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RCOG World Congress 2023
June 12 - 14, 2023 | London, UK
EP.0279
The association between serial β-hcg trends and ectopic pregnancy rupture post-methotrexate administration
Poster Presenter
Part of Topic
Early Pregnancy Complications and Gynaecology
The Association Between Serial β-hCG Trends and Ectopic Pregnancy Rupture Following Methotrexate Administration
Selena Meng1, Eyram Asem1, Catherine Varner1,2, Modupe Tunde-Byass1,3
Background
Ectopic pregnancy (EP) occurs when a blastocyst implants outside the uterine cavity1
EP is diagnosed based on transvaginal ultrasound findings in the context of inappropriately rising serum beta-human chorionic gonadotropin (β-hCG) levels1,2
EPs can be treated medically with methotrexate (MTX), a folic acid inhibitor with a success rate of 70-90% in single-dose protocol1,3,4,5
EP rupture is a surgical emergency that is a leading cause of maternal death in the first trimester1,3
Following MTX, patients must be followed with serial serum β-hCG measurements until β-hCG reaches 01,3
Early prediction of MTX failure leading to EP rupture is essential in guiding safe management of EP
Objectives
Primary: to assess whether serial trends in β-hCG values are associated with EP rupture in patients treated with MTX
Secondary: to identify other potential risk factors for EP rupture
Methods
•Retrospective cohort study of patients followed by Early Pregnancy Assessment Clinic at North York General Hospital between January 2016 and December 2020
•Patients received one dose of MTX following a sonographic diagnosis of EP or pregnancy of unknown location (PUL)
•Collected patient-level data from electronic medical records on demographic data, β-hCG trends, and pregnancy outcomes (rupture vs resolution)
•Out of 433 patients who were followed by the EPAC between 2016 and 2020, 145 patients met study inclusion criteria with sufficient data; 12 (8.3%) experienced EP rupture and 133 (91.7%) experienced resolution
•Univariate logistic regression was used to assess associations between rupture status and percent change in β-hCG and patient demographics
•Linear regression was used to calculate slopes for β-hCG trends over time for each patient, which were used to determine percent decreases in β-hCG for any 1-day, 2-day, and 4-day timespan
Conclusion
Our study describes observed b-hCG trends following MTX treatment for EP management
Increases in the rate of b-hCG decline post-MTX were associated with decreasing odds of EP rupture
These data suggest assessment of rupture risk in clinical settings may deviate from standard b-hCG measurement guidelines of 0, 4, and 7 days post-MTX