CA-125 level as a prognostic factor for response in medical treatment of fallopian ectopic pregnancy

Background Ectopic pregnancies (EP) are a complication of pregnancy in which an ectopic pregnancy sac form. EP can be associated with rupture / hemodynamic instability / hemorrhagic shock and eventual death. Recent studies have shown that the use of markers such as CA-125 can be very accurate in predicting the clinical course of these patients. The present study was designed to measure the accuracy of CA-125 in the diagnostic and therapeutic evaluation of this group of patients and to investigate the relationship of this marker with the occurrence of some EP complications such as rupture in patients undergoing medical treatment. Patients and Methods‎: In this prospective cohort study, all patients with EP candidates for medical treatment with methotrexate entered the study after obtaining informed consent. On days 1, 4 and 7, βhCG and CA-125 markers were measured in patients. Patients were monitored for EP complications leading to surgery as well as response to single-dose drug therapy and βhCG titer. The course of CA-125 levels in the blood and its relationship with the incidence of complications and βhCG levels were also examined. Result 100 patients with a mean age of 6.1 ± 29.8years were included in the study. 22 patients (22%) required a second dose of methotrexate and 30 patients (30%) required surgical intervention. The result of single-dose treatment was successful in 48% of patients, but 52% failed treatment, including surgery and the second dose of methotrexate. Statistical analysis showed that CA125 levels were higher on days four and seven in patients who needed the next dose of MTX (P < 0.001). CA-125 levels were higher in patients who underwent surgery, which was also statistically significant on day 1 (P < 0.001). The mean level of CA-125 on all days was significantly higher in patients who failed treatment (P < 0.001). Conclusion It can be concluded that by performing serial CA-125 in tubal pregnancy, it is possible to understand the possibility of rupture of the pregnancy sac and the need for surgical intervention or administration of a second dose of MTX.