Management of early ectopic pregnancy

Abstract

OBJECTIVE: Management of early ectopic pregnancy was investigated in a multicenter, prospective study. METHODS: Serum β-hCG levels were monitored after therapy and correlated to the type of management, gestational age, and initial serum β-hCG levels in 119 patients with ectopic pregnancies detected at 5–7 postmentrual weeks. RESULTS: Salpingectomy was performed in 16 patients. No postoperative complications were reported. After conservative laparoscopic surgery of 51 ectopic pregnancies, 9 (18%) had delayed decrease or an increase of serum β-hCG levels. Re-operations were performed in 4 (7%) patients. Similar findings were noted in 216 patients after conservative operations performed by laparotomy. Intrachorionic injection treatment was sucessful in 17/18 ectopic pregnancies, and expectant management in 7/8 patients with initial serum β-hCG levels below 250 mIU/ml. CONCLUSIONS: Persistence of trophoblastic activity is a potential complication of conservative surgical treatment of ectopic pregnancy. A detailed diagnosis as early as 6–7 postmenstrual weeks may be the key for future nonsurgical management of ectopic pregnancy.