Preoperative serum hCG level and intraoperative failure of laparoscopic linear salpingostomy for ectopic pregnancy

[Can medical treatment be the first-line treatment for most ectopic pregnancies? A series of 202 patients]

OBJECTIVES

To assess the efficacy and safety of a liberal policy of medical treatment for ectopic pregnancies (EUP).

MATERIAL AND METHODS

Retrospective study of EUP that received active management between January 1999 and December 2003. Patients with rupture or near-rupture and those who refused medical treatment received surgical treatment. Other patients were treated by methotrexate.

RESULTS

Two hundred and two EUP were managed; 26 % were treated surgically, 74 % medically. The success rate of medical treatment was 83 %. A ss-hCG threshold of 2526 IU/l was selected. Under this level, the success rate was 90.7 % compared with 68 % when it was higher (p=0.001). Cardiac activity tripled the failure rate. Morbidity with medical treatment consisted of an augmentation in transaminases in 18.8 % and one case of severe dermatosis (0.7 %). Almost half of the patients treated medically required hospitalizations.

CONCLUSION

The extension of medical treatment in our population to 74 % of all EUP yielded a high success rate, 83 %.

Human chorionic gonadotropin level as a predictor of trophoblastic infiltration into the tubal wall in ectopic pregnancy: a blinded study

OBJECTIVE

To determine the relationship between gestational age, tubal ultrasonographic diameter, and serum hCG levels and different stages of trophoblastic infiltration of the tubal wall in ectopic pregnancy.

DESIGN

Blinded prospective study.

SETTING

University-based clinic in Italy.

PATIENT(S)

Thirty-seven consecutive patients with an ampullary ectopic pregnancy.

INTERVENTION(S)

Laparoscopic salpingectomy.

MAIN OUTCOME MEASURE(S)

Gestational age, diameter of the tubal mass as determined by transvaginal ultrasonography. and hCG level on the day of surgery. Ectopic pregnancy was classified according to the depth of trophoblastic infiltration: trophoblast limited to the tubal mucosa (stage I), extension to the tubal muscularis (stage II), or complete tubal wall infiltration up to the serosa discontinued by trophoblastic cells (stage III).

RESULT(S)

Fifteen patients (40.5%) had stage I tubal infiltration, 14 (37.8%) had stage II infiltration, and 8 (21.6%) had stage III infiltration. Gestational age and diameter of the tube did not differ among the three groups. The median hCG level was 1,710.5 mIU/mL (range, 113-5,635 mIU/mL) for patients with stage I infiltration. 4,690.0 mIU/mL (range, 150-21,531 mIU/mL) for patients with stage II infiltration, and 15,700.0 mIU/mL (range, 13,809-21,650 mIU/mL) for patients with stage III infiltration. All the patients with hCG levels > 6,000 mIU/mL had stage II or III invasion.

CONCLUSION(S)

These findings may explain why the conservative treatment of ectopic pregnancy is less successful in patients with high hCG levels than in patients with low levels. Use of radical procedures may be justified in the former group.

The potential of preoperative beta-hCG and progesterone levels to predict failure of laparoscopic linear salpingostomy in ectopic pregnancies

STUDY OBJECTIVE

To estimate the association between preoperative beta-human chorionic gonadotropin (hCG) and progesterone levels, and success of linear salpingostomy in treatment of tubal pregnancy.

DESIGN

Retrospective case control study (Canadian Task Force classification II-1).

SETTING

Women's general hospital.

PATIENTS

Three hundred five women undergoing laparoscopic linear salpingostomy for ectopic pregnancy.

INTERVENTION

Examination of risk factors for surgical failure of salpingostomy by analyzing corresponding receiver operating curves.

MEASUREMENTS AND MAIN RESULTS

In 305 women, intervention was successful in 272 and failed in 33, as assessed by either postoperative hemorrhage (16) or rising beta-hCG values (14); 3 women had both. Of 295 patients in whom beta-hCG was evaluated preoperatively, 149 (50.5%) had values of 1000 mU/ml. or less; 75% had progesterone levels of 10 ng/ml or below. No association was found between preoperative beta-hCG and progesterone levels and the success of linear salpingostomy.

CONCLUSION

Preoperative beta-hCG and progesterone levels are of no significance with regard to success of linear salpingostomy for treatment of tubal pregnancy.