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Yolk sac on transvaginal ultrasound as a prognostic indicator in the treatment of ectopic pregnancy with single-dose methotrexate

      Objective

      To determine whether yolk sac on transvaginal ultrasound was an independent predictor for single-dose methotrexate failure for tubal ectopic pregnancies.

      Study Design

      Seven hundred sixty-six consecutive methotrexate-treated ectopic pregnancy patients were reviewed. After excluding 25 oral and 97 multidose methotrexate patients, 18 cornual, 4 cervical pregnancies, and 63 patients with ectopic cardiac activity, 559 study patients remained. Variables studied included age, gravidity, parity, previous ectopic pregnancy, serum human chorionic gonadotropin and progesterone levels, ectopic size, ectopic volume, body surface area, and yolk sac presence.

      Results

      Sixteen of 73 (21.9%) patients with yolk sac failed treatment vs 36 of 486 (7.4%) patients without yolk sac (P = .0003). Other significant variables on single factor analysis were previous ectopic (P = .0005), human chorionic gonadotropin (P < .0001), and progesterone (P = .003). Only previous ectopic and human chorionic gonadotropin remained significant on logistic regression analysis.

      Conclusion

      The presence of a yolk sac, although a risk factor for failure of single-dose methotrexate in treatment of tubal ectopic pregnancy, is not an independent predictor.

      Key words

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      References

        • Kooi S.
        • Kock H.C.
        A review of the literature on nonsurgical treatment in tubal pregnancies.
        Obstet Gynecol Surv. 1992; 47: 739-749
        • Glock J.L.
        • Johnson J.V.
        • Brumsted J.R.
        Efficacy and safety of single-dose systemic methotrexate in the treatment of ectopic pregnancy.
        Fertil Steril. 1994; 62: 716-721
        • Ransom M.X.
        • Garcia A.J.
        • Bohrer M.
        • Corsan G.H.
        • Kemmann E.
        Serum progesterone as a predictor of methotrexate success in the treatment of ectopic pregnancy.
        Obstet Gynecol. 1994; 83: 1033-1037
        • Corsan G.H.
        • Karacan M.
        • Qasim S.
        • Bohrer M.K.
        • Ransom M.X.
        • Kemmann E.
        Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy.
        Hum Reprod. 1995; 10: 2719-2722
        • Shalev E.
        • Peleg D.
        • Bustan M.
        • Romano S.
        • Tsabari A.
        Limited role for intratubal methotrexate treatment of ectopic pregnancy.
        Fertil Steril. 1995; 63: 20-24
        • Stika C.S.
        • Anderson L.
        • Frederiksen M.C.
        Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience.
        Am J Obstet Gynecol. 1996; 174: 1840-1846
        • Lipscomb G.H.
        • McCord M.L.
        • Stovall T.G.
        • Huff G.
        • Portera S.G.
        • Ling F.W.
        Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies.
        N Engl J Med. 1999; 341: 1974-1978
        • Lipscomb G.H.
        • Givens V.A.
        • Meyer M.L.
        • Bran D.
        Previous ectopic pregnancy as a risk factor for failure of systemic methotrexate therapy.
        Fertil Steril. 2004; 81: 1221-1224
        • Bixby S.
        • Tello R.
        • Kuligowska E.
        Presence of a yolk sac on transvaginal sonography is the most reliable predictor of single-dose methotrexate treatment failure in ectopic pregnancy.
        J Ultrasound Med. 2005; 24: 591-598
        • Potter M.B.
        • Lepine L.A.
        • Jamieson D.J.
        Predictors of success with methotrexate treatment of tubal ectopic pregnancy at Grady Memorial Hospital.
        Am J Obstet Gynecology. 2003; 188: 1192-1194
        • Stovall T.G.
        • Ling F.W.
        • Carson S.A.
        • Buster J.E.
        Nonsurgical diagnosis and treatment of tubal pregnancy.
        Fertil Steril. 1990; 54: 537-538
        • Stovall T.G.
        • Ling F.W.
        • Gray L.A.
        • Carson S.A.
        • Buster J.E.
        Methotrexate treatment of unruptured ectopic pregnancy: a report of 100 cases.
        Obstet Gynecol. 1991; 77: 749-753
        • Stovall T.G.
        • Ling F.W.
        Single-dose methotrexate: an expanded clinical trial.
        Am J Obstet Gynecol. 1993; 168: 1759-1762