Examining the relationship between human chorionic gonadotropin levels and the success of medical treatment for ectopic pregnancy.

Researchers from Poland have identified a threshold for human chorionic gonadotropin (hCG) levels above which medical treatment of ectopic pregnancy is unlikely to be successful.

However, despite these findings, the investigators stress that the condition is complex and “each case of ectopic pregnancy must be considered individually” before deciding on the best course of treatment.

The team from Poznan University of Medical Science, led by Ewa Nowak-Markwitz, enrolled 68 patients with ectopic pregnancy who were administered 50 mg/m2 of methotrexate every 7 days. Surgery was carried out in the case of tubal rupture or if beta-hCG levels increased by more than 50 percent.

Medical treatment was successful in 53 (78 percent) women. The median baseline beta-hCG level was significantly lower in these women than in those who required surgery, both at baseline (943 vs 3085 mIU/ml) and after the first methotrexate dose (564 vs 4049 mIU/ml).

Nowak-Markwitz et al calculate that an initial beta-hCG level of 1790 mIU/ml represented the cutoff value above which medical treatment was at risk for failure.

Nevertheless, given that the range of beta-hCG levels in the successfully treated group was very wide, the researchers recommend: “For the sake of clinical practice, we might suggest that methotrexate treatment is always worth trying, unless there are clear indications for surgical procedure.”