Introduction: Ectopic pregnancy occurs in 1-2% of all pregnancies and commonly affects the ampullary part of the fallopian tube. In single dose protocol, HCG levels are measured on Day 1,4 and 7 after methotrexate. A fall in levels of HCG by 15% or more between day 4 and 7 indicates success of medical management. The day 4 HCG levels may give an indication to success of this protocol need for additional doses of methotrexate, early recourse to surgery etc.
AIM: To analyse the trends in HCG on day 4 after medical management of ectopic pregnancy with methotrexate and analyse its predictive effect on the success of single dose protocol.
Materials and methods: Retrospective data of all patients with ectopic pregnancy treated medically with methotrexate from January 2017 to December 2019 was analysed. The women included had ectopic pregnancy diagnosed by transvaginal sultrasound and inappropriate HCG values. HCG. The protocol for Methotrexate administration is in accordance with the accepted guidelines (ACOG2018). HCG concentrations are measured on day 1,4 and 7.
Results: Statistical analysis was done in SPSS software version 18.Out of 123 patients, 74 patients responded to a single dose of methotrexate.43 patients required additional doses of methotrexate.6 patients required surgery. In 47.8% (56/117) of the cases there was a fall in HCG between days 1 to 4.In this sub cohort 1, 87.5% (49/56) had success with single injection of methotrexate. There was a rise in HCG values on day 4 in 52.2% (61/117).In this sub cohort 2, only 40.9% (25/61) had treatment success. Receiver Operating Characteristic curve (ROC) was plot to compare the fall in β HCG on day 4 and day 7. The area under the curve obtained was 0.851 (p< 0.001) indicating good differentiating capacity for a change in β HCG from day 0 to 4.The optimal cut off for prediction of treatment success was a fall of 8% from day 1 to day 4.
Conclusions: A fall in HCG values on day 4 in can predict a high likelihood of success following medical treatment of ectopic pregnancies.