Successful therapy was defined as having the serum beta-HCG drop to < 50 mIU/mL.
Failure in therapy was defined as the need to perform a surgical intervention for any reason after giving the initial dose of methotrexate.
85% of women were successfully treated, leaving 15% failing.
Major risk factor for failure (adjusted odds ratio 19):
(1) visualization of a yolk sac within the tube on vaginal ultrasonography
Additional risk factors (adjusted odds ratio 2.2 to 3.8)
(2) pretreatment beta-HCG > 5,000 mIU/mL
(3) decline in serum beta-HCG by < 15% between days 4 and 7, with the serum level on day 7 > 0.85 * (serum level on day 4)
|
Risk Factor(s)
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Risk of Failure
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yolk sac visualized
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high
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pretreatment HCG AND failure to decline
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moderate to high
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pretreatment HCG OR failure to decline
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low to moderate
|
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no risk factors
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low
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Additional risk factors:
(1) failure to receive an additional dose when indicated
(2) development of a contraindication to further methotrexate dose (leukopenia, thrombocytopenia, elevated serum liver function tests, and/or elevated serum creatinine)
