Dai Y, et al. – An alternative monitoring protocol without D4 β–HCG measurement for predicting the requirement for a repeated methotrexate (MTX) dose in patients undergoing single–dose MTX therapy for ectopic pregnancy is assessed in this study. The new monitoring model without the D4 β–HCG measurement may offer both patients and clinicians multiple options to monitor single–dose MTX therapy for selected ectopic pregnancy patients, with a comparable clinical effectiveness to Stovall's protocol and less expense and follow–up the burden to patients.

Methods

• For this research, they designed a single center, retrospective study (Canadian Task Force classification II–3).
• This study was conducted on university–affiliated hospital.
• Between January 2009 and December 2016, total 184 ectopic pregnancy patients who were treated with MTX were included in the study.

Results

• The patients were treated with repeated doses of MTX every 7 days, if necessary, as indicated by Stovall's protocol or with laparoscopic surgery in cases of tubal rupture.
• The success of a single–dose of MTX according to the alternative measure was defined as a >50% reduce in the β–HCG level between day (D) 1 and D7 in clinically stable patients.
• The sensitivity, specificity, false–negative rate, false–positive rate and attributable risk of this new monitoring measure were calculated and compared to the traditional regimen.
• The new protocol had a sensitivity and specificity of 100% and 88.7%, respectively, for predicting a required second dose in patients whose D1 β–HCG levels were <2000 mIU/mL.
• For patients with D1 β–HCG level ≥2000 mIU/mL, both monitoring regimens had the same effectiveness.