MANAGEMENT OF PATIENTS WITH PERSISTENT BETA-HCG VALUES FOLLOWING LAPAROSCOPIC SURGICAL AND LOCAL-DRUG TREATMENT FOR ECTOPIC PREGNANCY

Objectives: To show that the beta-human chorionic gonadotropin (hCG) d ecline following tubal-preserving techniques for ectopic pregnancy (EP ) can take a longer course than currently believed, indicating expecta nt management; and to define the indications for a second-look laparos copy if beta-hCG persists. Methods. Three hundred thirty-seven patient s treated for EP were retrospectively reviewed. In order to define the 'normal' beta-hCG decline following tubal-preserving techniques we ac quired a Kaplan-Meier curve for 98 patients treated by laparoscopic li near salpingotomy, the main method performed for EP (253 patients). Th e Mann-Whitney U-test served as a statistical test. The patient popula tion requiring a second-look laparoscopy for proliferating trophoblast ic remnants is described. Results: Twenty-eight patients (8.3%) requir ed a second-look laparoscopy (acute abdominal pain and sonographically suspect findings combined with increasing beta-hCG values). The major ity (15 patients) underwent a preceding laparoscopic linear salpingoto my (6.5% unresolved cases). The relative beta-hCG values differed sign ificantly from the unresolved group compared to the group with resolve d EP starting at postoperative day 2 (P < 0.01). A maximal beta-hCG de cline period of 77 days postoperatively was observed. Conclusions. Pat ients with slowly declining beta-hCG levels following tubal-preserving techniques for EP can be managed expectantly. Increasing beta-hCG val ues combined with abdominal pain and sonographically suspect observati ons indicate a second-look laparoscopy.