Serum human chorionic gonadotropin: surveillance after radical and conservative management of ectopic pregnancy

Monitoring of serum hCG concentrations has become an integral part of the postoperative management of patients with ectopic pregnancy. We monitored serial serum hCG concentrations in 25 patients to determine and compare the time for eventual clearance for two groups of patients managed by either radical or conservative surgery. Fifteen patients with ruptured ectopic pregnancy were managed by salpingectomy (group A) and 10 patients with unruptured ectopic pregnancy were managed by salpingostomy (group B). Serum samples were drawn on the first postoperative day (day 0) and at three-day intervals thereafter and followed to the limits of detectability. Serum hCG levels on day 0 were 3,542 +/- 2,480 mIU/mL (mean +/- standard deviation [SD]) with a range of 117 to 10,300 mIU/mL for group A, and 1,022 +/- 282 mIU/mL (mean +/- SD) with a range of 17 to 4,180 mIU/mL for group B. Time required for clearance to less than 10 mIU/mL was 14 +/- 4.9 days with a range of 2 to 28 days for group A and 12 +/- 3.9 days with a range of 2 to 16 days for group B. The primary factor influencing clearance was initial hCG concentration. Based on clearance data, a nomogram was developed to assist in the postoperative management and timing of serum sampling for hCG.