POSTOPERATIVE DAY 1 SERUM HUMAN CHORIONIC-GONADOTROPIN LEVEL AS A PREDICTOR OF PERSISTENT ECTOPIC PREGNANCY AFTER CONSERVATIVE SURGICAL-MANAGEMENT

Objective: To determine characteristics predictive of persistent ectop ic pregnancy (EP). Design: Retrospective cohort study. Setting: Tertia ry 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 treatme nt or persistent EP. Result(s): Twenty-six (17.7%) of 147 patients wer e diagnosed with a persistent EP. An inverse relationship was noted be tween the percent decrease in hCG at postoperative day 1 and the incid ence of persistent EP. A significantly greater percentage of persisten t EPs were noted when the postoperative day 1 hCG fell <50% from the i nitial preoperative hCG level (relative risk = 3.51 [1.25 to 6.68]). N o case of persistent EP was noted if the postoperative day 1 hCG decli ned by greater than or equal to 77%. Surgical time differed significan tly (129 minutes versus 101 minutes) between cases treated successfull y as compared with cases in which conservative treatment failed. No ot her preoperative or intraoperative variables were found to be signific antly different. Conclusion(s): Although no single postoperative hCG v alue is predictive of conservative surgical treatment for EP, a day-1 postoperative hCG value may be used as a predictor of persistent EP. ( C) 1997 by American Society far Reproductive Medicine.