Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate

Objective: To de ectopic pregnancy. Design: Retrospective cohort study. Setting: Canadian teaching hospital. Patient(s): Sixty patients diagnosed with and treated for ectopic pregnancy. Intervention(s): A single dose of methotrexate (50 mg/m(2)) by i.m. injection. Main Outcome Measure(s): Resolution of serum beta -hCG or clinical evidence of treatment failure. Result(s): Treatment failure was observed following methotrexate administration in 65% of cases: when initial beta -hCG was >4000 IU/L, but in only 7.58 of patients when serum beta -hCG was <4000 IU/L (OR = 52.06, 95% CI 4.88-555,56). Patients who presented with pelvic pain without tenderness had treatment failure 56% of the time versus only 17% in those without pain (OR = 9.20, 95% CI 1.02-82.60). Treatment failure also occurred in 53% of patients presenting with vaginal bleeding versus 16% without bleeding (OR = 6.18, 95% CI 0.73-51,93). Conclusion(s): Methotrexate should not be used to treat ectopic pregnancy when initial beta-hCG is >4000 IU/L. Caution should also be exercised in using methotrexate for ectopic pregnancy when the patient presents with bleeding or pain even without tenderness. (C) 2000 by American Society for Reproductive Medicine.)