An alternative monitoring protocol for single-dose methotrexate therapy in ectopic pregnancy.

Abstract

We sought to determine the sensitivity and specificity of alternative monitoring regimens in predicting the need for a second methotrexate (MTX) dose in women undergoing medical therapy for ectopic pregnancy. We reviewed 187 women who received MTX for ectopic pregnancy. We defined MTX treatment success as a clinically stable patient whose day-7 beta human chorionic gonadotropin (beta-hCG) level decreased by > or = 50%, compared with the day-of-treatment (DOT) beta-hCG. In comparison to the standard MTX monitoring protocol, this model was 100% sensitive and 57.4% specific in predicting the need for a second MTX dose in women whose DOT beta-hCG was <2000 mIU/mL and was 100% sensitive and 37.9% specific in women whose DOT beta-hCG was > or = 2000 mIU/mL. This model is an alternative to the traditional MTX monitoring regimen.