血绒毛膜促性腺激素β在异位妊娠病情监测中的应用

目的探讨监测绒毛膜促性腺激素-β（human chorionic gonadotropin,β-hCG）在异位妊娠（ectopic pregnancy,EP）病情监测中的应用。方法对123例具有相同保守治疗指征的EP患者,保守治疗前均常规监测β-hCG,间隔48h复测一次。按50mg/m2计算给药,采用甲氨蝶呤（methotrexate,MTX）单次肌肉注射,用药后第4d（96h）再次监测β-hCG下降情况,每周一次,至β-hCG降到正常（β-hCG〈100U/L）。EP保守治疗成功组93例根据β-hCG上升或下降分为A组37例、B组56例,EP保守治疗失败的30例为C组（保守后改手术治疗）。结果三组在年龄、孕龄、EP包块直径大小间比较,无统计学意义（P〉0.05）;第一次测定血的β-hCG值结果A与B组比较无统计学意义（P〉0.05）。间隔48h测定,A组β-hCG有所下降,B组升高,A与B组比较有统计学意义（P〈0.01）。应用MTX治疗后A组β-hCG下降幅度〉15%,B组β-hCG有不同程度的升高,与A组比较差异有统计学意义（P〈0.01）。C组因在观察中改行手术治疗,保守治疗失败未做比较。三组β-hCG降至正常的时间B组较A组长,C组最短,差异有统计学意义（P〈0.01）。结论EP保守治疗前后监测β-hCG值的高低有助于判断治疗效果和时间。     

血清β-hCG监测在单剂量氨甲喋呤治疗异位妊娠中的临床价值

目的:评价动态检测血β-hCG 在单剂量氨甲喋呤(MTX)治疗宫外孕的临床价值。方法:回顾性分析MTX单剂量肌肉注射治疗宫外孕104例。结果:治疗总成功率为79.8%。成功组:用药前血β-hCG　948.7±893.8　mIU/mL,与失败组(1784.5±1157.5　mIU/mL)相比差异显著(P<0.001),用药后血β-hCG在d　2 以及d　7 下降显著。结论:MTX治疗前血β-hCG不是影响治疗效果的唯一危险因素,血β-hCG联合超声检测附件包块、后穹隆积液、是适时手术干预的重要客观指标,是保证治疗效果的关键。     

BMI对MTX治疗异位妊娠患者临床效果的影响研究

目的:探讨体质量指数(BMI)对甲氨蝶呤(MTX)治疗异位妊娠临床效果的影响。方法:选取于宝鸡市人民医院采用MTX保守治疗的异位妊娠患者240例,观察治疗前后患者包块直径、血人绒毛膜促性腺激素(β-HCG)水平变化。根据BMI将患者分为25kg/m~2、≥25kg/m~2组,比较两组的临床疗效。多因素分析MTX治疗异位妊娠的相关影响因素。结果:治疗2周后,240例异位妊娠患者的平均包块直径、血β-HCG平均水平较治疗前显著降低(P0.05);≥25kg/m~2组患者的治疗有效率(68.49%)显著低于25kg/m~2组患者(87.43%)(P0.05);以治疗效果作为因变量,年龄、血β-HCG、包块直径、停经时间、BMI、治疗方式作为自变量进行Logistic回归分析,血β-HCG增高、包块直径增大、BMI增加、单次MTX治疗方法是MTX治疗异位妊娠无效的独立危险因素(P0.05)。结论:血β-HCG增高、包块直径增大、BMI增加、单次MTX治疗方法均可影响MTX治疗异位妊娠的临床效果,其中BMI增加是治疗效果不佳的独立危险因素之一。     

血β-hCG 2000～8000 IU/L的输卵管妊娠保守治疗方案研究

目的:探讨较高水平血β-hCG(2 000~8 000 IU/L)输卵管妊娠的保守治疗方案。方法:将106例输卵管妊娠要求保守治疗的患者随机分为复方组和对照组,每组53例。复方组口服复方米非司酮片+肌内注射氨甲蝶呤(MTX)+口服本院协定处方宫外孕方+口服大黄蛰虫胶囊;对照组除不服用复方米非司酮片外,其余治疗同复方组。结果:临床总有效率复方组为96.2%,对照组为75.5%,组间比较差异有统计学意义(P<0.05);复方组45例1个疗程内治愈,对照组23例1个疗程内治愈,组间差异有显著统计学意义(P<0.01),阴道流血时间、平均住院时间、血β-hCG转阴时间和盆腔包块消失时间组间比较均有统计学差异(P<0.05)。结论:复方米非司酮协同MTX及中药治疗输卵管妊娠,能明显提高有较高水平血β-hCG(2 000~8 000 IU/L)输卵管妊娠的治愈率。     

剖宫产瘢痕部位妊娠保守治疗时出血的影响因素探讨

目的:探讨剖宫产瘢痕部位妊娠(CSP)保守治疗时影响出血的相关因素。方法:选取2010年1月至2013年1月收入我院的78例剖宫产瘢痕部位妊娠患者,患者均行药物[甲氨蝶呤(MTX)+米非司酮]联合宫腔镜下清宫术加球囊压迫术保守治疗。按治疗过程中的出血量分为出血量200ml组和出血量≤200ml组,比较两组的停经天数、妊娠包块最大直径、有无胎心、瘢痕厚度、治疗前后β-HCG值、MTX用药方式等,探讨影响出血的因素。结果:78例患者均保守治疗成功,其中10例(12.8%)出血200ml。妊娠包块直径越大、活胎、治疗前β-HCG50000U/L、清宫术前β-HCG5000U/L是出血量多的高危因素,而停经天数、瘢痕厚度、MTX用药方式不影响出血量。结论:妊娠包块直径、绒毛活性影响CSP保守治疗出血量,缩小包块、降低绒毛活性后行清宫,可减少出血量,提高保守治疗的安全性和可靠性。     

甲氨蝶呤治疗血液动力学稳定伴腹腔游离液输卵管妊娠48例报道CSCD

目的 探索单剂量甲氨蝶呤(MTX)治疗血液动力学稳定具有游离腹腔液输卵管妊娠(TP)作用。方法 回顾性分析单剂量MTX治疗超声发现3 cm以上游离腹腔液TP 48例,以最多2次单剂量MTX无需其他治疗、血h CG下降至正常定义为成功,大于2次单剂量MTX或手术治疗定义为失败。结果 单剂量MTX治疗超声发现游离腹腔液TP成功率85.4%,与同期无或小于3 cm游离腹腔液TP成功率82.0%相似(χ2=0.03, P=0.86)。在具有腹腔液TP中,TVS卵巢旁包块直径和血流不同于无游离腹腔液TP(P=0.00和P=0.01),具有游离腹腔液TP不同治疗结果不孕史、治疗前血h CG值差异有统计学意义(P=0.02, P=0.00)。积液大于5 cm需要重复单剂量机率更高(P=0.03)。结论 单剂量MTX是血液动力学稳定具有游离腹腔液TP的可选择治疗方式。     

异位妊娠保守治疗的临床观察

目的：观察甲氨蝶呤（MTX）联合米非司酮治疗异位妊娠的疗效。方法：回顾性分析符合保守治疗条件,采用单纯MTX（29例）和MTX联合米非司酮（31例）治疗的异位妊娠患者的资料,比较2组的成功率、住院时间以及治疗后β人绒毛膜促性腺激素（β-hCG）恢复正常时间。结果：治疗组成功率、住院时间以及治疗后β-hCG恢复正常时间分别为90.3%、（13.9±1.3）d和（12.8±1.2）d,对照组分别为65.5%、（20.9±6.2）d 和（23.6±2.9）d,2组差别有统计学意义（P ＜0.01）。结论：MTX联合米非司酮治疗异位妊娠效果好,恢复快,优于其单独使用。     

氨甲喋呤单次肌肉注射治疗输卵管妊娠疗效分析

目的 探讨氨甲喋呤（ＭＴＸ）单次肌肉注射治疗输卵管妊娠的疗效,并观察失败的相关因素及其数量与失败可能性的关系。方法 对４１例治疗成功和１１例治疗失败病例的临床资料、包块面积改变以及血清β－ｈＣＧ值的变化进行对比分析。结果 失败组平均停经时间６３．４天、血β－ｈＣＧ平均１５７７６．５ＩＵ／Ｌ、治疗３日后β－ｈＣＧ平均下降１８．３％、治疗后包块平均面积增加６４．２％。成功组平均停经时间５６．４天、血β     

氨甲喋呤单次肌内注射治疗异位妊娠

目的：探讨氨甲喋呤（ＭＴＸ）单次肌内注射治疗异位妊娠的效果及适应证。方法：对２７例异位妊娠患者采用ＭＴＸ单次肌内注射（５０ｍｇ／ｍ２），不用四氢叶酸解毒方案治疗。定时监测血β－ｈＣＧ直至正常。结果：２４例成功，成功率８８．９％。成功与失败患者的孕龄、异位妊娠包块直径间的差异无显著性（Ｐ＞０．０５），但治疗前腹痛症状的发生率及血β－ｈＣＧ值间的差异有非常显著性（Ｐ均＜０．０１）。结论：早期诊断和严格选择病例是治疗成功的关键。无腹痛症状、异位妊娠包块直径≤５ｃｍ，血β－ｈＣＧ＜６０００ＩＵ／Ｌ为药物治疗的适应证。     

输卵管妊娠放射介入治疗的临床研究

目的 探讨输卵管妊娠放射介入治疗的临床疗效及适应证。方法 用X线影像临视下选择性子宫动脉内插管，一次性灌注MTX 50mg或MTX 80mg加5-FU 500mg，并辅以明胶海绵颗粒栓塞治疗输卵管妊娠28例，观察其症状、体征、血尿β-hCG及B超结果的变化情况。结果 25例输卵管妊娠经介入治疗成功，治愈率为89.3%。腹痛症状于介入治疗后5～17天内消失，阴道流血症状于介入治疗后3～13天内消失。血、尿β-hCG于介入治疗后3周内转为阻性。B超检查盆腔液性暗区80%于介入治疗后2周内消失，附件包块88%于介入治疗后4周内消失。结论 未破裂型输卵管妊娠或破裂型与流产型输卵管妊娠但无明显贫血和休克征象的患者采用放射介入治疗是有效的。     

Risk factors for rupture in tubal ectopic pregnancy: definition of the clinical findings

Objectives

The aim of this study is to determine the risk factors for rupture of an ectopic pregnancy (EP) to help physicians identify those women who are at greatest risk.

Study design

The study group comprised the cases of EP treated in our department from January 2003 to September 2009. The following parameters were retrospectively examined: rupture status, past history of pelvic infection or EP, use of an intrauterine device (IUD), parity and gestational age. Women with tubal rupture were compared to those without rupture. Where appropriate, univariate and multivariate analyses were used to identify predictors of the outcome of EP.

Results

Two hundred and thirty-two cases of EP were retrieved. Eighty-eight of them (37.9%) were cases with ruptured EP and 144 (62.1%) were cases with unruptured EP. No significant associations existed regarding IUD use, smoking, previous ectopic pregnancy, past history of pelvic inflammatory disease (PID) or history of endometriosis. The mean gestation (in weeks) since the last menstrual period and the mean level of βhCG were significantly higher in patients with ruptured EP compared with patients with unruptured EP (7.8 ± 1.09 versus 6.4 ± 1.2, p < 0.0001; and 8735.3 ± 11317.8 IU/ml versus 4506 ± 5673.7 IU/ml, p < 0.0001, respectively). Logistic regression analysis revealed that 6-8 weeks of amenorrhoea (OR: 3.67; 95% CI: 1.60-8.41) and >8 weeks of amenorrhoea (OR: 46.46; 95% CI: 14.20-152.05) and also 1501-5000 IU/ml of βhCG level (OR: 4.11; 95% CI: 1.53-11.01) and >5000 IU/ml of βhCG levels (OR: 4.40; 95% CI: 1.69-11.46) were the significant risk factors for tubal rupture.

Conclusions

Higher βhCG levels and higher gestational age seem to be significant risk factors for rupture of an EP.     

Trichosanthin, a Chinese medicine for the medical treatment of ectopic pregnancy with high levels of β-hCG

This was a retrospective study of the effectiveness of trichosanthin (TCS), an active component isolated from the Chinese herb root tuber of Trichosanthes kirilowii on 140 cases of ectopic pregnancy with higher levels of β-human chorionic gonadotropin (β-hCG) managed with a single dose of TCS treatment. Trichosanthin has been used for medical treatment of ectopic pregnancy in China since the 1980s. This study was performed in a major teaching hospitals in China. The mean pretreatment level of β-hCG in the TCS treatment group was 3387.57 IU/L. The success rate of TCS treatment was 85% (119 of 140) which was similar to methotrexate (MTX) treatment. In 86 women with a high level of β-hCG (over 2000 IU/L), the success rate was 80.08% when treated with TCS. Of this group, 26 women who had a high level of β-hCG (over 5000 IU/L) showed a success rate of 73%. The level of β-hCG on days 4, 7, and 10 in TCS group was significantly decreased. This study has shown that TCS may be an option for the medical treatment of unruptured ectopic pregnancy or an option for the treatment of ectopic pregnancy with higher levels of β-hCG than currently recommended for medical management with MTX.     

Treatment of ectopic pregnancy with a single intramuscular dose of methotrexate

This study evaluates the outcome of unruptured ectopic pregnancies treated with single-dose intramuscular methotrexate injection. There were 77 women with unruptured non-laparoscopically diagnosed ectopic pregnancies who were prospectively followed after receiving a single dose of 50 mg/m2 intramuscular methotrexate. Diagnosis required transvaginal ultrasound and serial quantification of beta subunit of human chorionic gonadotropin (betahCG). A repeat dose was given if the weekly drop of betahCG was less than 30%. Therapy was considered successful if complete resolution of betahCG to a level below 25 IU/L was achieved without surgical intervention. Treatment in 73 (95%) cases was successful. The mean pre-treatment level of betahCG was 2592 +/- 3771 IU/L (177-15000 IU/L), the mean diameter of ectopic mass was 2.4 +/- 1.0 cm (1.7-3.5 cm). The average resolution period was 3.2 +/- 1.0 weeks (1-6 weeks) and this significantly correlated with the pre-treatment betahCG level. With strict criteria of inclusion and follow-up, single-dose intramuscular methotrexate is a successful method for the treatment of selected cases of ectopic pregnancy.     

Comparison of double- and single-dose methotrexate protocols for treatment of ectopic pregnancy

ObjectiveTo compare efficacy between double-dose methotrexate and single-dose methotrexate for treatment of tubal ectopic pregnancy (EP).MethodsBetween March 2008 and February 2011,157 patients who had tubal EP diagnosed by a non-laparoscopic approach and were hemodynamically stable were enrolled in a prospective study in Qassim, Saudi Arabia. The participants were randomized to receive either double-dose (50 mg/m² intramuscularly on days 0 and 4; group 1) or single-dose (50 mg/m² intramuscularly on day 0; group 2) methotrexate. Serum human chorionic gonadotropin (β-hCG) levels were followed until negative.ResultsThe overall success rate was comparable between groups 1 and 2 (88.6% versus 82.0%, P = 0.1). The duration of follow up until negative β-hCG was shorter in group 1 (P = 0.001). Receiver operative characteristics showed that higher cut-off levels of β-hCG and gestational mass diameter were associated with successful outcome in group 1. Among participants with initial β-hCG of 3600–5500 mIU/mL, the success rate was higher in group 1 (P = 0.03). There was no significant difference between groups in adverse effects.ConclusionFor treatment of EP, double-dose methotrexate had efficacy and safety comparable to that of single-dose methotrexate; it had better success among patients with moderately high β-hCG and led to a shorter follow up.     

甲氨蝶呤和米非司酮联合治疗非破裂型输卵管妊娠

目的探讨甲氨蝶呤(MTX)和米非司酮联合治疗非破裂型输卵管妊娠的效果。方法米非司酮300mg一次顿服,MTX20mg静注×5d。单用MTX的病人设为对照组。结果MTX和米非司酮联合治疗的成功率为87.5％,明显高于对照组。观察治疗期间病情变化,发现疗效与血β-hCG高低及有无心管搏动有关。结论MTX和米非司酮联合治疗非破裂型输卵管妊娠安全有效,适用于生命体征平稳、无剧烈腹痛、无心管搏动及血β-hCG＜30μg/L的非破裂型输卵管妊娠。     

A medical management of interstitial ectopic pregnancy: a 5-year clinical study

BACKGROUND: Medical treatment of the rare interstitial ectopic pregnancy with methotrexate has been considered an alternative to surgical resection. AIM: To determine the treatment success rate with a single-dose intravenous methotrexate/folinic acid regimen and to identify predictors of treatment outcome. METHODS: A 5-year audit (April 2000-August 2005) was carried out, collecting clinical imaging data and serum beta-human chorionic gonadotrophin (beta-hCG). Time taken for complete beta-hCG resolution was recorded, and a negative beta-hCG result was used as an endpoint of successful outcome. RESULTS: Of the 13 cases, two required urgent surgery for rupture on presentation. In the remaining 11 cases, intravenous methotrexate (300 mg) was used, with oral folinic acid rescue (15 mg x 4 doses). There were no side-effects. Complete beta-hCG resolution was achieved in 10 of the 11 medically treated cases (91% success rate), requiring 21-129 days. Successful outcome was seen with initial beta-hCG level as high as 106 634 IU/L and gestation sac as large as 6 cm and a live fetus. CONCLUSION: The methotrexate/folinic acid regimen used as a one-dose treatment is safe and effective for unruptured interstitial pregnancy, with no side-effects and the advantage of avoiding invasive surgery. Subsequent tubal patency and reproductive function are yet to be ascertained.     

An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy

Objective To compare the direct and indirect costs of single dose systemic methotrexate with laparoscopic surgery for the treatment of unruptured ectopic pregnancy.
Design A cost minimisation study undertaken alongside a randomised trial.
Setting Departments of Obstetrics and Gynaecology in three hospitals in Auckland, New Zealand.
Participants Sixty-two women with an ectopic pregnancy randomised to treatment with either a single dose of methotrexate (  50mg/m²  ) or laparoscopic surgery.
Main outcome measures Direct and indirect costs based on the results of the randomised trial.
Results Direct costs per case were significantly lower in the methotrexate group (mean $NZ 1470) than in the laparoscopy group (mean $NZ 3083) with a mean difference of $NZ 1613 (95% CI $NZ 1166 - $NZ 2061). These significant differences existed under a wide range of alternative assumptions about unit costs. The difference in direct costs in favour of methotrexate was greatest for women presenting with low pretreatment serum β-hCG concentrations. Mean indirect costs were also significantly lower in the methotrexate group (mean $NZ 1141) than in the laparoscopy group (mean $NZ 1899) with a mean difference of $NZ 758 (95% CI $NZ 277 - $NZ 1240). For women presenting with pretreatment serum β-hCG concentrations of over 1500 IU/L this difference in indirect costs is lost due to the prolonged follow up required and a higher rate of surgical intervention in women receiving methotrexate.
Conclusion This economic evaluation shows that treating suitable women with an ectopic pregnancy using systemic methotrexate therapy results in a significant reduction in direct costs. The indirect costs borne by the woman and her carers are only likely to be reduced in women with pretreatment serum β-hCG concentrations under 1500 IU/L.     

Evaluation of serum creatine kinase in ectopic pregnancy with reference to tubal status and histopathology

Objective To study the value of creatine kinase in ectopic pregnancy with reference to tubal histopathology.
Design Prospective controlled study.
Setting Academic tertiary-care institution.
Population Thirty-two women with ectopic pregnancy and 20 controls with intrauterine pregnancies.
Methods Creatine kinase and β-hCG levels were measured on admission. Ectopic pregnancies were removed at surgery and examined histologically.
Main outcome measures Tubal localisation and integrity of ectopic pregnancies as judged at surgery and later histologically, and placental growth patterns in unruptured ectopic pregnancies classified as intraluminal, extraluminal or mixed as determined histologically.
Results Creatine kinase levels were higher in isthmic than ampullary ectopic pregnancies (   P = 0.011  ), and higher in ruptured than in unruptured cases (   P = 0.003  ) and normal pregnancies (   P < 0.0001  ). A creatine kinase value >120iu/L was 65% sensitive and 87% specific in discriminating ruptured from unruptured ectopic pregnancies. Creatine kinase levels were above this cutoff in two of five unruptured ampullary ectopic pregnancies with invasive trophoblastic growth, yet in none of nine cases with intraluminally confined placentation (   P = 0.04  ). Creatine kinase was positively correlated with gestational age in ruptured (   P = 0.007  ), but not in unruptured ectopic pregnancies or normal pregnancies.
Conclusions Serum creatine kinase may help in discriminating ruptured from unruptured ectopic pregnancies, while it is not useful for the primary diagnosis of ectopic pregnancy. An increase in creatine kinase levels accompanying muscular damage in ectopic pregnancy probably antedates tubal rupture, and may be related to trophoblastic growth patterns.     

宫腔镜联合子宫动脉栓塞术终止剖宫产术后子宫瘢痕妊娠的疗效与安全性

目的 探讨宫腔镜终止剖宫产术后子宫瘢痕妊娠(CSP)的疗效和安全性.方法 回顾性分析2003年8月至2010年12月浙江大学医学院附属妇产科医院收治的、术中采用B超或腹腔镜监护的33例采用宫腔镜治疗的CSP病例资料,观察分析孕龄、术前血β-hCG水平、子宫峡部肌层厚度、病灶形态、手术成功率、治愈率、手术时间、术中出血量、CSP包块消失时间、血β-hCG恢复正常时间以及并发症等.结果 33例患者中位孕龄为54 d(37～140d),术前中位血β-hCG为15 000 U/L(3.3～151 747U/L),子宫峡部肌层厚度平均为3.3 mm.33例中29例术前联合子宫动脉栓塞术(UAE),宫腔镜下见91%(30/33)的患者子宫峡部凹陷呈腔隙状,所有病例妊娠物均突向宫腔或峡部腔隙内,采用宫腔镜电切割环联合刮宫清除妊娠物.平均手术时间为(34±10)min,手术成功率、治愈率均为94%(31/33),其中1例术后追加单次甲氨蝶呤(MTX)治疗.血β-hCG术后平均(22±10)d恢复正常,子宫峡部包块平均(21±12)d消失.并发症发生率为9%(3/33),其中1例下肢静脉血栓形成,2例大出血并行子宫切除术,无子宫穿孔发生.出血量≤100ml者31例.术后4例再次妊娠,其中1例足月妊娠,3例人工流产各1次,无CSP复发.结论 宫腔镜联合UAE终止CSP安全、有效.

Abstract：

Objective To investigate safety and efficacy of hysteroscopy in treatment of cesarean scar pregnancy(CSP).Methods From Aug.2003 to Dec.2011, 33 cases with CSP treated by hysteroscopy guided by transabdominal ultrasound or laparoscopy were studied retrospectively in Women's Hospital,School of Medicine, Zhejiang University.The clinical characteristics including gestational age, myometrial thickness anterior to the CSP, β-hCG level before treatment,success rate, cure rate, operative time, blood loss, time of serum β-hCG resolution and CSP mass clearance, and complication were collected and analyzed.Results Median gestational age was 54 days (range, 37 - 140 days).Median level of β-hCG before treatment was 15 000 U/L( range,3.3 - 151 747 U/L).Mean thickness of anterior myometrium was 3.3 mm.Twenty-nine cases underwent uterine artery embolism (UAE) before hysteroscopy.Pouch in the anterior uterine isthmus with gestation masses implanted were observed in 30 cases (91%, 30/33 ).CSP masses progressed toward the pouch or uterine cavity in all cases was removed by cutting wire loop electrode combined with curettage.The mean operative time was (34 ± 10) minutes.Both success rate and cure rate were 94% ( 31/33 ) .Salvage methotrexate ( MTX ) therapy was administrated in one case.Complication occurred in three cases (9%, 3/33 ).Both massive hemorrhage rate and hysterectomy rate were performed in two cases (6%, 2/33).No uterine perforation occurred.The mean time of hCG resolution was (22 ± 10)days.The mean time of CSP mass clearance was (21 ± 12) days.Four pregnancies were achieved in four cases:one term pregnancy and three abortions.No recurrent CSP occurred.Conclusion Management of CSP by hysteroscopy combined with UAE is safe and effective.     

The effect of parental 5,10-methylenetetrahydrofolate reductase 677C/T and 1298A/C gene polymorphisms on response to single-dose methotrexate in tubal ectopic pregnancy

Object: The aim of this study was to assess the effect of parental 5,10-methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms (677C/T and 1298A/C) on response to single-dose methotrexate (MTX) treatment in tubal ectopic pregnancy (TEP).

Materials and methods: In this prospective cohort study, cases with unruptured TEPs were grouped into two according to their response to single-dose MTX treatment (Group 1: responsive, n:88; Group 2: unresponsive, n:21). The groups were compared with regard to baseline demographic and clinical parameters. As a main outcome measure, the independent effects of parental MTHFR gene polymorphisms on response to single dose MTX treatment were evaluated.

Results: One hundred and nine unruptured TEP were included in the final analysis. The mean maternal age was 29.30?±?5.21 years, gravity 2 (min–max: 1–5), parity 1 (min–max: 0–4). The median serum beta-human chorionic gonadotropin (β-hCG) was 1403.35?MI/I (Q₁–Q₃: 517–2564). The overall response rate was 81% (88/109). The groups were similar with respect to basic baseline demographic data and serum β-hCG level. Binary logistic regression analysis showed that the presence of parental MTHFR677C/T and 1298A/C polymorphism were not independent factor predicting treatment success (p?>?0.05). The only independent factor for resistance to single dose MTX was the previous TEP (OR: 4.47 (1.18–16.9)).

Conclusion: Parental MTHFR 677C/T and 1298A/C mutations do not predict the outcome of single dose intramuscular MTX treatment in unruptured TEP.