Ectopic pregnancy: when is expectant management safe?
| Autor: | Kirsten J. de Burlet, Erik W. van Zwet, Sharon P. Rodrigues, Trudy C.M. Trimbos-Kemper, Frank Willem Jansen, Ellen Hiemstra, Andries R. H. Twijnstra |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Cutoff Unnecessary Surgery Reproductive medicine Asymptomatic Surgical oncology Obstetrics and Gynaecology medicine Complication rate Expectant management medicine.diagnostic_test Ectopic pregnancy Obstetrics business.industry Obstetrics and Gynecology Interventional radiology Beta-hCG medicine.disease Management Surgery Original Article medicine.symptom business Suspected ectopic pregnancy |
| Zdroj: | Gynecological Surgery |
| ISSN: | 1613-2084 1613-2076 |
| DOI: | 10.1007/s10397-012-0736-6 |
| Popis: | This study was conducted to evaluate expectant management in asymptomatic patients with an initial serum beta-hCG titer of N = 418) with suspected ectopic pregnancy (EP) between January 1991 and July 2008 is described. Three groups were defined: group I (n = 182), immediate surgical intervention (n = 130), unsuccessful expectant management (surgical intervention during follow-up), and group IIb (n = 99), successful expectant management (spontaneous regression of trophoblast). Hospital protocol was not complied in 35 cases (Table 1). Beta-hCG levels >3,000 IU/l occur in our expectant management group; however, none of these cases were successful. Unnecessary surgery was prevented in 14% (n = 7) of asymptomatic patients with initial beta-hCG of >2,000 IU/l. The success rate of expectant management was 49%, without a rise in complication rate or number of acute cases. In conclusion, the initial serum beta-hCG cutoff level of 2,000 IU/l is not a rigid upper limit for accepting expectant management in suspected EP and best practice is case specific. In asymptomatic patients, the serum beta-hCG cutoff level of at least 2,500 IU/l can be used for expectant management. This cutoff could be higher, but interpretation is limited due to censure in follow-up inherent to the predefined clinical protocol. There is no gain in including patients for expectant management with initial serum beta-hCG level >3,000 IU/l. |
| Databáze: | OpenAIRE |
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