Management of patients with persistent β-hCG values following laparoscopic surgical and local drug treatment for ectopic pregnancy

Objectives: To show that the β-human chorionic gonadotropin (hCG) decline following tubal-preserving techniques for ectopic pregnancy (EP) can take a longer course than currently believed, indicating expectant management; and to define the indications for a second-look laparoscopy if β-hCG persists. Methods: Three hundred thirty-seven patients treated for EP were retrospectively reviewed. In order to define the ‘normal’ β-hCG decline following tubal-preserving techniques we acquired a Kaplan-Meier curve for 98 patients treated by laparoscopic linear salpingotomy, the main method performed for EP (253 patients). The Mann-Whitney U-test served as a statistical test. The patient population requiring a second-look laparoscopy for proliferating trophoblastic remnants is described. Results: Twenty-eight patients (8.3%) required a second-look laparoscopy (acute abdominal pain and sonographically suspect findings combined with increasing β-hCG values). The majority (15 patients) underwent a preceding laparoscopic linear salpingotomy (6.5% unresolved cases). The relative β-hCG values differed significantly from the unresolved group compared to the group with resolved EP starting at postoperative day 2 ( P < 0.01). A maximal β-hCG decline period of 77 days postoperatively was observed. Conclusions: Patients with slowly declining β-hCG levels following tubal-preserving techniques for EP can be managed expectantly. Increasing β-hCG values combined with abdominal pain and sonographically suspect observations indicate a second-look laparoscopy.