Elito et al developed a score for predicting the likelihood of successful therapy with a single dose of methotrexate for a woman with an unruptured ectopic pregnancy. The authors are from the Federal University of Sao Paulo in Brazil.
Single dose of methotrexate: 50 mg per square meter BSA given IM.
Parameters:
(1) serum beta-HCG in mIU/mL
(2) risk estimate on color Doppler
(3) size of the mass in cm
(4) features seen on the Doppler images
|
Parameter |
Finding |
Points |
|
serum beta-HCG |
> 5,000 mIU/mL |
0 |
|
|
1,500 to 5,000 mIU/mL |
1 |
|
|
< 1,500 mIU/mL |
2 |
|
risk estimate |
high |
0 |
|
|
intermediate |
1 |
|
|
low |
2 |
|
diameter of mass in cm |
> 3.0 cm |
0 |
|
|
2.6 to 3.0 cm |
1 |
|
|
<= 2.5 cm |
2 |
|
features |
live embryo |
0 |
|
|
tubal ring |
1 |
|
|
hematosalpinx |
2 |
where:
• The points assigned reflect the situation, with 0 for unfavorable and 2 favorable.
• A low risk Doppler image: (a) trophoblastic blood flow to < 33% of the adnexal mass, (b) presence of arterial flow with high resistance (resistance index > 0.5), (c) flow with "bizarre morphology", (d) long acceleration periods with negative or absent diastole.
• An intermediate risk Doppler image: trophoblastic blood flow in 33 to 67% of the adnexal mass.
• A high risk Doppler image: trophoblastic blood flow in > 67% of the adnexal mass.
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the chances of the single dose will be successful.
|
Total Score |
Percent Success |
|
< 5 |
0% |
|
>= 5 |
97% |
Specialty: Obstetrics & Gynecology
