PROGNOSTIC FACTORS FOR SUCCESSFUL EXPECTANT MANAGEMENT OF ECTOPIC PREGNANCY

Objective: 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). Design: Case-control study. Setting: University hospital. Patients: Sixty-seve n patients with EP managed expectantly, 49 of whom (73%) had a spontan eous resolution, whereas 3 (5%) underwent medical treatment, and 15 (2 2%) eventually underwent surgical treatment. Results: Univariate analy sis showed that the initial hCG titer, the trend in hCG titers between first and second sample, and ultrasonographic visualization of absenc e of an ectopic gestational sac were significant predictors of a succe ssful expectant management. Using receiver operating characteristic cu rve analysis, an hCG titer < 1,000 mIU/mL was chosen as the optimal cu toff for this prediction, identifying 88% of women destined to have sp ontaneous resolution of the EP. Multivariate analysis showed that both initial hCG titer and trend in hCG titers but not ultrasonographic vi sualization of an ectopic gestational sac were independent predictors of a successful or failed expectant management. Conclusion: Expectant management of EP is successful in the majority of patients with initia l hCG titer < 1,000 mIU/mL.