Early and late half-life of human chorionic gonadotropin as a predictor of persistent trophoblast after laparoscopic conservative surgery for tubal pregnancy

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Abstract
Background. To determine if the early or late half‐lives (T0.5) of human chorionic gonadotropin (hCG) can identify patients with persistent trophoblastic activity after conservative surgery for tubal pregnancy. Design. Prospective cohort study. Setting. Department of obstetrics and gynecology of a university hospital. Methods. All patients with a tubal pregnancy treated by laparoscopic salpingostomy between June 1997 and September 2000 were enrolled in the study. Postoperative sequential hCG sampling was performed at days 0, 2 (± 1) and 7 (± 2) and followed until levels were undetectable. Taking the biexponential hCG declining curve as a model, we calculated the early (days 0–2) and late (days 2–7) T0.5 hCG values. Main outcome measure. To assess success or failure of surgical treatment. Results. Seventy‐three patients with an ectopic pregnancy were managed by conservative surgery. Early and late T0.5 allowed us to identify 2/10 and 9/10 women, respectively, with persistent trophoblast. Late T0.5 levels revealed two patients with false‐positive values, but one patient showed a secondary increase in hCG after day 7 (false‐negative) despite a normal late T0.5. Conclusions. Early and late half‐lives of hCG do not identify all women at risk for persistent ectopic pregnancy. To exclude persistent trophoblast, postoperative serum hCG determination should be performed until levels are undetectable.

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