Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy

Gary H. Lipscomb, Vanessa A. Givens, Norman Meyer, Derita Bran

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objective To investigate whether a history of previous ectopic pregnancy is an independent risk factor for failure of methotrexate therapy in subsequent ectopic pregnancies and whether the previous treatment method influenced failure. Setting Inner-city teaching hospital. Design Retrospective case review. Patient(s) Five hundred four consecutive patients treated with "single-dose" methotrexate for ectopic pregnancy. Nine patients electing surgery after beginning medical therapy were excluded from analysis. Intervention(s) Systemic methotrexate 50 mg/m2. Main outcome measure(s) Failure of methotrexate therapy. Result(s) Twenty-one (18.6%) of 113 of previous ectopic patients and 26 (6.8%) of 382 first-time ectopic patients failed methotrexate therapy (odds ratio, 3.12). The overall success rate was 90.5% (448/495 patients). Univariant analysis showed that treatment hCG and progesterone (P) levels and ectopic cardiac activity were significantly different between successful and failed therapy. Logistic regression analysis for these four variables showed that only hCG and history of previous methotrexate remained significant risk factors for failure of methotrexate therapy. The likelihood of failure in patients with a previous ectopic was not influenced by previous treatment with salpingostomy, salpingectomy, or medical treatment. Conclusion(s) A history of previous ectopic pregnancy appears to be an independent risk factor for failure of systemic methotrexate treatment, but failure is not affected by previous treatment method.

Original languageEnglish (US)
Pages (from-to)1221-1224
Number of pages4
JournalFertility and Sterility
Volume81
Issue number5
DOIs
StatePublished - Jan 1 2004

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Ectopic Pregnancy
Methotrexate
Therapeutics
Salpingostomy
Salpingectomy
Urban Hospitals
Treatment Failure
Teaching Hospitals
Progesterone
Logistic Models
Odds Ratio
Regression Analysis
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy. / Lipscomb, Gary H.; Givens, Vanessa A.; Meyer, Norman; Bran, Derita.

In: Fertility and Sterility, Vol. 81, No. 5, 01.01.2004, p. 1221-1224.

Research output: Contribution to journalArticle

Lipscomb, Gary H. ; Givens, Vanessa A. ; Meyer, Norman ; Bran, Derita. / Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy. In: Fertility and Sterility. 2004 ; Vol. 81, No. 5. pp. 1221-1224.
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