Xiu Li1, Chen Zhang1, Yuhong Li1, Jiangjing Yuan1, Qi Lu2, Yudong Wang1. 1. International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai 200030, China. 2. Jinshan Hospital, Fudan University Shanghai 201500, China.
Abstract
BACKGROUND: We evaluated the predictors of unsuccessful salpingostomy that required surgical treatment or additional medical treatment after initial removal of ectopic pregnancy (EP) by laparoscopy. MATERIAL/ METHODS: The study was an observational retrospective cohort study done at International Peace Maternity and Child Health Hospital in Shanghai, which included patients with ectopic pregnancy (EP). The predictors of persistent ectopic pregnancy (PEP) were measured either on serum β-hCG ratios before and after salpingostomy or demographics (age, parity, in-vitro fertilization (IVF), abortion history, EP history, mass location, appendectomy history and diameter of EP lesion). We used nomogram analyses to evaluate the significant factors consisting of serum β-hCG ratio, parity and performed IVF that predicted the failure or success of salpingostomy. RESULTS: We retrospectively analyzed 429 patients in this study who received salpingostomy for EP from January 2013 and December 2017. Of these patients, 29 (6.76%) were diagnosed with PEP after salpingostomy and 400 (93.24%) had satisfactory treatment. The median of serum β-hCG ratio (after salpingostomy 24 h/after salpingostomy 48 h) 2.43 in PEP patients was lower than that in successful treatment patients (P<0.001). Logistic regression analyses identified several predictors for PEP, including parity, IVF and serum β-hCG (after salpingostomy 24 h/after salpingostomy 48 h), with a higher clear predictive value (area under the curve [AUC]=0.865, 95% CI: 0.812-0.919, P<0.001). CONCLUSIONS: The serum β-hCG ratio (after salpingostomy 24 h/after salpingostomy 48 h) in combination with parity and IVF are important predictors for PEP patients after surgery. These findings provide higher risk PEP patients for early interventions to improve outcome. IJCEP
BACKGROUND: We evaluated the predictors of unsuccessful salpingostomy that required surgical treatment or additional medical treatment after initial removal of ectopic pregnancy (EP) by laparoscopy. MATERIAL/ METHODS: The study was an observational retrospective cohort study done at International Peace Maternity and Child Health Hospital in Shanghai, which included patients with ectopic pregnancy (EP). The predictors of persistent ectopic pregnancy (PEP) were measured either on serum β-hCG ratios before and after salpingostomy or demographics (age, parity, in-vitro fertilization (IVF), abortion history, EP history, mass location, appendectomy history and diameter of EP lesion). We used nomogram analyses to evaluate the significant factors consisting of serum β-hCG ratio, parity and performed IVF that predicted the failure or success of salpingostomy. RESULTS: We retrospectively analyzed 429 patients in this study who received salpingostomy for EP from January 2013 and December 2017. Of these patients, 29 (6.76%) were diagnosed with PEP after salpingostomy and 400 (93.24%) had satisfactory treatment. The median of serum β-hCG ratio (after salpingostomy 24 h/after salpingostomy 48 h) 2.43 in PEPpatients was lower than that in successful treatment patients (P<0.001). Logistic regression analyses identified several predictors for PEP, including parity, IVF and serum β-hCG (after salpingostomy 24 h/after salpingostomy 48 h), with a higher clear predictive value (area under the curve [AUC]=0.865, 95% CI: 0.812-0.919, P<0.001). CONCLUSIONS: The serum β-hCG ratio (after salpingostomy 24 h/after salpingostomy 48 h) in combination with parity and IVF are important predictors for PEPpatients after surgery. These findings provide higher risk PEPpatients for early interventions to improve outcome. IJCEP