open access

Vol 94, No 3 (2023)
Research paper
Published online: 2023-02-09
Get Citation

Is it possible to predict the success of single dose methotrexate in the treatment of tubal ectopic pregnancies?

Eren Pek1, Fatma Beyzait1, Duygu Siddikoglu2
·
Pubmed: 36929795
·
Ginekol Pol 2023;94(3):249-257.
Affiliations
  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Canakkale Onsekiz Mart University, Turkey
  2. Department of Biostatistics, Faculty of Medicine, Canakkale Onsekiz Mart University, Turkey

open access

Vol 94, No 3 (2023)
ORIGINAL PAPERS Obstetrics
Published online: 2023-02-09

Abstract

Objectives: In this study, the aim was to determine whether the use of endometrial thickness or neutrophil/lymphocyte and platelet/lymphocyte ratio would be useful in predicting the success of methotrexate in the treatment of ectopic pregnancies located in the fallopian tubes.

Materal and methods: This study was carried out by retrospectively examining 68 study group cases with an ultrasonographically detectable gestational sac in the fallopian tubes and 189 control group cases with an unruptured ectopic pregnancy diagnosis at any location. The cut-off value of endometrial thickness was calculated as a new marker between the cases in which single-dose methotrexate treatment was successful and the cases with treatment failure. Treatment success was evaluated with different models including endometrial thickness, fetal cardiac activity status, measurable crown-rump length, and β-hCG.

Result: The cut-off value of β-hCG for treatment success was determined as 2960.5 ng/mL, and the cut-off value for endometrial thickness was determined as 10.5 mm. Although NLR seems to be a marker with a cut-off value of 2.49, it does not provide an extra benefit in combined use as it is not a specific predictor. The highest success in predicting treatment success was achieved in the modeling in which crown-rump length + fetal cardiac activity + β-hCG + endometrial thickness were used together.

Conclusions: The use of endometrial thickness as a marker seems to be quite reliable in predicting treatment success. And we think it would be beneficial to thin the endometrium before using methotrexate.

Abstract

Objectives: In this study, the aim was to determine whether the use of endometrial thickness or neutrophil/lymphocyte and platelet/lymphocyte ratio would be useful in predicting the success of methotrexate in the treatment of ectopic pregnancies located in the fallopian tubes.

Materal and methods: This study was carried out by retrospectively examining 68 study group cases with an ultrasonographically detectable gestational sac in the fallopian tubes and 189 control group cases with an unruptured ectopic pregnancy diagnosis at any location. The cut-off value of endometrial thickness was calculated as a new marker between the cases in which single-dose methotrexate treatment was successful and the cases with treatment failure. Treatment success was evaluated with different models including endometrial thickness, fetal cardiac activity status, measurable crown-rump length, and β-hCG.

Result: The cut-off value of β-hCG for treatment success was determined as 2960.5 ng/mL, and the cut-off value for endometrial thickness was determined as 10.5 mm. Although NLR seems to be a marker with a cut-off value of 2.49, it does not provide an extra benefit in combined use as it is not a specific predictor. The highest success in predicting treatment success was achieved in the modeling in which crown-rump length + fetal cardiac activity + β-hCG + endometrial thickness were used together.

Conclusions: The use of endometrial thickness as a marker seems to be quite reliable in predicting treatment success. And we think it would be beneficial to thin the endometrium before using methotrexate.

Get Citation

Keywords

ectopic pregnancy; endometrial thickness; prognostic endometrial knownledge; human chorionic gonadotropin- β; single-dose methotrexate; neutrophil-lymphocyte ratio; platelet-lymphocyte ratio

About this article
Title

Is it possible to predict the success of single dose methotrexate in the treatment of tubal ectopic pregnancies?

Journal

Ginekologia Polska

Issue

Vol 94, No 3 (2023)

Article type

Research paper

Pages

249-257

Published online

2023-02-09

Page views

2332

Article views/downloads

449

DOI

10.5603/GP.a2023.0004

Pubmed

36929795

Bibliographic record

Ginekol Pol 2023;94(3):249-257.

Keywords

ectopic pregnancy
endometrial thickness
prognostic endometrial knownledge
human chorionic gonadotropin- β
single-dose methotrexate
neutrophil-lymphocyte ratio
platelet-lymphocyte ratio

Authors

Eren Pek
Fatma Beyzait
Duygu Siddikoglu

References (26)
  1. Fylstra D. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol. 2012; 206(4): 289–299.
  2. Barnhart K. Ectopic Pregnancy. N Engl J Med. 2009; 361(4): 379–387.
  3. Alur-Gupta S, Cooney LG, Senapati S, et al. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis. Am J Obstet Gynecol. 2019; 221(2): 95–108.e2.
  4. ACOG Practice Bulletin No. 94: Medical Management of Ectopic Pregnancy. Obstet Gynecol. 2008; 111(6): 1479–1485.
  5. Faraji Darkhaneh R, Asgharnia M, Farahmand Porkar N, et al. Predictive value of maternal serum β-hCG concentration in the ruptured tubal ectopic pregnancy. Iran J Reprod Med. 2015; 13(2): 101–106.
  6. Goksedef BP, Kef S, Akca A, et al. Risk factors for rupture in tubal ectopic pregnancy: definition of the clinical findings. Eur J Obstet Gynecol Reprod Biol. 2011; 154(1): 96–99.
  7. Jiang R, Mei S, Zhao Z. Leucovorin (folinic acid) rescue for high-dose methotrexate: A review. J Clin Pharm Ther. 2022; 47(9): 1452–1460.
  8. Erdil G, Ercin ME, Guven S. Effect of methotrexate on embryonal implantation: an experimental rat model. Gynecol Endocrinol. 2020; 36(11): 978–981.
  9. Tas EE, Akcay GF, Avsar AF. Single-dose methotrexate for the treatment of ectopic pregnancy: Our experience from 2010 to 2015. Pak J Med Sci. 2017; 33(1): 13–17.
  10. Turgut A, Sak ME, Ozler A, et al. Alteration of peripheral blood cells in tubal ectopic pregnancy. Ginekol Pol. 2013; 84(3): 193–196.
  11. Kanmaz AG, Inan AH, Beyan E, et al. Role of various complete blood count parameters in predicting the success of single-dose Methotrexate in treating ectopic pregnancy. Pak J Med Sci. 2018; 34(5): 1132–1136.
  12. Akkaya H, Uysal G. Can hematologic parameters predict treatment of ectopic pregnancy? Pak J Med Sci. 2017; 33(4): 937–942.
  13. Tsakiridis I, Giouleka S, Mamopoulos A, et al. Diagnosis and Management of Ectopic Pregnancy: A Comparative Review of Major National Guidelines. Obstet Gynecol Surv. 2020; 75(10): 611–623.
  14. Sindiani AM, Alshdaifat E, Obeidat B, et al. The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years' Experience in a Tertiary Center. Int J Womens Health. 2020; 12: 1233–1239.
  15. Mashiach R, Kislev I, Gilboa D, et al. Significant increase in serum hCG levels following methotrexate therapy is associated with lower treatment success rates in ectopic pregnancy patients. Eur J Obstet Gynecol Reprod Biol. 2018; 231: 188–191.
  16. McLaren JF, Burney RO, Milki AA, et al. Effect of methotrexate exposure on subsequent fertility in women undergoing controlled ovarian stimulation. Fertil Steril. 2009; 92(2): 515–519.
  17. Morris ID, Stephen TM. In vitro and in vivo interactions of methotrexate and other antimetabolites with the oestrogen high affinity receptors of the rat uterus. Br J Cancer. 1983; 47(3): 433–437.
  18. Di Carlo F, Reboani C, Conti G, et al. Changes in the concentration of uterine cytoplasmic oestrogen receptors induced by doxorubicin and methotrexate. J Endocrinol. 1978; 79(2): 201–208.
  19. Kroft J, Sabra S, Arthur R, et al. Unexplained amenorrhea in a patient taking methotrexate for the treatment of rheumatoid arthritis. Gynecol Endocrinol. 2010; 26(3): 179–180.
  20. da Costa Soares R, Elito J, Han KK, et al. Endometrial thickness as an orienting factor for the medical treatment of unruptured tubal pregnancy. Acta Obstet Gynecol Scand. 2004; 83(3): 289–292.
  21. Takacs P, Chakhtoura N, De Santis T, et al. Evaluation of the relationship between endometrial thickness and failure of single-dose methotrexate in ectopic pregnancy. Arch Gynecol Obstet. 2005; 272(4): 269–272.
  22. Nikolic I, Andjelkovic M, Zaric M, et al. Enhanced cytotoxicity and apoptosis by raloxifene in combination with estrogen and methotrexate in human endometrial stromal cells. Chem Biol Drug Des. 2018; 91(4): 885–892.
  23. Cecchino GN, Araujo Júnior E, Elito Júnior J. Methotrexate for ectopic pregnancy: when and how. Arch Gynecol Obstet. 2014; 290(3): 417–423.
  24. Kölbl AC, Schlenk K, Behrendt N, et al. The importance of hCG in human endometrial adenocarcinoma and breast cancer. Int J Biol Markers. 2018; 33(1): 33–39.
  25. El-Baradie SMY, El-Said MH, Ragab WS, et al. Endometrial thickness and serum beta-hCG as predictors of the effectiveness of oral misoprostol in early pregnancy failure. J Obstet Gynaecol Can. 2008; 30(10): 877–881.
  26. Sherwin JRA, Hastings JM, Jackson KS, et al. The endometrial response to chorionic gonadotropin is blunted in a baboon model of endometriosis. Endocrinology. 2010; 151(10): 4982–4993.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl