PREDICTION OF PERSISTENT ECTOPIC PREGNANCY AFTER LAPAROSCOPIC SALPINGOSTOMY

Objective: To evaluate whether preoperative measurements of progestero ne and hCG in serum can predict the risk of needing a second therapeut ic intervention after laparoscopic salpingostomy. Methods: In 158 pati ents with unruptured tubal pregnancies smaller than 4 cm, serum proges terone and hCG levels were measured in two venous blood samples taken preoperatively. Fourteen complicated cases, in which a second therapeu tic intervention was necessary, were compared with 144 uncomplicated c ases. Results: Eleven of the 14 complicated cases (79%) had preoperati ve progesterone values exceeding 35 nmol/L, whereas this was true for only 15 (10%) of the uncomplicated cases. Among the complicated cases, 12 (86%) had preoperative daily hCG changes above 100 IU/L, compared to 44 (31%) of the uncomplicated cases. Cases with a progesterone leve l above 35 nmol/L and a daily hCG change exceeding 100 IU/L had a 61% risk for a second therapeutic intervention, whereas with a progesteron e value below 35 nmol/L and/or a daily hCG change of less than 100 IU/ L, the risk was only 2%. Conclusion: The risk for a second therapeutic intervention after laparoscopic salpingostomy for ectopic pregnancy c an be predicted by the combined use of two sequential serum hCG sample s and one serum progesterone sample, the last of each taken within 24 hours preoperatively.