Open AccessPersistent ectopic pregnancy after linear salpingotomy: a non‐predictable complication to conservative surgery for tubal gestation
Author(s) -
Lund Claus Otto,
Nilas Lisbeth,
Bangsgaard Nannie,
Ottesen Bent
Publication year - 2002
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1034/j.1600-0412.2002.811110.x
Subject(s) - medicine , ectopic pregnancy , methotrexate , human chorionic gonadotropin , surgery , gestational sac , gestation , antifolate , complication , pregnancy , gonadotropin , hemoperitoneum , hormone , antimetabolite , genetics , biology
Background. The drawback of conservative surgery for ectopic pregnancy (EP) is the risk of persistent trophoblast. The purpose was to characterize patients who develop persistent ectopic pregnancy (PEP) after salpingotomy for EP and to assess prognostic factors. Methods. The medical records of 417 patients treated by salpingotomy for EP were reviewed. Forty‐eight (11.5%) patients were diagnosed with persistent EP. The data were analyzed using the Mann–Whitney U ‐test, Fischer's exact test or the χ 2 ‐test. Results. Of 417 women, 48 (11,5%) were treated for PEP by either repeat surgery ( n = 25) or methotrexate ( n = 23). Oral methotrexate failed in 4/19 cases while intramuscular (i.m.) methotrexate was successful in 4/4 cases. Women treated for PEP had a higher preoperative and a slower postoperative decline of serum human chorionic gonadotropin (hCG). Both the preoperative and the early postoperative hCG levels had a low diagnostic sensitivity (0.38–0.66) and specificity (0.74–0.77) for predicting PEP. In multivariate logistic analysis, none of the following clinical variables were predictive of PEP: duration of surgery, laparoscopic approach, history of previous EP, history of previous lower abdominal surgery, ruptured EP, pelvic adhesions, absence of products of conception at microscopy and hemoperitoneum. Conclusions. Persistent ectopic pregnancy can neither be predicted from clinical variables nor from single measurements of hCG with an accuracy sufficient for clinical use.