Physical resolution of tubal ectopic pregnancy on ultrasound imaging following successful expectant management

• Published in: Reproductive biomedicine online Vol. 40; no. 6; pp. 880 - 886
• Main Authors: Dooley, William, De Braud, Lucrezia, Memtsa, Maria, Thanatsis, Nikolaos, Jauniaux, Eric, Jurkovic, Davor
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2020
• Subjects: Adult; Chorionic Gonadotropin, beta Subunit, Human - blood; Ectopic pregnancy; Female; Humans; Pregnancy; Pregnancy complications; Pregnancy, Tubal - blood; Pregnancy, Tubal - diagnostic imaging; Prospective Studies; Tubal Pregnancy; Ultrasonography; Watchful Waiting; Ectopic pregnancy; Tubal Pregnancy; Pregnancy complications
• ISSN: 1472-6483; 1472-6491
• DOI: 10.1016/j.rbmo.2020.02.006

What is the time required for complete physical resolution of tubal ectopic pregnancies diagnosed on ultrasound imaging in women undergoing successful expectant management? A prospective observational cohort study of 177 women who had successful expectant management of tubal ectopic pregnancy, who attended a single Early Pregnancy Unit between January 2014 and December 2018. All participants were monitored until their serum beta-human chorionic gonadotrophin (beta-HCG) dropped to non-pregnant concentrations and with 2-weekly follow-up ultrasound scans until resolution of the pregnancy. A total of 112/177 (63.3%, 95% confidence interval [CI] 55.7–70.4) of tubal ectopic pregnancies were indiscernible on ultrasound 2 weeks after serum beta-HCG had returned to non-pregnant concentrations. In 8/177 (4.5%, 95% CI 2.0–8.7), physical resolution took longer than 78 days. There was a positive correlation between biochemical and physical resolution of tubal ectopic pregnancy (r = 0.21, P = 0.006). Physical resolution of tubal ectopic pregnancy is often prolonged and is positively correlated with initial and maximum beta-HCG concentrations. Results of this study indicate that beta-HCG resolution cannot be used as the end-point of expectant management of tubal ectopic pregnancy, which should be considered when counselling women and planning for future pregnancies.