Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate

Objective: To evaluate the efficacy of a predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate in order to select the best cases for the medical treatment. Method: Our study included 40 patients. The inclusion criteria were: hemodynamic stability; adnexal mass less than or equal to 3.5 cm; desire of future pregnancy; and a written permission to participate in the study. All patients were treated with a single dose of methotrexate (50 mg/m(2) i.m.). A predictive score was elaborated based on four parameters: initial levels of beta-hCG, aspects of the image at ultrasound (hematosalpinx, tubal ring or live embryo), size of the mass, vascular flow of the color Doppler. Each parameter received a grade from 0 to 2. Grade 0 represented an unfavorable situation, grade 1 a borderline situation and grade 2 a favorable situation. Results: The success rate with a single dose of methotrexate was 75% (30/40). In the present study the cut off grade was 5, because the majority of patients with grade 2 5 were treated successfully (29/30 - 97%), while those with grade < 5 failed. Conclusion: The predictive score helps us to indicate the best cases for the medical treatment. Therefore, we do not advise it when the grade is < 5. However, we can predict a good evolution of the treatment when the grade is greater than or equal to 5. (C) 1999 International Federation of Gynecology and Obstetrics.