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Postoperative day 1 serum human chorionic gonadotropin level as a predictor of persistent ectopic pregnancy after
S D Spandorfer1, S W Sawin, I Benjamin
1University of Pennsylvania Medical Center, Philadelphia, USA.
Objective:
To determine characteristics predictive of persistent ectopic pregnancy (EP).
Design:
Retrospective cohort study.
Setting:
Tertiary care, university hospital.
Patient(S):
All women treated surgically for an EP whose postoperative hCG levels were followed until complete resolution or determination of a persistent EP over a 54-month period.
Main Outcome Measure(S):
Final outcome defined as successful treatment or persistent EP.
Result(S):
Twenty-six (17.7%) of 147 patients were diagnosed with a persistent EP. An inverse relationship was noted between the percent decrease in hCG at postoperative day 1 and the incidence of persistent EP. A significantly greater percentage of persistent EPs were noted when the postoperative day 1 hCG fell < 50% from the initial preoperative hCG level (relative risk = 3.51 [1.25 to 6.68]). No case of persistent EP was noted if the postoperative day 1 hCG declined by > or = 77%. Surgical time differed significantly (129 minutes versus 101 minutes) between cases treated successfully as compared with cases in which conservative treatment failed. No other preoperative or intraoperative variables were found to be significantly different.
Conclusion(S):
Although no single postoperative hCG value is predictive of conservative surgical treatment for EP, a day-1 postoperative hCG value may be used as a predictor of persistent EP.