Expectant Management Of Ectopic Pregnancy Research Articles

OC04.04: Prognostic factors for successful expectant management of ectopic pregnancy

OC04.04: Prognostic factors for successful expectant management of ectopic pregnancy

OC06.07: Pre‐treatment 48‐hour β‐hCG ratio to predict success of medical and expectant management of ectopic pregnancy

OC06.07: Pre‐treatment 48‐hour β‐hCG ratio to predict success of medical and expectant management of ectopic pregnancy

β-hCG resolution times during expectant management of tubal ectopic pregnancies.

BackgroundA subset of women with a tubal ectopic pregnancy can be safely managed expectantly. Expectant management involves a degree of disruption with hospital visits to determine serum β-hCG (β-human chorionic gonadotrophin) concentration until the pregnancy test becomes negative and expectant management is considered complete. The length of time required for the pregnancy test to become negative and the parameters that influence this interval have not been described. Information on the likely length of follow up would be useful for women considering expectant management of their tubal ectopic pregnancy.MethodsThis was a retrospective study at a tertiary referral center in an inner city London Hospital. We included women who were diagnosed with a tubal ectopic pregnancy by transvaginal ultrasound between March 2009 and March 2014. During the study period 474 women were diagnosed with a tubal ectopic pregnancy and 256 (54 %) of them fulfilled our management criteria for expectant management. A total of 158 (33 %) women had successful expectant management and in those cases we recorded the diameter of the ectopic pregnancy (mm), the maximum serum β-hCG (IU/L) and levels during follow up until resolution as well as the interval to resolution (days).ResultsThe median interval from maximum serum β-hCG concentration to resolution was 18.0 days (IQR 11.0–28.0). The maximum serum β-hCG concentration and the rate of decline of β-hCG were independently associated with the length of follow up. Women’s age and size of ectopic pregnancy did not have significant effects on the length of follow up.ConclusionWomen undergoing expectant management of ectopic pregnancy can be informed that the likely length of follow up is under 3 weeks and that it positively correlates with initial β-hCG level at the time of diagnosis.

Relative factors of expectant management of ectopic pregnancy

To analyze select patients of ectopic pregnancy for expectant management. Retrospective analyses were conducted for the relative factors of 180 cases of ectopic pregnancy with expectant management at Department of Family Planning of our hospital from August 2004 to January 2012. Their general clinical data, clinical manifestations and laboratory tests were collected. The cases requiring neither surgery nor drug therapy belonged to the cure group while the rest fell into the failure group. A total of 140 patients were successfully managed with a cure rate of 75.27%. There was no significant difference between two groups in size of mass on ultrasonography (P > 0.05). The cases with gestational sac of mass on ultrasonography had statistical difference between two groups (P < 0.05). Statistical difference existed between two groups (P < 0.01) in initial blood beta-human chorionic gonadotropin (β-hCG), initial bloodβ-hCG and D3-5/D0 (ratio of bloodβ-hCG at day 3 - 5 and initial) were the variables for predicting the likelihood of successful expectant management under the ROC curve. The Youden Index was the largest at an initial bloodβ-hCG of 634 IU/L or D3-5/D0 of 0.711. At blood β-hCG ≤ 634 IU/L or D3-5/D0 < 0.711, expectant management may be offered. And mass with gestational sac on ultrasonography is a relative factor of expectant management.

OP05.03: Expectant management of ectopic pregnancy: when can we safely, successfully and efficiently try?

OP05.03: Expectant management of ectopic pregnancy: when can we safely, successfully and efficiently try?

Expectant Management of Ectopic Pregnancy

This article will provide a review of the literature regarding expectant management of ectopic pregnancy. Detailed definitions and methods of evaluation are discussed, as well as pooled existing data on success rates of expectant management. A comparison of expectant management versus other treatment options is provided as well as a review of fertility outcomes after expectant management of ectopic pregnancy.

OP02.07: Ectopic pregnancy: how accurate is ultrasound in the diagnosis

To evaluate the diagnostic accuracy of Ultrasound in the diagnosis of ectopic pregnancy compared to operative findings in women undergoing surgical management. Prospective observational study in a University hospital of 6444 consecutive women who underwent ultrasound for early pregnancy problems in 2008 and 2009. Data was collected from astria ultrasound database and evaluation of clinical notes. Excel spreadsheet was used for data analysis. 138 women diagnosed with ectopic pregnancy on pelvic ultrasound who underwent surgical management, ultrasound features were compared with surgical findings and histological diagnosis. Ectopic pregnancy was diagnosed with TAS/TVS if one or more of the following signs were noted. 1. Non cystic adnexal strcture. 2. Ectopic gestational sac with or without fetal heart. 3. Empty uterus + echogenic free fluid in pouch of Douglas. Women who underwent medical or expectant management of ectopic pregnancy were excluded. 6444 women had TAS/TVS for early pregnancy problems, out of which 138 women were diagnosed with ectopic pregnancy. 138 (2.1%) women were diagnosed with ectopic pregnancy. 135 (97.8%) were symptomatic. 97 (70%) did not have any risk factors for any ectopic pregnancy. 113 (81.8%) had adnexal mass, 12 (8.6%) had live ectopic pregnancy, 20 (14.4%) had ectopic gestational sac. 100 (72.4%) had echogenic free fluid in POD. 6 (4.3%) women had negative laparoscopies. The sensitivity of ultrasound was 91%, specificity was 99% to detect ectopic pregnancy. Positive predictive value of ultrasound was 95.6% and negative predictive value was 99.8%. High resolution transvaginal ultrasound is the gold standard in diagnosing ectopic pregnancies. In our study 91% of ectopic pregnancy was accurately diagnosed with ultrasound alone thereby significantly reducing the number of negative laparoscopies.

Retrospective analysis of laparoscopic salpingostomy and conservative expectant management of tubal ectopic pregnancy.

To identify predictive factors for successful expectant management of ectopic pregnancy and to evaluate the prognosis for fertility after expectant management and laparoscopic salpingostomy. Forty-six cases of expectant management and eighty cases of laparoscopic salpingostomy for tubal ectopic pregnancy were retrospectively analyzed. Subjects were classified in three groups: those who underwent laparoscopic salpingostomy, those treated by expectant management only, and those treated by expectant management but requiring additional treatment. The rates of tubal patency, intrauterine pregnancy and repeated ectopic pregnancy in the laparoscopic salpingostomy group were 75, 40, and 16%. The rates in the expectant management group were not significantly different: 72, 42 and 15%. Finally, the rates in the extra treatment group were 75, 39 and 15%. Success rate of expectant management was 54%. In 93% of cases expectant management was successfully completed when the initial levels of urinal hCG were less than 3000 mIU/ml and the levels of hCG 48 h later were less than 80% of the initial levels. However, expectant management alone was insufficient and required extra treatment in 90% of cases when the initial levels of hCG were 3000 mIU/ml and above or when the levels of hCG level 48 h later was 80% of initial levels and above. Expectant management in combination with salpingostomy is not only minimally invasive but also a useful way to preserve fertility. Initial urine hCG levels and their variation over time can help predict whether expectant management will succeed.

OP12.07: Haemoperitoneum is not an absolute contraindication for expectant management of ectopic pregnancy: An ongoing pilot study

OP12.07: Haemoperitoneum is not an absolute contraindication for expectant management of ectopic pregnancy: An ongoing pilot study

Tubal patency and fertility outcome after expectant management of ectopic pregnancy

Objective: To study tubal patency and fertility outcome of patients with expectantly managed ectopic pregnancy (EP). Design: A prospective study. Setting: Department of Obstetrics and Gynecology, Turku University Central Hospital, Turku, Finland. Patient(s): Thirty patients who wanted to become pregnant again were treated successfully by expectant management of EP. Intervention(s): Patients were examined with posttreatment hysterosalpingography, and they filled out a questionnaire about their subsequent pregnancies. Main Outcome Measure(s): Free passage through open lumen showing tubal patency; number of full-term pregnancies and EPs revealing relative rate of subsequent fertility. Result(s): A free passage through the diseased tube was seen in 93% of the cases (28 of 30). Two of the 24 patients (8.4%) who wanted to become pregnant had an obstruction in the diseased tube. One (4.2%) of them had a normal opposite tube and later had a normal pregnancy. The other (4.2%) had an obstruction in both tubes and subsequently had a repeat EP. One of the 6 patients had an EP (this patient did not want to become pregnant and did not use contraception). However, her posttreatment hysterosalpingography was normal. In total, the subsequent pregnancy rate was 88% (21 of 24), and the rate of repeat EP was 4.2% (1 of 24). Conclusion(s): Patients who are treated with expectant management have a good long-term fertility outcome. Spontaneous regression of EP does not lead to increased harm or damage to the tube, i.e., the risk for repeat EP is low.

Low-dose oral methotrexate with expectant management of ectopic pregnancy

To investigate recovery times and need for laparoscopy in women with ectopic pregnancy who were treated for 5 days 2.5 mg/day of oral methotrexate or placebo. Sixty women with ectopic pregnancy among patients of an outpatient clinic specializing in early pregnancy disorders were selected for medical treatment in a double-blind, placebo-controlled study. The diagnosis was made by transvaginal sonography and serum hCG determinations, either at admission or after repeated examinations. Women were recruited for the study if they had mild symptoms: the hCG increase was less than 50% within 2 days, the diameter of the ectopic pregnancy was less than 40 mm, there were no signs of intra-abdominal bleeding by transvaginal sonography, and there were no secondary reasons for laparoscopy. Either 2.5 mg of methotrexate or placebo was given orally for 5 days. Serum hCG was determined after 2 days, and hCG, red blood cell count, white blood cell count, platelet count, and serum glutamic-oxaloacetic transaminase were measured; transvaginal sonography was performed after 5 and 12 days. Expectant management was continued individually with check-ups at 1-3-week intervals. Laparoscopy was performed if the patient developed abdominal pain or intra-abdominal hemorrhage, as seen by transvaginal sonography. Statistical analysis was by paired or unpaired t test, Mann-Whitney U test, regression analysis, and repeated measures analysis of variance. Seventy-seven percent of the patients recovered without the need for laparoscopy in both groups, and there were no significant differences in recovery times or the need for laparoscopy between groups. Oral methotrexate, 2.5 mg for 5 days, does not appear to be more effective than placebo in the treatment of ectopic pregnancy in women eligible for expectant management.

Reproductive outcome after expectant management of ectopic pregnancy

Objective: To study fertility rates following expectant management of clinically stable ectopic pregnancies. Study design: Twenty of 33 patients with laparoscopically confirmed aborting tubal pregnancies managed expectantly were followed for a period of 1–5 years (mean 2.7 years). Excluded were the patients not desiring pregnancy, and patients with known impediments to fertility, such as age >40 years and previous infertility, as well as patients lost to follow-up. Results: Successful pregnancies occurred in 16 patients (80%); one patient (5%) had a repeat ectopic pregnancy. Conclusions: Expectant management is associated with a favorable reproduction outcome.

Chronic ectopic pregnancy after clinically successful methotrexate treatment of ectopic pregnancy

Persistent ectopic pregnancy, often a sequelae of conservative surgical procedures, is characterized by a residual trophoblastic activity site with rising or plateauing ß-human chorionic gonadotropin (hCG) titers after the initial treatment. Chronic ectopic pregnancy is a different entity which may be seen after expectant management of ectopic pregnancy and contains no active trophoblast with low or absent ß-hCG titers. A rare with features of a chronic ectopic pregnancy, which followed successful methotrexate medical treatment of a persistent ectopic pregnancy, is presented.

Chronic ectopic pregnancy after clinically successful methotrexate treatment of ectopic pregnancy

Persistent ectopic pregnancy, often a sequelae of conservative surgical procedures, is characterized by a residual trophoblastic activity site with rising or plateauing ß-human chorionic gonadotropin (hCG) titers after the initial treatment. Chronic ectopic pregnancy is a different entity which may be seen after expectant management of ectopic pregnancy and contains no active trophoblast with low or absent ß-hCG titers. A rare with features of a chronic ectopic pregnancy, which followed successful methotrexate medical treatment of a persistent ectopic pregnancy, is presented.

Prognostic factors for successful expectant management of ectopic pregnancy

To determine the independent ability of initial hCG titers, trend of hCG titers, and ultrasonographic findings in the prediction of successful expectant management in ectopic pregnancy (EP). Case-control study. University hospital. Sixty-seven patients with EP managed expectantly, 49 of whom (73%) had a spontaneous resolution, whereas 3 (5%) underwent medical treatment, and 15 (22%) eventually underwent surgical treatment. Univariate analysis showed that the initial hCG titer, the trend in hCG titers between first and second sample, and ultrasonographic visualization of absence of an ectopic gestational sac were significant predictors of a successful expectant management. Using receiver operating characteristic curve analysis, an hCG titer < 1,000 mIU/mL was chosen as the optimal cutoff for this prediction, identifying 88% of women destined to have spontaneous resolution of the EP. Multivariate analysis showed that both initial hCG titer and trend in hCG titers but not ultrasonographic visualization of an ectopic gestational sac were independent predictors of a successful or failed expectant management. Expectant management of EP is successful in the majority of patients with initial hCG titer < 1,000 mIU/mL.

Spontaneous resolution of ectopic tubal pregnancy: natural history

To determine the characteristics and long-term outcome of women succeeding or failing expectant management of ectopic pregnancy (EP). Prospective, defined protocol. University-affiliated gynecology department. We used a protocol that selected women with laparoscopic confirmed ectopic tubal pregnancy and declining plasma hCG values. Over a 5-year period, 60 women representing 20.1% of EPs fulfilled the inclusion criteria. Women were followed with serial hCG testing and transvaginal ultrasound. Success or failure of expectant management. Expectant management was successful in 28 (47.7%) of the patients. Thirty-two (53.3%) failed expectant management, and a treatment procedure was required. There was no difference in the resultant ipsilateral tubal patency or 1-year fertility rates of those women succeeding or failing expectant management. Analysis showed that in the face of declining values and with a starting hCG > 2,000 mIU/mL (conversion to SI unit, 1.00), 93.3% failed expectant management, whereas < 2,000 mIU/mL, 60.0% succeeded. We conclude that expectant management should be offered as a treatment option only in those women fulfilling the criteria for a good prognosis.

Expectant management of suspected ectopic pregnancies even with rising beta-subunit human chorionic gonadotropin levels. A clinical prospective study.

A prospective study was undertaken to evaluate possibility of expectant management of ectopic pregnancy in a selected group of patients with few symptoms, no gestational sac on sonography, and rising but low beta hCG levels. Using the above mentioned criteria, 26 patients were enrolled during prospective study period of 24 month. Five patients (19.2%) had a ruptured tubal pregnancy during the period of observation. Ten patients (38.5%) underwent laparoscopy with subsequent surgery for tubal pregnancy. The indication for laparoscopy in all 10 cases was abdominal pain. In all these 10 patients the pregnancy was unruptured. The remaining 11 patients (42.3%) escaped surgical intervention. Three had intrauterine pregnancies. In the remaining 8 patients the diagnosis remained presumed ectopic. The mean interval from admission of beta hCG level of < 5 mIU/ml in these 8 patients was 19.2 +/- 8.4 days. They were inpatients until the beta hCG level begun to decline. Thereafter, the patients were observed as outpatients. We conclude that in carefully selected cases of suspected ectopic pregnancies with rising but low beta hCG levels, expectant management is appropriate as long as the patient remains relatively asymptomatic.