title: Management of patients with persistent beta-hCG values following laparoscopic surgical and local drug treatment for ectopic pregnancy.
abstract: 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.
authors.affiliation: Clinic of Obstetrics and Gynecology, University of Kiel, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Bonatz
authors.forename: E
authors.initials: E
authors.lastname: Lehmann-Willenbrock
authors.forename: P
authors.initials: P
authors.lastname: Kunstmann
authors.forename: I
authors.initials: I
authors.lastname: Semm
authors.forename: J
authors.initials: J
authors.lastname: Hedderich
authors.forename: K
authors.initials: K
authors.lastname: Semm
mesh_terms: 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
chemical_list: D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments; D009951:Ornipressin; D008727:Methotrexate