{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:45:33Z","timestamp":1786977933844,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T00:00:00Z","timestamp":1696032000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe outcomes of expectant management (EM) versus methotrexate (MTX) treatment in tubal pregnancies with pretreatment human chorionic gonadotropin (hCG) less than 2000\u2009mIU\/mL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort from two tertiary hospitals included women with confirmed tubal pregnancies and pretreatment hCG &lt;2000\u2009mIU\/mL. Exclusion criteria were unrecorded pregnancy site, unconfirmed diagnosis, and surgical treatment upon diagnosis. The primary outcome was eventual rate of surgical treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between December 2009 and June 2021, 545 of 2114 (25.8%) women diagnosed with a tubal pregnancy met our inclusion criteria. We compared women who underwent EM (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009201) with women who received MTX (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009344). All women in the EM group had a declining trend of hCG. The MTX group had higher pretreatment hCG and higher rates of yolk sac or embryo presence on ultrasound. Eventual surgical treatment rate was higher in the MTX group compared with the EM group (39 [11.3%] vs. 9 [4.5%],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006), with no difference in the treatment failure rate or tubal rupture rate. In a subgroup analysis of women with pretreatment hCG between 1000 and 2000\u2009mIU\/mL, eventual surgical treatment, treatment failure, and tubal rupture rates did not differ between groups. Logistic regression analysis revealed that eventual surgical treatment was independently associated with hCG levels less than 1000\u2009mIU\/mL (adjusted odds ratio [aOR] 0.28, 95% confidence interval [CI] 0.14\u20130.56) and endometriosis (aOR 9.20, 95% CI 3.55\u201323.81).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Expectant management of tubal pregnancies with pretreatment hCG levels less than 2000\u2009mIU\/mL and even between 1000 and 2000\u2009mIU\/mL and with a declining trend of hCG demonstrated lower or comparable rates of eventual surgical treatment, when compared with MTX treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.15162","type":"journal-article","created":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T03:28:43Z","timestamp":1696044523000},"page":"1094-1100","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Expectant management of tubal pregnancies with human chorionic gonadotropin up to 2000\u2009mIU\/mL"],"prefix":"10.1002","volume":"164","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2473-7408","authenticated-orcid":false,"given":"Nir","family":"Kugelman","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Carmel Medical Center  Haifa Israel"},{"name":"Rappaport Faculty of Medicine Technion\u2010Israel Institute of Technology  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bracha","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Carmel Medical Center  Haifa Israel"},{"name":"Rappaport Faculty of Medicine Technion\u2010Israel Institute of Technology  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fayrooz","family":"Yossef","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine Technion\u2010Israel Institute of Technology  Haifa Israel"},{"name":"Department of Obstetrics and Gynecology Bnai Zion Medical Center  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Margieh","sequence":"additional","affiliation":[{"name":"Rappaport Faculty of Medicine Technion\u2010Israel Institute of Technology  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noam","family":"Regev","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sheba Medical Center  Tel\u2010Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uria","family":"Shani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sheba Medical Center  Tel\u2010Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yossi","family":"Bart","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sheba Medical Center  Tel\u2010Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002560"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14189"},{"key":"e_1_2_8_4_1","volume-title":"Expectant Versus Medical Management of Tubal Ectopic Pregnancy: Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management: Evidence Review B","author":"National Guideline Alliance (UK)","year":"2019"},{"key":"e_1_2_8_5_1","first-page":"803","article-title":"Fertility after ectopic pregnancy. 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