients were treated with repeated doses of MTX every 7 days, if necessary, according to Stovall's protocol, or with laparoscopic surgery in cases of tubal rupture. The success of a single-dose of MTX according to the alternative measure was defined as a >50% decrease in the β-hCG level between days 1 and 7 in clinically stable patients. The sensitivity, specificity, false-negative rate, false-positive rate, and attributable risk of this new monitoring measure were calculated and compared with the traditional regimen. The new protocol had a sensitivity and specificity of 100% and 88.7%, respectively, for predicting a required second dose in patients whose day 1 β-hCG levels were <2000 mIU/mL. For patients with day 1 β-hCG level ≥2000 mIU/mL, both monitoring regimens had the same efficiency. CONCLUSIONS: The new monitoring model without the day 4 β-hCG measurement may offer both patients and clinicians multiple options to monitor single-dose MTX therapy for selected EP patients, with a comparable clinical efficiency to Stovall's protocol and less expense and follow-up burden to patients.
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