Persistent ectopic pregnancy after linear salpingotomy: a non-predictable complication to conservative surgery for tubal gestation.
BACKGROUND
The drawback of conservative surgery for ectopic pregnancy (EP) is the risk of persistent trophoblast. The purpose was to characterize patients who develop persistent ectopic pregnancy (PEP) after salpingotomy for EP and to assess prognostic factors.


METHODS
The medical records of 417 patients treated by salpingotomy for EP were reviewed. Forty-eight (11.5%) patients were diagnosed with persistent EP. The data were analyzed using the Mann-Whitney U-test, Fischer's exact test or the chi2-test.


RESULTS
Of 417 women, 48 (11,5%) were treated for PEP by either repeat surgery (n = 25) or methotrexate (n = 23). Oral methotrexate failed in 4/19 cases while intramuscular (i.m.) methotrexate was successful in 4/4 cases. Women treated for PEP had a higher preoperative and a slower postoperative decline of serum human chorionic gonadotropin (hCG). Both the preoperative and the early postoperative hCG levels had a low diagnostic sensitivity (0.38-0.66) and specificity (0.74-0.77) for predicting PEP. In multivariate logistic analysis, none of the following clinical variables were predictive of PEP: duration of surgery, laparoscopic approach, history of previous EP, history of previous lower abdominal surgery, ruptured EP, pelvic adhesions, absence of products of conception at microscopy and hemoperitoneum.


CONCLUSIONS
Persistent ectopic pregnancy can neither be predicted from clinical variables nor from single measurements of hCG with an accuracy sufficient for clinical use.
Lund
Claus Otto
CO
Department of Obstetrics and Gynecology and Laparoscopic Unit, Hvidovre University Hospital, Copenhagen, Denmark. claus.otto.lund@hh.hosp.dk
Nilas
Lisbeth
L
Bangsgaard
Nannie
N
Ottesen
Bent
B
D000019:Abortifacient Agents / Q000008:administration & dosage; D000284:Administration, Oral; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008499:Medical Records; D008727:Methotrexate / Q000008:administration & dosage; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D011237:Predictive Value of Tests; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D012372:ROC Curve; D012189:Retrospective Studies; D012489:Salpingostomy / Q000379:methods; D012680:Sensitivity and Specificity
D000019:Abortifacient Agents; D006063:Chorionic Gonadotropin; D008727:Methotrexate