title: Ectopic pregnancy: when is expectant management safe?
abstract: This study was conducted to evaluate expectant management in asymptomatic patients with an initial serum beta-hCG titer of <2,500 IU/l and to determine the independent ability of initial serum beta-hCG titers and trend of serum beta-hCG to predict successful expectant management. A cohort of patients (N = 418) with suspected ectopic pregnancy (EP) between January 1991 and July 2008 is described. Three groups were defined: group I (n = 182), immediate surgical intervention (<24 h); group IIa (n = 130), unsuccessful expectant management (surgical intervention during follow-up), and group IIb (n = 99), successful expectant management (spontaneous regression of trophoblast). Hospital protocol was not complied in 35 cases (Table 1). Beta-hCG levels >3,000 IU/l occur in our expectant management group; however, none of these cases were successful. Unnecessary surgery was prevented in 14% (n = 7) of asymptomatic patients with initial beta-hCG of >2,000 IU/l. The success rate of expectant management was 49%, without a rise in complication rate or number of acute cases. In conclusion, the initial serum beta-hCG cutoff level of 2,000 IU/l is not a rigid upper limit for accepting expectant management in suspected EP and best practice is case specific. In asymptomatic patients, the serum beta-hCG cutoff level of at least 2,500 IU/l can be used for expectant management. This cutoff could be higher, but interpretation is limited due to censure in follow-up inherent to the predefined clinical protocol. There is no gain in including patients for expectant management with initial serum beta-hCG level >3,000 IU/l.
authors.affiliation: Department of Gynecology, K6-76, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
authors.forename: Sharon P
authors.initials: SP
authors.lastname: Rodrigues
authors.forename: Kirsten J
authors.initials: KJ
authors.lastname: de Burlet
authors.forename: Ellen
authors.initials: E
authors.lastname: Hiemstra
authors.forename: Andries R H
authors.initials: AR
authors.lastname: Twijnstra
authors.forename: Erik W
authors.initials: EW
authors.lastname: van Zwet
authors.forename: Trudy C M
authors.initials: TC
authors.lastname: Trimbos-Kemper
authors.forename: Frank W
authors.initials: FW
authors.lastname: Jansen