Prognostic accuracy of a novel methotrexate protocol for the resolution of tubal ectopic pregnancies

Mathew Leonardi*, Eleanor Allison, Chuan Lu, Batool Nadim, George Condous

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (SciVal)


Objective To evaluate if a decreasing human chorionic gonadotropin (hCG) between day (D) 1 and D7 is an equal or better predictor of tubal ectopic pregnancy (EP) resolution following methotrexate (MTX) treatment than the current standard of care. Study design This was a retrospective cohort prognostic accuracy study of women with a transvaginal ultrasound (TVS)-confirmed tubal EP (November 2006–December 2015). After single-dose MTX treatment, D4/7 hCG ratios were compared with that of D1/D7 in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to predict EP resolution. Results Tubal EP was diagnosed in 301/7350 (4.1%) women who underwent TVS for early pregnancy-related complaints. The patients were managed accordingly: expectant, 84/301 (27.9%); MTX, 65/301 (21.6%); surgery, 152/301 (50.5%). A D1/D7 hCG ratio ≤0.85 predicted successful resolution of tubal EPs (P < 0.001) treated with MTX with sensitivity 0.84 [95% confidence interval (CI), 0.69–0.94]), specificity 0.71 [95%CI, 0.48–0.89], PPV 0.84 [95%CI, 0.69–0.94], NPV 0.84 [95%CI, 0.69–0.94], which is comparable to the prognostic performance of the D4/7 protocol. Conclusion In patients with tubal EP carefully selected for and treated with MTX, it may be reasonable to eliminate the D4 hCG in the follow-up algorithm.
Original languageEnglish
Pages (from-to)186-190
Number of pages5
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Early online date19 Feb 2020
Publication statusPublished - 01 Apr 2020


  • Ectopic pregnancy
  • Methotrexate
  • Pregnancy outcome
  • Prognostic accuracy
  • Resource allocation
  • Tubal pregnancy
  • New South Wales/ethnology
  • Humans
  • Abortifacient Agents, Nonsteroidal/administration & dosage
  • Pregnancy, Tubal/blood
  • Methotrexate/administration & dosage
  • Pregnancy
  • Young Adult
  • Chorionic Gonadotropin/blood
  • Adult
  • Female
  • Watchful Waiting/statistics & numerical data
  • Retrospective Studies


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