Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single-dose methotrexate treatment in women with tubal ectopic pregnancy.

PURPOSE: The purpose of this study was to evaluate the initial and day 4 beta-human chorionic gonadotropin (ß-hCG) levels as a predictor of methotrexate (MTX) therapy success for ectopic pregnancy. METHODS: Retrospective study of 87 patients with tubal ectopic pregnancy treated with a single dose of 50 mg/m(2) MTX at Bursa Sevket Yilmaz Research and Education Hospital between January 2011 and July 2012 was performed. RESULTS: The overall success rate is measured as 72.4 %. The two groups of patients, successfully treated patients (n = 63) and unsuccessfully treated patients (n = 24), were compared. The mean initial ß-hCG level was significantly lower in the treatment success group than in the treatment failure group (1,417 mIU/mL versus 5,995 mIU/mL, p < 0.001). The number of cases with decreasing ß-hCG level on day 4 was significantly more in the success group compared to the failure group (61.9 and 37.5 %, respectively, p = 0.04). The success rate was 90 % when ß-hCG levels were <1,000 mIU/mL, 85.7 % when the levels were between 1,000 and 1,999 mIU/mL, and 76.5 % when the levels were between 2,000 and 2,999 mIU/mL, 54.5 % when the levels were between 3,000 and 3,999 mIU/mL. CONCLUSION: Single-dose MTX therapy is a safe and effective treatment modality for tubal ectopic pregnancies with the ß-hCG serum concentration below 3,000 mIU/mL, and ß-hCG level changes between days 0 and 4 after MTX therapy are important in predicting the outcome of treatment.

First-trimester crown-rump length affects birth size symmetrically.

OBJECTIVE: To investigate the relationship between crown-rump length (CRL) and birth weight, length and head circumference of the newborn. METHODS: From a database of delivery records of 12,000 pregnancies, we identified 999 women with singleton pregnancies who had no medical problems, a normal menstrual history and a first trimester ultrasound scan in which CRL had been measured. All of the pregnancies resulted in live births without evidence of chromosomal and congenital abnormalities. The population in this study was divided into three groups according to CRL measurement; Group A (smaller-than-expected CRL), Group B (normal CRL) and Group C (larger-than-expected CRL). RESULTS: The incidence of low birth weight infant was higher in Group A than in Group C (p = 0.010). The rate of small for gestational age (SGA) infants was similar between groups. The number of macrosomic or large for gestational age (LGA) infants was higher in Group C than Groups A and B. Both birth head circumference and length of infant were greater in Group C than Groups A and B. No significant difference for ponderal index value was observed between the groups (p = 0.927). CONCLUSION: The growth pattern in the first trimester affects neonatal birth weight and length symmetrically without changing the ponderal index.