Clinical Health Updates

Methotrexate for ectopic pregnancy successful with beta-hCG < 5000

Clinical Question:
What is the appropriate cutoff for human chorionic gonadotropin to predict successful treatment of ectopic pregnancy with single-dose methotrexate?

Bottom Line:
The success rate of single-dose methotrexate therapy for ectopic pregnancy has been observed to be approximately 95% when the human chorionic gonadotropin (hCG) level is less than 5000 mIU/mL. The success rate is less than 90% when the hCG level is higher.

Reference:
Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril 2007;87:481-484.

Study Design:
Diagnostic test evaluation

Synopsis:
Successful medical management of an ectopic pregnancy is inversely associated with initial hCG level. The authors assessed whether there is a level of hCG above which failure rate substantially increases. A systematic review and summary analysis was performed, including studies reporting methotrexate treatment outcomes as stratified by various hCG ranges. They did it in a academic medical center. Review was done of published information regarding patients treated with methotrexate. Five observational studies, including 503 women, were found that reported successes in using single-dose methotrexate stratified by initial hCG concentration. Failure rates increase with increasing hCG levels. A substantial and statistically significant increase in failure rates is seen when comparing patients who have initial hCG levels of >5,000 mIU/mL with those who have initial levels of <5,000 mIU/mL (odds ratio: 5.45; 95% confidence interval: 3.04, 9.78). The failure rate for women who had an initial concentration between 5,000 and 9,999 mIU/mL was significantly higher than that for those who had initial levels between 2,000 and 4,999 mIU/mL (odds ratio: 3.76; 95% confidence interval: 1.16, 12.33).