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Prognostic factors for successful expectant management of ectopic pregnancy
D Trio1, N Strobelt, C Picciolo
1Department of Obstetrics and Gynecology, Ospedale San Gerardo, III Branch of the University of Milan.
Objective:
To determine the independent ability of initial hCG titers, trend of hCG titers, and ultrasonographic findings in the prediction of successful expectant management in ectopic pregnancy (EP).
Design:
Case-control study.
Setting:
University hospital.
Patients:
Sixty-seven patients with EP managed expectantly, 49 of whom (73%) had a spontaneous resolution, whereas 3 (5%) underwent medical treatment, and 15 (22%) eventually underwent surgical treatment.
Results:
Univariate analysis showed that the initial hCG titer, the trend in hCG titers between first and second sample, and ultrasonographic visualization of absence of an ectopic gestational sac were significant predictors of a successful expectant management. Using receiver operating characteristic curve analysis, an hCG titer < 1,000 mIU/mL was chosen as the optimal cutoff for this prediction, identifying 88% of women destined to have spontaneous resolution of the EP. Multivariate analysis showed that both initial hCG titer and trend in hCG titers but not ultrasonographic visualization of an ectopic gestational sac were independent predictors of a successful or failed expectant management.
Conclusion:
Expectant management of EP is successful in the majority of patients with initial hCG titer < 1,000 mIU/mL.