Mj. Sinosich et al., DIAGNOSIS AND MANAGEMENT OF EXTRAUTERINE PREGNANCIES, Australian and New Zealand Journal of Obstetrics and Gynaecology, 33(3), 1993, pp. 307-311
This study was based on 16 women provisionally diagnosed as having ext
rauterine pregnancies. Of these, 13 (81.3%) were confirmed as positive
at operation. Patients were managed according to 1 of 3 regimens; 1)
methotrexate (n = 4), 2) methotrexate followed by surgery (n = 3) and
3) surgery (n = 6). Serial blood samples, collected before and after t
reatment, were analyzed for ovarian (oestradiol, E2; progesterone, P4)
uterine (placental protein 14, PP14) and placental markers (chorionic
gonadotrophin, HCG; pregnancy-associated plasma protein-A (PAPP-A). O
f the pretreatment samples, only 30.4% and 41.7% were depressed for PP
14 and HCG, respectively. By contrast, the diagnostic value of PAPP-A
(77.8%) and P4 (87.5%) was greater. Biochemical monitoring of treatmen
t was best achieved with trophoblastic derived antigens (HCG), whereas
antigens of maternal origin demonstrated widely varied responses. Thi
s study established the effectiveness of chemotherapy for treatment of
tubal pregnancies as an alternative to surgery, but if a biochemical
marker is required, the marker of choice is HCG.