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Spontaneous resolution of ectopic tubal pregnancy: natural history
1Department of Obstetrics and Gynecology, Central Emek Hospital, Afula, Israel.
Objective:
To determine the characteristics and long-term outcome of women succeeding or failing expectant management of ectopic pregnancy (EP).
Design:
Prospective, defined protocol.
Setting:
University-affiliated gynecology department.
Patients:
We used a protocol that selected women with laparoscopic confirmed ectopic tubal pregnancy and declining plasma hCG values. Over a 5-year period, 60 women representing 20.1% of EPs fulfilled the inclusion criteria. Women were followed with serial hCG testing and transvaginal ultrasound.
Main Outcome Measure:
Success or failure of expectant management.
Results:
Expectant management was successful in 28 (47.7%) of the patients. Thirty-two (53.3%) failed expectant management, and a treatment procedure was required. There was no difference in the resultant ipsilateral tubal patency or 1-year fertility rates of those women succeeding or failing expectant management. Analysis showed that in the face of declining values and with a starting hCG > 2,000 mIU/mL (conversion to SI unit, 1.00), 93.3% failed expectant management, whereas < 2,000 mIU/mL, 60.0% succeeded.
Conclusion:
We conclude that expectant management should be offered as a treatment option only in those women fulfilling the criteria for a good prognosis.