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

To determine the risks when the primary methotrexate (MTX) treatment ofcervical pregnancy has an unsatisfactory outcome, we conducted a Medlinesearch on relevant literature published from January 1983 to June 1997. Thesearch yielded 28 publications of 48 cases of cervical pregnancy. These andfour new cases from our institutions were used in our study. A cervicalpregnancy that presented with a serum beta-human chorionic gonadotrophinconcentration of > or = 10,000 mIU/ml [odds ratio (OR) 10.82, 95%confidence interval (CI) 2.59, 45.14], gestational age at > or = 9 weeks(OR 6.44, 95% CI 1.46, 28.52), embryonic cardiac activity (OR 14.29, 95% CI2.95, 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 unsatisfactory rateof primary MTX treatment. A concomitant feticide was found to enhance thetherapeutic effect of MTX treatment if embryonic cardiac activity wasevident (OR 0.13, 95% CI 0.02, 0.68). Administration of a high dose of MTXdid not seem to be more effective than a lower one. Our findings supportedsome previous observations and, more importantly, provided useful clinicalinformation in selecting appropriate candidates for MTX treatment in casesof cervical pregnancy.