Abstract
OBJECTIVE: Methotrexate remains the most commonly used agent for the medical management of ectopic pregnancy. The aim of this study was to develop a novel scoring system to predict the efficacy of single-dose methotrexate treatment in ectopic pregnancy. METHODS: In this retrospective study, information on patients diagnosed with ectopic pregnancy between January 2012 and December 2023 was obtained from the hospital information system. Notably, 156 patients received a single dose of methotrexate for ectopic pregnancy treatment and met the study criteria. Almost 117 of those who were successful in single-dose methotrexate treatment constituted the successful methotrexate treatment group. The other 39 cases who failed single-dose methotrexate treatment constituted the failed methotrexate treatment group. A new scoring system was developed based on six parameters, including serum human chorionic gonadotropin level, gestational week, and ultrasound findings. RESULTS: According to the scoring system, the total score was significantly higher in the group in which methotrexate treatment failed compared to the group with successful treatment (4 points versus 2 points, respectively, p<0.001). In receiver operating characteristic analysis, the optimal cut-off value for the scoring system was determined as 2.5, with 92% sensitivity and 78% specificity (AUC=0.804, 95%CI 0.731-0.877). The overall success rate of single-dose methotrexate treatment was 75%. However, when only patients with a score below the cut-off value of 2.5 were considered, the success rate of single-dose methotrexate treatment in ectopic pregnancy increased to 90.5%. CONCLUSION: This new scoring system significantly enhances the ability to predict outcomes of methotrexate therapy, allowing for faster decision-making regarding surgical intervention.