Predictive values of the ratio of beta-human chorionic gonadotropin for failure of salpingostomy in ectopic pregnancy

BACKGROUND

We evaluated the predictors of unsuccessful salpingostomy that required surgical treatment or additional medical treatment after initial removal of ectopic pregnancy (EP) by laparoscopy.

MATERIAL/METHODS

The study was an observational retrospective cohort study done at International Peace Maternity and Child Health Hospital in Shanghai, which included patients with ectopic pregnancy (EP). The predictors of persistent ectopic pregnancy (PEP) were measured either on serum β-hCG ratios before and after salpingostomy or demographics (age, parity, in-vitro fertilization (IVF), abortion history, EP history, mass location, appendectomy history and diameter of EP lesion). We used nomogram analyses to evaluate the significant factors consisting of serum β-hCG ratio, parity and performed IVF that predicted the failure or success of salpingostomy.

RESULTS

We retrospectively analyzed 429 patients in this study who received salpingostomy for EP from January 2013 and December 2017. Of these patients, 29 (6.76%) were diagnosed with PEP after salpingostomy and 400 (93.24%) had satisfactory treatment. The median of serum β-hCG ratio (after salpingostomy 24 h/after salpingostomy 48 h) 2.43 in PEP patients was lower than that in successful treatment patients (P<0.001). Logistic regression analyses identified several predictors for PEP, including parity, IVF and serum β-hCG (after salpingostomy 24 h/after salpingostomy 48 h), with a higher clear predictive value (area under the curve [AUC]=0.865, 95% CI: 0.812-0.919, P<0.001).

CONCLUSIONS

The serum β-hCG ratio (after salpingostomy 24 h/after salpingostomy 48 h) in combination with parity and IVF are important predictors for PEP patients after surgery. These findings provide higher risk PEP patients for early interventions to improve outcome.

Ruptured secondary abdominal pregnancy after primary laparoscopic treatment for tubal pregnancy: A case report

INTRODUCTION

Most secondary abdominal pregnancies happen after spontaneous abortion of tubal pregnancy or ruptured intrauterine pregnancy. However, we presented a case of ruptured secondary abdominal pregnancy after primary laparoscopic treatment of tubal pregnancy.

CASE REPORT

The ectopic pregnant lesion in the affected tube was thoroughly removed in the primary laparoscopy, and nothing abnormal was detected in abdomen or pelvis. Beta human chorionic gonadotropin levels dropped significantly after surgery, but the patient came back again for severe abdominal pain with beta human chorionic gonadotropin increasing, and free peritoneal fluid in the pouch of Douglas was detected at ultrasonography. The secondary laparoscopy was done according to the intraperitoneal hemorrhage and unstable vital signs. The secondary pregnancy was found ruptured in the splenic flexure of the colon. Although several cases of secondary abdominal pregnancies were reported in the literature, herein we describe a case secondary to the salpingotomy of the primary tubal pregnancy.

CONCLUSION

After surgery for ectopic pregnancy, the patient's serum beta human chorionic gonadotropin levels should be closely followed until negative. When persistent ectopic pregnancy was suspected after surgery, physicians should keep in mind a rare possibility of secondary abdominal pregnancy.

Clinical characteristics and salvage management of persistent cesarean scar pregnancy

Aim

The study was conducted to illustrate the clinical characteristics and treatment outcomes of patients with persistent cesarean scar pregnancy (PCSP).

Methods

During a six‐year period, 38 cases of PCSP were diagnosed and treated conservatively to preserve fertility. The clinical presentations, imaging findings and treatment outcomes of these patients were reviewed.

Results

Fourteen out of 38 women (37%) presenting with PCSP suffered heavy vaginal bleeding. Gestational age at diagnosis was 73.1 ± 21.7 days. The maximum diameter of the PCSP mass was 3.6 ± 1.6 cm. The presence of a rich vascular pattern in the area of the PCSP mass was detected by ultrasound in 33/38 (87%) patients. Six patients with a PCSP gestational age of 64.2 ± 6.2 days and a mass diameter of 2.5 ± 0.6 cm were successfully treated with medical treatment alone and 32 patients with a gestational age of 74.8 ± 23.1 days and a mass diameter of 3.8 ± 1.6 cm were successfully treated with surgical or combined treatment.

Conclusions

Patients with PCSP are diagnosed at advanced gestational age and are more prone to heavy bleeding. Surgery is the main treatment for PCSP. Medical treatment of PCSP has become an attractive alternative, especially for hemodynamically stable patients with a PCSP mass with a maximum diameter of < 3.5 cm.