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[Persistent ectopic pregnancy, report of seven cases]
1Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Objective:
To investigate and evaluate the occurrence, diagnosis and treatment of persistent ectopic pregnancy.
Methods:
411 patients with ectopic pregnancy treated via laparoscopy or laparotomy between July 1995 and June 2000 were reviewed. The clinic manifestations of patients who were successfully treated by laparoscopic surgery and those with persistent ectopic pregnancy were analyzed by multivariate stepwise logistic regression.
Results:
Seven cases with persistent ectopic pregnancy occurred after laparoscopic surgery with an incidence rate of 3.5%. Six cases had been treated by conservative approach and one case by tubectomy. Persistent ectopic pregnancy was diagnosed in two cases because of abdominal pain and intra-abdominal hemorrhage and in five cases because of plateauing beta-hCG titers. Two of the seven cases underwent a second time laparoscopic surgery and five were treated with methotrexate. The size of ectopic mass and the absence of villi by pathologic finding were relevant factors of persistent ectopic pregnancy.
Conclusion:
Small mass of ectopic pregnancy, short amenorrhea time, and biopsy specimens in which no villi are found are all warning indicators of persistent ectopic pregnancy. Close postoperative beta-hCG surveillance is critical for diagnosis and treatment.