Prognostic factors for an unsatisfactory primary methotrexate treatment ofcervical pregnancy: a quantitative review

To determine the risks when the primary methotrexate (MTX) treatment of cer vical pregnancy has an unsatisfactory outcome, we conducted a Medline searc h on relevant literature published from January 1983 to June 1997, The sear ch yielded 28 publications of 48 cases of cervical pregnancy. These and fou r new cases from our institutions were used in our study. A cervical pregna ncy that presented with a serum beta-human chorionic gonadotrophin concentr ation of greater than or equal to 10 000 mIU/ml [odds ratio (OR) 10.82, 95% confidence interval (CI) 2.59, 45.14], gestational age at greater than or equal to 9 weeks (OR 6.44, 95% CI 1.46, 28.52), embryonic cardiac activity (OR 14.29, 95% CI 2.95, 76.92), and crown-rump length of >10 mm (OR 13.33, 95% CI 1.46, 120.48) was considered to be associated with a higher unsatisf actory rate of primary MTX treatment. A concomitant feticide was found to e nhance the therapeutic effect of MTX treatment if embryonic cardiac activit y was evident (OR 0.13, 95% CI 0.02, 0.68), Administration of a high dose o f MTX did not seem to be more effective than a lower one. Our findings supp orted some previous observations and, more importantly, provided useful cli nical information in selecting appropriate candidates for MTX treatment in cases of cervical pregnancy.