A study on the association between demographic and clinical characteristics of ectopic pregnancy cases and treatment outcomes

Abstract

Purpose: Ectopic pregnancy (EP) is a life-threatening condition and a significant cause of maternal mortality. The aim of this study was to find out association between demographic and clinical characteristics of EP patients and treatment outcomes, success rate of methotrexate (MTX) therapy and the need for surgical intervention.

Methods: This was a retrospective study of 821 EP cases attended to Kamali Hospital, Karaj, Iran between April 2015 to March 2020. Medical records of all cases were reviewed and following parameters were extracted: sociodemographic characteristics, ultrasonography findings, treatment methods, laboratory data of β hCG concentrations on day 0, 4 and 7 after initiation of treatment.

Results: Our results indicated that β-hCG concentration upon EP diagnosis was the only associated factor with the degree of β-hCG decline during days 4-7 after treatment initiation. In addition, β-hCG initial concentration, presence of peritoneal effusion and size of adnexal mass had association with success of MTX treatment and predicted the need for surgery. Most of cases who experienced a 15%≤ decline in β-hCG during days 4-7 after treatment initiation needed no surgery. Furthermore, single-dose MTX therapy was the most successful approach and the mean time for β-hCG clearance was the shortest in the cases who received single dose of MTX.

Conclusion: Collectively, initial β-hCG concentration, size of adnexal mass and peritoneal effusion may be important predictors in choosing the best treatment for EP cases and to prevent unnecessary surgeries for patients who desire fertility preservation, and avoid side effects of EP.