Clinical usefulness of monitoring beta-hCG levels after laparoscopic treatment for tubal pregnancy

The aim of this study was to determine if postoperative monitoring of beta-hCG is able to identify persistence of trophoblastic tissue promptly in patients treated conservatively for tubal pregnancy. Seventy consecutive patients underwent laparoscopic treatment for tubal pregnancy; the intervention was conservative in 32 cases (45.7%). Our data showed a significant difference in the mean percentage beta-hCG decreases between women with and without retained trophoblastic tissue as early as day 3 (mean +/- SEM 55.2% +/- 9.7% vs 80.1% +/- 3.3%). In the group with persistent trophoblastic tissue, the mean value rose again on day 7 and stabilized on day 14. The difference in preoperative beta-hCG levels between women with and without retained trophoblastic material was not significant (2280.3 +/- 572.8 vs 2585 +/- 1817.7 mIU/ml) and became significant only on postoperatively day 7 (p < 0.01). The presence of fetal heart beat and the size of the ectopic pregnancy did not demonstrate prognostic value. A sharp fall in beta-hCG occurred in all patients on the third postoperative day. It was, however, significantly smaller in women with retained trophoblastic tissue. A single dose of methotrexate or simple observation appears to constitute valid options for persistence of trophoblast.