Description

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%

 


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