Can We predict patients at risk for persistent ectopic pregnancy after laparoscopic salpingotomy?

To identify factors that may predict patients at increased risk for persistent ectopic pregnancy after linear salpingotomy, we analyzed demographic, surgical, and biochemical variables retrospectively in 60 women who underwent laparoscopic linear salpingotomy, and compared data in those who developed persistent ectopic pregnancy (study group) versus those who were cured (controls). The two groups were similar with respect to demographic features and surgical findings. They did not differ significantly in gestational age and human chorionic gonadotropin (hCG) levels at time of surgery. There was, however, a significant difference in hCG dynamics when the average daily increase in the week before surgery was analyzed. Eleven (18%) women developed persistent ectopic pregnancy. The disorder did not occur in those whose hCG levels were flat or declining, whereas patients whose levels increased more than 40% per day had a significantly greater risk. In addition, at surgery, tubal bleeding was significantly more common in study patients than in controls (55 vs 9%, p <0.001). We conclude that hCG dynamics in the week before salpingotomy, and bleeding activity at surgery may identify patients who are the most likely candidates for persistent ectopic pregnancy.