To identify the rate and risk factors for readmission following methotrexate (MTX) treatment for tubal pregnancy.

Design:

A retrospective study undertaken in two tertiary medical centers, including all individuals with tubal pregnancy, between December 2009 and June 2021.

Setting:

A retrospective study.

Patients or Participants:

Cohorts of individuals with tubal pregnancy were compared according to the mode of management: expectant (n=240), medical (N=511), and surgical (N=708).

Interventions:

Individuals with and without readmission following MTX treatment were compared.

Measurements and Main Results:

Primary outcome was the readmission rate. Secondary outcomes included tubal rupture rate and the eventual need for surgical treatment.

Readmission following methotrexate treatment occurred in 224/511 patients (43.8%). Most readmissions were due to abdominal pain or suspicion of treatment failure. Readmitted individuals were more likely to have a history of pelvic inflammatory disease and pretreatment serum human chorionic gonadotropin >2,000 mIU/mL. Both factors remained significantly associated with higher readmission rates in a logistic regression analysis (adjusted OR 6.28, 95% CI 1.30-30.45, and adjusted OR 2.73, 95% CI 1.83-4.07, respectively) after adjustment for age, endometriosis, tubal pathology, abdominal pain, and presence of yolk sac or embryo at diagnosis. A dose-dependent association was observed between pretreatment serum human chorionic gonadotropin levels and readmission rate (p<0.001). Pretreatment human chorionic gonadotropin levels were also associated with tubal rupture and the eventual need for surgical treatment (p<0.001 for both). A prediction model using human chorionic gonadotropin was not sufficiently accurate to predict readmission risk.

Conclusion:

Readmission following MTX treatment for tubal pregnancy was independently associated with previous PID and pretreatment serum hCG levels. The latter was also associated with surgical intervention rate.