Delayed hemorrhage of a persistent ectopic pregnancy following laparoscopic salpingostomy and methotrexate therapy

This report describes the first known case of delayed hemorrhage of a persistent ectopic pregnancy following surgical and medical therapy. A 2.5-cm ampullary pregnancy without cardiac activity was removed by laparoscopic salpingostomy. The serum beta-hCG level before laparoscopy was 1542 mIU/mL, increasing to 3163 mIU/mL by the eighth postoperative day. Administration of methotrexate and citrovorum factor caused a 48% decline in the level of serum beta-hCG over 72 hours, but did not prevent delayed hemorrhage by the tubal gestation. This case emphasizes that close surveillance during the treatment of persistent ectopic pregnancy should continue until serum beta-hCG is undetectable.