Archives of Gynecology and Obstetrics

, Volume 255, Issue 3, pp 125–129 | Cite as

Expectant management of suspected ectopic pregnancies even with risingβ-subunit human chorionic gonadotropin levels

A clinical prospective study
  • S. Lurie
  • Z. Katz
  • R. Goldshmit
  • Z. Gotlibe
  • V. Insler
Originals

Abstract

A prospective study was undertaken to evaluate possibility of expectant management of ectopic pregnancy in a selected group of patients with few symptoms, no gestational sac on sonography, and rising but lowβhCG levels. Using the above mentioned criteria, 26 patients were enrolled during prospective study period of 24 month. Five patients (19.2%) had a ruptured tubal pregnancy during the period of observation. Ten patients (38.5%) underwent laparoscopy with subsequent surgery for tubal pregnancy. The indication for laparoscopy in all 10 cases was abdominal pain. In all these 10 patients the pregnancy was unruptured. The remaining 11 patients (42.3%) escaped surgical intervention. Three had intrauterine pregnancies. In the remaining 8 patients the diagnosis remained presumed ectopic. The mean interval from admission toβhCG level of <5 mIU/ml in these 8 patients was 19.2 ± 8.4 days. They were inpatients until theβhCG level begun to decline. Thereafter, the patients were observed as outpatients. We conclude that in carefully selected cases of suspected ectopic pregnancies with rising but lowβhCG levels, expectant management is appropriate as long as the patient remains relatively asymptomatic.

Key words

Ectopic pregnancy Expectant management 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bateman BG, Nanley WC Jr, Kolo LA, Kitchin III JD, Felder R (1990) Vaginal sonography findings and hCG dynamics of early intrauterine and tubal pregnancies. Obstet Gynecol 75:421–427PubMedGoogle Scholar
  2. Garcia AJ, Aubert JM, Sama J, Josimovich JB (1987) Expectant management of presumed extopic pregnancies. Fertil Steril 48:395–400PubMedGoogle Scholar
  3. Gertz E, Quagliarello J (1987) Declining serum concentrations of the beta subunite of human chorionic gonadotropin and ruptured ectopic pregnancy. Am J Obstet Gynecol 146:940–941Google Scholar
  4. Kadar N, DeVore G, Romero R (1981) Discriminatory hCG zone: Its use in sonographic evaluation for ectopic pregnancy. Obstet Gynecol 58:156–161PubMedGoogle Scholar
  5. Leach RE, Ory SJ (1989) Modern management of ectopic pregnancy. J Reprod Med 34:324–338PubMedGoogle Scholar
  6. Lund J (1955) Early ectopic pregnancy: Comments on conservative treatment. J Obstet Gynecol Br Emp 62:70–76Google Scholar
  7. Lurie S (1992) The history of the diagnosis and treatment of ectopic pregnancy: a medical adventure. Eur J Obstet Gynecol Reprod Biol 43:1–7CrossRefPubMedGoogle Scholar
  8. Lurie S, Insler V (1992) Can the serumβhCG level reliably predict the likelihood of a ruptured tubal pregnancy? Isr J Obstet Gynecol 4:152–154Google Scholar
  9. Lurie S, Katz Z, Weisman A, Zalel Y, Caspi B (1994) Decliningβ-human Chorionic Gonadotropin level may provide false security that tubal pregnancy will not rupture. Eur J Obstet Gynecol Reprod Biol 53:72–73CrossRefPubMedGoogle Scholar
  10. Stock RJ (1990) Ectopic pregnancy: a look at changing concepts and problems. Clin Obstet Gynecol 33:448–453PubMedGoogle Scholar
  11. Ylostalo P, Cacciatore B, Sjoberg J, Kaariainen M, Tenhunen A, Stenman UH (1992) Expectant management of ectopic pregnancy. Obstet Gynecol 80:345–348PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • S. Lurie
    • 1
    • 2
  • Z. Katz
    • 1
    • 2
  • R. Goldshmit
    • 1
    • 2
  • Z. Gotlibe
    • 1
    • 2
  • V. Insler
    • 1
    • 2
  1. 1.Department of Obstetrics and GynecologyKaplan HospitalRehovotIsrael
  2. 2.Medical School of the Hebrew University and HadassahJerusalem

Personalised recommendations