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. 2025 Feb;168(2):620-627.
doi: 10.1002/ijgo.15927. Epub 2024 Sep 26.

Nomogram to predict methotrexate treatment success in ectopic pregnancy

Gil Zeevi  1   2 , Or Bercovich  1   2 , Yael Haring  1   2 , Shir Nahum  1   2 , Asaf Romano  1   2 , Ohad Houri  1   2 , Effi Yeoshoua  1   2 , Ram Eitan  1   2 , Yoav Peled  1   2 , Haim Krissi  1   2
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Nomogram to predict methotrexate treatment success in ectopic pregnancy

Gil Zeevi et al. Int J Gynaecol Obstet. 2025 Feb.

Abstract

Objective: To evaluate clinical factors prior to methotrexate (MTX) treatment for tubal ectopic pregnancy and to apply the data to a prediction model for treatment success.

Methods: A retrospective cohort study was conducted during 2014-2022. Of the 808 patients with a tubal ectopic pregnancy, 372 with a β-hCG level less than 5000 IU/L were treated with a single dose of MTX and were included in this study. Pretreatment factors, including patient characteristics, initial β-hCG level, and sonographic parameters, were compared between those who achieved complete resolution and those who needed additional MTX or surgical intervention. A logistic regression model and multivariable analysis were used to predict success. A graphic nomogram was generated to represent the model.

Results: Complete resolution of the ectopic pregnancy was achieved in 290 (77.9%) patients after a single dose of MTX. A second dose or surgical intervention was required for 82 (22.0%): 49 (13.2%) received a second dose of MTX and 33 (8.9%) underwent laparoscopic salpingectomy. In the MTX Success group compared to the MTX Failure group, the median β-hCG levels were lower (746 vs 1347 IU/L, P < 0.001) and the presence of a yolk sac and a fetal pole were less frequent. The predictive model, based on significant variables, includes initial β-hCG concentration and the visibility of a yolk sac or fetal pole. Analysis with cross-validation techniques revealed that the model was both accurate and discriminative.

Conclusion: A predictive nomogram was developed to predict the success of single-dose MTX treatment for tubal ectopic pregnancy.

Keywords: beta‐human chorionic gonadotropin; ectopic pregnancy; methotrexate; nomogram; prediction model; tubal pregnancy.

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REFERENCES

    1. Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. 2007;2007(1):CD000324.
    1. Stovall TG, Ling FW, Carson SA, Buster JE. Nonsurgical diagnosis and treatment of tubal pregnancy. Fertil Steril. 1990;54:537‐538.
    1. ACOG Practice Bulletin No. 193. Tubal ectopic pregnancy [published correction appears in Obstet Gynecol 2019;133:1059]. Obstet Gynecol. 2018;131(3):e91‐e103.
    1. Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril. 2007;87:481‐484.
    1. Hajenius PJ, Engelsbel S, Mol BW, et al. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. Lancet. 1997;350(9080):774‐779. doi:10.1016/s0140-6736(97)05487-1

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