Evaluation of Predictive Factors for Success of Single-Dose Methotrexate Treatment in Tubal Ectopic Pregnancy With Low Beta- Human Chorionic Gonadotropin Levels.

BACKGROUND

Ectopic pregnancy (EP) is the most important cause of first-trimester maternal deaths.

OBJECTIVES

The aim of this study was to evaluate the clinical findings, ultrasound results, and systemic hematologic markers of inflammation associated with the success of single-dose methotrexate (MTX) treatment at low β-hCG levels in the medical management of tubal EP.

METHODS

This retrospective study included 145 patients diagnosed with tubal EP at a tertiary referral hospital. Following approval from the hospital ethics committee, patients with β-hCG levels < 2500 IU/L who underwent single-dose MTX treatment were divided into 2 groups based on treatment success. The groups were compared in terms of initial β-hCG levels, gynecological examination findings, ultrasound findings, and systemic hematological markers of inflammation.

RESULTS

A total of 145 patients were included in this study. No significant differences were observed between the groups in terms of age, gravidity, parity, endometrial thickness, ectopic focus diameter, intrauterine device (IUD) usage, or in vitro fertilization (IVF) pregnancy (p > 0.05). However, significant differences were found in the initial β-hCG levels, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), which were higher in the unsuccessful group (p < 0.05). In the successful group, a 27.2% decrease in median β-hCG levels was observed between days 0 and 4, whereas the unsuccessful group experienced a 19.6% increase during the same period.

CONCLUSION

A high initial β-hCG level, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) may predict treatment failure with single-dose MTX at low β-hCG levels. A decrease in β-hCG levels between days 0 and 4 may be an early indicator of successful treatment.