[Follow-up of beta-hCG after pelviscopic linear salpingotomy for therapy of tubal pregnancy].
From 1987 until 1993 a total of 337 patients underwent a therapy for tubal pregnancy at the Department of Gynaecology and Obstetrics of the University of Kiel. The percentage of cases treated by tubal-preserving pelviscopic linear salpingotomy and subsequent extraction of the conceptus, increased from 59% in 1987 to 88% in 1993. In 6.5% a second look pelviscopy was performed for suspected remnants of trophoblastic tissue. Remaining trophoblastic cells can be recognised by serial determination of serum beta-hCG titers postoperatively. However, the interval of the postoperative beta-hCG decline reveals considerable interindividual variation. A regression following the "Cox Proportional Hazard" model shows that the period of the beta-hCG decline depends on the initial titer. The Kaplan Meier curve obtained via beta-hCG determination in 98 patients following pelviscopic linear salpingotomy until values reached 20 mIU/ml or less, shows that 50% of the patients had to be controlled for more than 7 days, 10% for more than 28 days and individual patients even for more than 70 days. The relative beta-hCG titers differ significantly from the unresolved group compared to the group with resolved ectopic pregnancy starting at postoperative day 2 (p < 0.01). At postoperative day 3/4 10% of the initial beta-hCG value is attained in 50% of cases. Even then a serial beta-hCG follow-up should be obtained down to the detection limit to ensure complete resolution of viable trophoblastic cells.
Bonatz
G
G
Universitätsfrauenklinik Kiel.
Lehmann-Willenbrock
E
E
Hedderich
J
J
Semm
K
K
D006063:Chorionic Gonadotropin / Q000097:blood*; D018997:Chorionic Gonadotropin, beta Subunit, Human; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D016016:Proportional Hazards Models; D012016:Reference Values; D012086:Reoperation
D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments