CAN WE PREDICT PATIENTS AT RISK FOR PERSISTENT ECTOPIC PREGNANCY AFTER LAPAROSCOPIC SALPINGOTOMY

To identify factors that may predict patients at increased risk for pe rsistent ectopic pregnancy after linear salpingotomy, we analyzed demo graphic, surgical, and biochemical variables retrospectively in 60 wom en who underwent laparoscopic linear salpingotomy, and compared data i n those who developed persistent ectopic pregnancy (study group) versu s those who were cured (controls). The two groups were similar with re spect to demographic features and surgical findings. They did not diff er significantly in gestational age and human chorionic gonadotropin ( hCG) levels at time of surgery. There was, however, a significant diff erence in hCG dynamics when the average daily increase in the week bef ore surgery was analyzed. Eleven (18%) women developed persistent ecto pic pregnancy. The disorder did not occur in those whose hCG levels we re flat or declining, whereas patients whose levels increased more tha n 40% per day had a significantly greater risk. In addition, at surger y, tubal bleeding was significantly more common in study patients than in controls (55 vs 9%, p <0.001). We conclude that hCG dynamics in th e week before salpingotomy, and bleeding activity at surgery may ident ify patients who are the most likely candidates for persistent ectopic pregnancy.