Evaluation of uterine artery resistance in adnexal ectopic pregnancy (ovary and appendages) before and after treatment with single dose of methotrexate and its relation with treatment success rate

Abstract

In an ectopic pregnancy, the amount of the Pulsatility Index and Resistance Index decreases, in case of response to methotrexate treatment, we expect an increase in these indices. The prognosis of the treatment of patients is helpful. This study aims to determine the resistance of the uterine artery in an adnexal ectopic pregnancy (ovary and appendages) before and after treatment with a single dose of methotrexate and its relationship with the treatment success rate. Materials and Methods: In this cross-sectional study, 66 patients with adnexal ectopic pregnancy (ovaries and appendages) were subjected to color Doppler ultrasound of the uterine artery and then, according to the gynecologist's opinion, were treated with methotrexate (a single dose of methotrexate with a dose of 50 mg per square meter) and at the end of the fourth day, the serum level of BhCG was measured and color Doppler ultrasound was performed and the values of RI, PI, S/D, PSV and EDV in uterine arteries on both sides along with the volume and dimensions of the mass were checked. The results before and after treatment were compared. Results: The success rate of single-dose methotrexate treatment was 86.4% and the average age of the patients was 32.10 ± 5.83 years. The average age was significantly lower in patients with treatment failure (28.66 ± 8.71 versus 32.64 ± 5.14 years; p=0.012). A statistically significant difference was observed in comparing the median BhCG level between treatment failure and success (respectively, 1840 mIU/L versus 1370 mIU/L; p=0.001). RI values of the uterine artery on the side involved in EP were significantly higher after treatment in patients with successful treatment than in patients with failed treatment (0.88 ± 0.08 vs. 0.76 ± 0.08; p=0.002). RI index with AUC equal to 0.828 (0.971 - 0.685: 95% CI) and p=0.002 and with a cutoff point of 0.815 had a sensitivity of 70.6% and specificity of 77.8% in estimating treatment success.