Premium
F17Expectant management of ectopic pregnancy: is it possible to predict successful outcome
Author(s) -
Elson J.,
Banerjee S.,
Lawrence A. C.,
Wölfer B.,
Jurkovic D.
Publication year - 2000
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2000.00015-1-17.x
Subject(s) - medicine , ectopic pregnancy , obstetrics , gestation , pregnancy , gynecology , expectant management , ultrasound , gestational sac , gestational age , predictive value , radiology , biology , genetics
Background The aim of this study was to examine the value of different clinical, ultrasound and biochemical parameters for the prediction of final outcome in women with ectopic pregnancies which are managed expectantly. Method Clinically stable women with ultrasound diagnosis of tubal ectopic pregnancy were offered expectant management. In all cases the gestational age, morphology, pregnancy size, serum hCG and progesterone levels were recorded. Surgery was indicated in women with a deterioration of clinical symptoms or rising/nondeclining hCG levels. Results 51 out of 114 (45%) tubal ectopic pregnancies were managed expectantly. The ectopic pregnancy resolved spontaneously in 33 cases (65%). None of the patients suffered tubal rupture and one patient with low pretreatment haemoglobin received blood transfusion. There were no significant differences in the length of gestation, morphological appearances and mean pregnancy diameter between pregnancies which resolved spontaneously and those requiring surgery. However, both serum hCG and progesterone were significantly lower in tubal pregnancies that resolved spontaneously. By combining serum progesterone at cut‐off level of < 10 nmol/L and serum hCG at < 1000 IU/L a successful resolution of the ectopic pregnancy could be predicted with a sensitivity of 63% and specificity of 93%. The positive predictive value of this test was 79% and the accuracy 85%. Conclusions Serum hCG and progesterone measurements could be used to predict the likelihood of successful expectant management of tubal ectopic pregnancies.