Spontaneous resolution of ectopic tubal pregnancy: natural history.

OBJECTIVE

To determine the characteristics and long-term outcome of women succeeding or failing expectant management of ectopic pregnancy (EP).

DESIGN

Prospective, defined protocol.

SETTING

University-affiliated gynecology department.

PATIENTS

We used a protocol that selected women with laparoscopic confirmed ectopic tubal pregnancy and declining plasma hCG values. Over a 5-year period, 60 women representing 20.1% of EPs fulfilled the inclusion criteria. Women were followed with serial hCG testing and transvaginal ultrasound.

MAIN OUTCOME MEASURE

Success or failure of expectant management.

RESULTS

Expectant management was successful in 28 (47.7%) of the patients. Thirty-two (53.3%) failed expectant management, and a treatment procedure was required. There was no difference in the resultant ipsilateral tubal patency or 1-year fertility rates of those women succeeding or failing expectant management. Analysis showed that in the face of declining values and with a starting hCG > 2,000 mIU/mL (conversion to SI unit, 1.00), 93.3% failed expectant management, whereas < 2,000 mIU/mL, 60.0% succeeded.

CONCLUSION

We conclude that expectant management should be offered as a treatment option only in those women fulfilling the criteria for a good prognosis.