Prediction of Tubal Rupture in Ectopic Pregnancy Using Methotrexate Treatment Protocols and Hematological Markers

Abstract

Ectopic pregnancy is a pregnancy complication in which the embryo implants outside the uterine cavity. Although medical treatment is chosen first, sometimes a rupture may occur, and surgical treatment may be required. The parameters to predict rupture have been the subject of many studies. This study aimed to compare the efficacy of different methotrexate protocols in the treatment of ectopic pregnancy and determine the parameters and methotrexate treatment protocols that can predict the risk of rupture. A total of 128 patients diagnosed with ectopic pregnancy were included in this study. Patients were separated into three categories based on their treatment protocols. Regarding the occurrence of rupture, all three groups were compared. The hematological parameters and methotrexate treatment protocols were analyzed and compared between groups. The mean age was 31.9 years. Parity was significantly higher in patients who received multiple doses of methotrexate compared to the other groups. There were significant variations observed among the groups regarding parity, initial β-hCG values, hematocrit (HTC), and mean corpuscular volume (MCV) (p = 0.048, p < 0.001, p = 0.019, and p = 0.047, respectively). According to receiver operating characteristic analysis, neutrophil-to-lymphocyte ratio (NLR) levels were significantly associated with histopathologically confirmed tubal rupture (p < 0.05). NLR levels should be examined in ectopic pregnancy, and the possibility of rupture should be considered in cases with high NLR levels. The potential of NLR to predict ectopic pregnancy rupture should be explored in multicenter prospective studies.