Medical management of ectopic pregnancy: a 10-year case series

Aims: The study was concerned with the medical management of ectopic pregnancy; specifically, (i) whether there is a significant increase in follow-up duration when the serum beta hCG is greater than 3000 iu/l and (ii) an association between the serum beta hCG concentration at presentation and the need for a repeat dose of Methotrexate and/or emergency surgical intervention, and if so, to try to quantify the probability of the requirement for either a repeat dose or surgery depending on serum beta hCG concentration. Methods: A retrospective case note review of all medically treated ectopic pregnancies over a 10-year period in a tertiary referral hospital in the southwest of England. Results: 398 women were identified in total. Three were excluded and five case notes could not be located. A beta hCG <= 3000 iu/l occurred in 73.8%. Mean follow-up duration was 25.9 days when the beta hCG was <= 3000 iu/l compared to 42.3 days when it was > 3000 iu/l. When beta hCG was = 3000 iu/l, a repeat dose of Methotrexate and emergency surgery were required in 10.4 and 4.5% cases, respectively, compared to 21.6 and 14.7% when beta hCG > 3000 iu/l. All differences were statistically significant. By fitting logistic regression models to our data, a reference table indicating the risk of requiring a repeat dose of Methotrexate or subsequent surgery for any beta hCG level has been created. Conclusions: Although follow-up duration and the need for repeat doses of Methotrexate and/or surgical intervention increases with increasing serum beta hCG, medical management is still safe and effective when the beta hCG is > 3000 iu/l and should be promoted.