Management of patients with persistent beta-hCG values following laparoscopic surgical and local drug treatment for ectopic pregnancy.
OBJECTIVE
To show that the beta-human chorionic gonadotropin (hCG) decline following tubal-preserving techniques for ectopic pregnancy (EP) can take a longer course than currently believed, indicating expectant management; and to define the indications for a second-look laparoscopy if beta-hCG persists.


METHODS
Three hundred thirty-seven patients treated for EP were retrospectively reviewed. In order to define the 'normal' beta-hCG decline following tubal-preserving techniques we acquired a Kaplan-Meier curve for 98 patients treated by laparoscopic linear salpingotomy, the main method performed for EP (253 patients). The Mann-Whitney U-test served as a statistical test. The patient population requiring a second-look laparoscopy for proliferating trophoblastic remnants is described.


RESULTS
Twenty-eight patients (8.3%) required a second-look laparoscopy (acute abdominal pain and sonographically suspect findings combined with increasing beta-hCG values). The majority (15 patients) underwent a preceding laparoscopic linear salpingotomy (6.5% unresolved cases). The relative beta-hCG values differed significantly from the unresolved group compared to the group with resolved EP starting at postoperative day 2 (P < 0.01). A maximal beta-hCG decline period of 77 days postoperatively was observed.


CONCLUSIONS
Patients with slowly declining beta-hCG levels following tubal-preserving techniques for EP can be managed expectantly. Increasing beta-hCG values combined with abdominal pain and sonographically suspect observations indicate a second-look laparoscopy.
Bonatz
G
G
Clinic of Obstetrics and Gynecology, University of Kiel, Germany.
Lehmann-Willenbrock
E
E
Kunstmann
P
P
Semm
I
I
Hedderich
J
J
Semm
K
K
D006063:Chorionic Gonadotropin / Q000097:blood*; D018997:Chorionic Gonadotropin, beta Subunit, Human; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use; D009951:Ornipressin / Q000627:therapeutic use; D010446:Peptide Fragments / Q000097:blood*; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors
D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments; D009951:Ornipressin; D008727:Methotrexate