Objective

Ectopic pregnancy (EP) rupture after methotrexate (MTX) treatment can have severe consequences. We examined clinical characteristics and beta-hCG trends that may predict EP rupture after MTX treatment.

Study Design

In this 10-year retrospective study of 277 women with an EP, we compared clinical, sonographic and beta-hCG trends, before and after MTX treatment, between those who did and did not have an EP rupture after MTX treatment.

Results

EP rupture was diagnosed in 41 women (15.1%) within 25 days of MTX treatment, and was correlated with higher parity and advanced pregnancy age: 2(0–5) vs. 1(0–6), P = 0.027 and 6.6(4.2–9.8) vs. 6.1(4–9.5), P = 0.045. EP rupture was also correlated with higher beta-hCG levels on days 0, 4 and 7 of MTX treatment: (2063 vs. 920 mIU/ml), (3221 vs. 921 mIU/ml) and (2368 vs. 703 mIU/ml), respectively, P < 0.001, for all. An increase of beta-hCG by>14% during days 0–4 showed a sensitivity of 71.4% CI 95% [55.4%-84.3%] and a specificity of 67.5% CI 95% [61.1%-73.6%] for predicting EP rupture after MTX treatment. Beta-hCG > 910 mIU/ml on day 0 showed a sensitivity of 80.9% CI 95% [66.7%-90.8%] and a specificity of 70.4% CI 95% [64.1%-76.3%] for predicting EP rupture after MTX treatment.

A beta-hCG increase by>14% during days 0–4, and a beta-hCG value > 910 mUI/mL on day 0 were associated with increased risks of EP rupture after MTX treatment; the odds ratios were 6.4 and 10.5, respectively. Odds ratios were 8.06 [CI 95% (3.70–17.56)], P < 0.001 for every percent rise in beta-hCG during days 0–4; 1.37 [CI 95% (1.06–1.86)], P = 0.046 for every week change in gestational age; and 1.001 [CI 95% (1.000–1.001)], P < 0.001 for every unit rise in beta-hCG at day 0.

Conclusion

Beta-hCG > 910 mIU/ml at day 0, a rise in beta-hCG by>14% during days 0–4, and more advanced gestational age were associated with EP rupture after MTX treatment.

中文翻译：

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甲氨蝶呤治疗后异位妊娠破裂的危险因素和预测：一项回顾性队列研究

客观的

甲氨蝶呤 (MTX) 治疗后异位妊娠 (EP) 破裂会产生严重后果。我们检查了可能预测 MTX 治疗后 EP 破裂的临床特征和 β-hCG 趋势。

学习规划

在这项对 277 名患有 EP 的女性进行的为期 10 年的回顾性研究中，我们比较了 MTX 治疗前后发生和未发生 EP 破裂的患者的临床、超声和 β-hCG 趋势。

结果

在 MTX 治疗后 25 天内，41 名妇女 (15.1%) 被诊断为 EP 破裂，并且与更高的胎次和高龄妊娠相关：2(0-5) 对 1(0-6)，P = 0.027 和 6.6( 4.2–9.8) 对比 6.1(4–9.5)，P = 0.045。EP 破裂也与 MTX 治疗第 0、4 和 7 天较高的 β-hCG 水平相关：（2063 对 920 mIU/ml）、（3221 对 921 mIU/ml）和（2368 对 703 mIU/ml )，分别为 P < 0.001。在第 0-4 天，β-hCG 增加 >14% 表明预测 EP 的敏感性为 71.4% CI 95% [55.4%-84.3%]，特异性为 67.5% CI 95% [61.1%-73.6%] MTX治疗后破裂。第 0 天 β-hCG > 910 mIU/ml 显示预测 MTX 治疗后 EP 破裂的敏感性为 80.9% CI 95% [66.7%-90.8%] 和特异性为 70.4% CI 95% [64.1%-76.3%] .

第 0-4 天 β-hCG 增加 >14%，以及第 0 天 β-hCG 值 > 910 mUI/mL 与 MTX 治疗后 EP 破裂风险增加相关；比值比分别为 6.4 和 10.5。在第 0-4 天，β-hCG 每升高一个百分比，优势比为 8.06 [CI 95% (3.70–17.56)]，P < 0.001；1.37 [CI 95% (1.06–1.86)]，P = 0.046 对于孕周的每周变化；和 1.001 [CI 95% (1.000–1.001)]，第 0 天 β-hCG 每升高一个单位，P < 0.001。

结论

第 0 天 β-hCG > 910 mIU/ml，第 0-4 天 β-hCG 升高 > 14%，以及更晚的胎龄与 MTX 治疗后 EP 破裂相关。