Human chorionic gonadotropin level as a predictor of trophoblastic infiltration into the tubal wall in ectopic pregnancy: a blinded study.
OBJECTIVE
To determine the relationship between gestational age, tubal ultrasonographic diameter, and serum hCG levels and different stages of trophoblastic infiltration of the tubal wall in ectopic pregnancy.


METHODS
Blinded prospective study.


METHODS
University-based clinic in Italy.


METHODS
Thirty-seven consecutive patients with an ampullary ectopic pregnancy.


METHODS
Laparoscopic salpingectomy.


METHODS
Gestational age, diameter of the tubal mass as determined by transvaginal ultrasonography. and hCG level on the day of surgery. Ectopic pregnancy was classified according to the depth of trophoblastic infiltration: trophoblast limited to the tubal mucosa (stage I), extension to the tubal muscularis (stage II), or complete tubal wall infiltration up to the serosa discontinued by trophoblastic cells (stage III).


RESULTS
Fifteen patients (40.5%) had stage I tubal infiltration, 14 (37.8%) had stage II infiltration, and 8 (21.6%) had stage III infiltration. Gestational age and diameter of the tube did not differ among the three groups. The median hCG level was 1,710.5 mIU/mL (range, 113-5,635 mIU/mL) for patients with stage I infiltration. 4,690.0 mIU/mL (range, 150-21,531 mIU/mL) for patients with stage II infiltration, and 15,700.0 mIU/mL (range, 13,809-21,650 mIU/mL) for patients with stage III infiltration. All the patients with hCG levels > 6,000 mIU/mL had stage II or III invasion.


CONCLUSIONS
These findings may explain why the conservative treatment of ectopic pregnancy is less successful in patients with high hCG levels than in patients with low levels. Use of radical procedures may be justified in the former group.
CUCESC (Centro Universitario di Chirurgia Endoscopica e Sperimentazione Clinica), Second Department of Obstetrics and Gynecology, University of Milan, Milan, Italy. dott.natale@email.it
Andrea
A
Natale
Massimo
M
Candiani
Daniela
D
Merlo
Stefano
S
Izzo
Luciano
L
Gruft
Mauro
M
Busacca
D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood*; D005187:Fallopian Tubes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D010535:Laparoscopy; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D014327:Trophoblasts / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography
D006063:Chorionic Gonadotropin