Persistent ectopic pregnancy following conservative surgery for tubal pregnancy

Objective To audit the incidence and management of persistent ectopic pregnancy following conservative tubal surgery performed at laparotomy and via the laparoscope. Design A retrospective analysis of the case records. Setting The Birmingham and Midland Hospital for Women. Participants Two hundred and fourteen women who received surgical treatment for ectopic pregnancy between October 1991 and December 1994. Results Of the 85 women who underwent conservative tubal surgery, nine were diagnosed as having persistent ectopic pregnancy on the basis of hCG values. The incidence after laparoscopy was no higher than after laparotomy. A second surgical procedure was indicated in only four cases. Conclusions Post-operative surveillance of serum hCG remains mandatory. Patients who remain symptom free may be managed conservatively The threshold for a second-look laparoscopy should be relatively high and be based on the presence of symptoms rather than changes in hCG values.