Persistent ectopic pregnancy: complication of conservative surgery?

Conservative surgery with conservation of the affected tube is widely recommended as optimal therapy in the management of unruptured tubal gestation. Unfortunately it is not possible to guarantee complete removal of all trophoblastic tissue and there remains the possibility of continuing trophoblastic growth after the conservative operation, usually necessitating a second, more radical procedure. Four cases of this complication have been reported in the literature and we have recently encountered a fifth. It is our impression that the problem may be under-reported. We recommend routine serial beta-subunit human chorionic gonadotropin surveillance in the postoperative period following conservative surgery and feel that patients should be advised of the possibility of this complication whenever conservative surgery is contemplated. Furthermore, there may be a potential for management of this problem with cytotoxic agents in a manner analogous to that used for gestational trophoblastic disease.