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Prediction of persistent ectopic pregnancy after laparoscopic salpingostomy
H G Hagström1, M Hahlin, B Bennegård-Edén
1Department of Obstetrics and Gynecology, Sahlgrenska Hospital, University of Göteborg, Sweden.
Objective:
To evaluate whether preoperative measurements of progesterone and hCG in serum can predict the risk of needing a second therapeutic intervention after laparoscopic salpingostomy.
Methods:
In 158 patients with unruptured tubal pregnancies smaller than 4 cm, serum progesterone and hCG levels were measured in two venous blood samples taken preoperatively. Fourteen complicated cases, in which a second therapeutic intervention was necessary, were compared with 144 uncomplicated cases.
Results:
Eleven of the 14 complicated cases (79%) had preoperative progesterone values exceeding 35 nmol/L, whereas this was true for only 15 (10%) of the uncomplicated cases. Among the complicated cases, 12 (86%) had preoperative daily hCG changes above 100 IU/L, compared to 44 (31%) of the uncomplicated cases. Cases with a progesterone level above 35 nmol/L and a daily hCG change exceeding 100 IU/L had a 61% risk for a second therapeutic intervention, whereas with a progesterone value below 35 nmol/L and/or a daily hCG change of less than 100 IU/L, the risk was only 2%.
Conclusion:
The risk for a second therapeutic intervention after laparoscopic salpingostomy for ectopic pregnancy can be predicted by the combined use of two sequential serum hCG samples and one serum progesterone sample, the last of each taken within 24 hours preoperatively.