Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The aim of the present study was to analyze retrospectively the safety and success rates of single- and two-dose methotrexate (MTX) protocols for the treatment of hemodynamically stable cases of ectopic pregnancy at University Department of Gynecology and Obstetrics, Zagreb University Hospital Center, during a five-year period. The study evaluated MTX treatment efficacy in 35 women with ectopic pregnancies in relation to the initial levels of human chorionic gonadotropin (hCG) and progesterone. Successful treatment was recorded in 32/35 women, 24/25 on single dose MTX and 8/10 on double dose MTX, whereas 3/35 patients underwent laparoscopy. The mean initial hCG level in all 35 patients on day 0 was 657.54±592.4 IU/L; 572.99±488.10 IU/L in those successfully treated with MTX and 1560.30±890.70 IU/L in those requiring additional laparoscopy (p<0.005). The mean initial hCG level was 393.10±305.9 IU/L in patients successfully treated with a single dose of MTX and 973.5±722.40 IU/L in those with an additional dose of MTX (p<0.002). The mean initial progesterone level was 16.36±10.70 nmol/L in 35 MTX-treated ectopic pregnancy patients, 13.64±8.89 nmol/L in those with treatment success and 28.45±11.32 nmol/L in cases of treatment failure (p<0.05). The mean level of progesterone on day 0 was 12.74±8.30 nmol/L in patients successfully treated with a single dose of MTX and 26.10±18.80 nmol/L in patients treated with double-dose MTX (p<0.006). It is concluded that pretreatment values of hCG and progesterone are inversely related to medicamentous treatment success in selected cases of hemodynamically stable patients, thus they may be used as an important predictor in the management of ectopic pregnancy treated with MTX.Cilj ove studije bio je retrospektivno analizirati uspješnost i pouzdanost liječenja metotreksatom (MTX) kroz protokole pojedinačne i dvostruke doze u slučajevima hemodinamski stabilnih izvanmaterničnih trudnoća u Klinici za ženske bolesti i porode, KBC Zagreb tijekom petogodišnjeg razdoblja. U radu se procjenjivala učinkovitost liječenja 35 izvanmaterničnih trudnoća pomoću MTX u odnosu na početne razine humanog korionskog gonadotropina (hCG) i progesterona. Uspješno liječenje zabilježeno je kod 32/35 žena, od kojih 24/25 uz pojedinačnu dozu, a 8/10 uz dvostruku dozu MTX, dok su 3/35 bolesnica podvrgnute laparoskopiji. Prosječna početna razina hCG nultoga dana u svih 35 bolesnica bila je 657,54±592,4 IU/L, 572,99±488,10 IU/L kod bolesnica izliječenih pomoću MTX i 1560,30±890,70 IU/L kod žena u kojih je bilo potrebno dodatno načiniti laparoskopiju (p<0,005). U bolesnica uspješno liječenih pomoću MTX prosječna početna razina hCG bila je 393,10±305,9 IU/L kod žena s pojedinačnom dozom i 973,5±722,40 IU/L kod žena s dvostrukom dozom lijeka (p<0,002). Prosječna početna razina progesterona u svih 35 žena liječenih pomoću MTX bila je 16,36±10,07 nmol/L, 13,64±8,89 nmol/L kod izliječenih žena i 28,45±11,32 nmol/L u slučajevima izostanka uspješnosti (p<0,05). Kod bolesnica izliječenih jednom dozom MTX prosječna početna razina progesterona bila je 12,74±8,30 nmol/L, a kod onih s dvije doze lijeka 26,10±18,80 nmol/L (p<0,006). Može se zaključiti da su početne vrijednosti hCG i progesterona bile obrnuto proporcionalne s uspješnošću medikamentnog liječenja u odabranoj skupini hemodinamski stabilnih bolesnica i da su važni prediktori u liječenju izvanmaternične trudnoće pomoću MTX
