Sarah Bixby MD, Presenter: Nothing to Disclose

Brandie Reid Fagin MD, Abstract Co-Author: Nothing to Disclose

Titilayo Olupona, Abstract Co-Author: Nothing to Disclose

Ewa Kuligowska MD, Abstract Co-Author: Nothing to Disclose

To determine which ultrasound characteristics reliably predict the outcome of single-dose methotrexate treatment in ectopic pregnancy, in correlation with patient age and beta-hCG.

A retrospective study was performed on sixty-two patients (age 16-47; mean 29) from November 2000 to August 2003 treated with methotrexate for ectopic pregnancy. The TVUS were reviewed and analyzed according to specific criteria, including documenting the amount and echogenicity of free fluid, presence and size of extraovarian mass, presence of pseudogestational sac, presence of yolk sac, and presence of fetal heart motion. The age of the patient and the beta-hCG level were also reviewed. Treatment success was defined as a single dose of methotrexate which resulted in appropriate lowering of beta-hCG levels.

Of 62 patients, 17 failed single dose methotrexate (27%). The amount of free fluid in the pelvis, the size of the extra-ovarian mass, and the presence of a pseudogestational sac had no statistically significant association with treatment outcome. A yolk sac was identified in 15 of the 17 treatment failures and in none of the cases in which treatment was successful (Sens 88%, Spec. 100%, PPV 100%, NPV 96%). Fetal heart motion was identified in one patient who failed treatment, and was not present in any of the cases of treatment success. The average beta-hCG level in the cases of treatment failure was 3282 mIU/ml, compared to an average value of 1544 mIU/ml in the treatment success group. The age of the patient was not statistically significant.

Our results challenge accepted protocols that exclude patients with larger tubal ectopic pregnancies (<3.5cm) and significant free fluid in the pelvis from single-dose methotrexate treatment regimens. Neither of these two findings was associated with lower rates of treatment success in our study population. The presence of fetal heart motion and yolk sac are the best predictors of treatment failure, in conjunction with beta-hCG levels. The mean beta-hCG value in the treatment failure group was approximately double the value of the treatment success group.

Bixby, S, Fagin, B, Olupona, T, Kuligowska, E, Ultrasound Characteristics as Predictor of Outcome of Single-Dose Methotrexate Treatment of Ectopic Pregnancy.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4411500.html