Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital

Objective: The purpose of this study was to determine our institutional success rate with single-dose intramuscular methotrexate therapy for the treatment of ectopic pregnancy and to identify predictors of treatment outcome. Study Design: This was a retrospective review of consecutive patients who were treated with methotrexate from January 2000 until April 2002. Successful treatment was defined as the resolution of the ectopic pregnancy without surgical intervention. Results: Our overall success rate was 85% (69/81 patients). The median pretreatment serum β-human chorionic gonadotropin level was lower in those women in whom treatment was successful compared with those women with treatment failure (793 vs 3804 mIU/mL, P< .002). The presence of a yolk sac that was visualized on vaginal ultrasonography was the only significant predictor of treatment failure (adjusted odds ratio, 19.3; P< .002). Conclusion: Our institutional success rate (85%) with methotrexate for treatment of tubal ectopic pregnancy is comparable with other published results. However, a finding unique to this study was that visualization of a yolk sac was a risk factor for failure. (Am J Obstet Gynecol 2003;188:1192-4.)