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Ectopic pregnancy: when is expectant management safe?
This study was conducted to evaluate expectant management in asymptomatic patients with an initial serum beta-hCG titer of <2,500 IU/l and to determine the independent ability of initial serum beta-hCG titers and trend of serum beta-hCG to predict successful expectant management. A cohort of pati...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer-Verlag
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491186/ https://www.ncbi.nlm.nih.gov/pubmed/23144641 http://dx.doi.org/10.1007/s10397-012-0736-6 |
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author | Rodrigues, Sharon P. de Burlet, Kirsten J. Hiemstra, Ellen Twijnstra, Andries R. H. van Zwet, Erik W. Trimbos-Kemper, Trudy C. M. Jansen, Frank W. |
author_facet | Rodrigues, Sharon P. de Burlet, Kirsten J. Hiemstra, Ellen Twijnstra, Andries R. H. van Zwet, Erik W. Trimbos-Kemper, Trudy C. M. Jansen, Frank W. |
author_sort | Rodrigues, Sharon P. |
collection | PubMed |
description | This study was conducted to evaluate expectant management in asymptomatic patients with an initial serum beta-hCG titer of <2,500 IU/l and to determine the independent ability of initial serum beta-hCG titers and trend of serum beta-hCG to predict successful expectant management. A cohort of patients (N = 418) with suspected ectopic pregnancy (EP) between January 1991 and July 2008 is described. Three groups were defined: group I (n = 182), immediate surgical intervention (<24 h); group IIa (n = 130), unsuccessful expectant management (surgical intervention during follow-up), and group IIb (n = 99), successful expectant management (spontaneous regression of trophoblast). Hospital protocol was not complied in 35 cases (Table 1). Beta-hCG levels >3,000 IU/l occur in our expectant management group; however, none of these cases were successful. Unnecessary surgery was prevented in 14% (n = 7) of asymptomatic patients with initial beta-hCG of >2,000 IU/l. The success rate of expectant management was 49%, without a rise in complication rate or number of acute cases. In conclusion, the initial serum beta-hCG cutoff level of 2,000 IU/l is not a rigid upper limit for accepting expectant management in suspected EP and best practice is case specific. In asymptomatic patients, the serum beta-hCG cutoff level of at least 2,500 IU/l can be used for expectant management. This cutoff could be higher, but interpretation is limited due to censure in follow-up inherent to the predefined clinical protocol. There is no gain in including patients for expectant management with initial serum beta-hCG level >3,000 IU/l. |
format | Online Article Text |
id | pubmed-3491186 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Springer-Verlag |
record_format | MEDLINE/PubMed |
spelling | pubmed-34911862012-11-08 Ectopic pregnancy: when is expectant management safe? Rodrigues, Sharon P. de Burlet, Kirsten J. Hiemstra, Ellen Twijnstra, Andries R. H. van Zwet, Erik W. Trimbos-Kemper, Trudy C. M. Jansen, Frank W. Gynecol Surg Original Article This study was conducted to evaluate expectant management in asymptomatic patients with an initial serum beta-hCG titer of <2,500 IU/l and to determine the independent ability of initial serum beta-hCG titers and trend of serum beta-hCG to predict successful expectant management. A cohort of patients (N = 418) with suspected ectopic pregnancy (EP) between January 1991 and July 2008 is described. Three groups were defined: group I (n = 182), immediate surgical intervention (<24 h); group IIa (n = 130), unsuccessful expectant management (surgical intervention during follow-up), and group IIb (n = 99), successful expectant management (spontaneous regression of trophoblast). Hospital protocol was not complied in 35 cases (Table 1). Beta-hCG levels >3,000 IU/l occur in our expectant management group; however, none of these cases were successful. Unnecessary surgery was prevented in 14% (n = 7) of asymptomatic patients with initial beta-hCG of >2,000 IU/l. The success rate of expectant management was 49%, without a rise in complication rate or number of acute cases. In conclusion, the initial serum beta-hCG cutoff level of 2,000 IU/l is not a rigid upper limit for accepting expectant management in suspected EP and best practice is case specific. In asymptomatic patients, the serum beta-hCG cutoff level of at least 2,500 IU/l can be used for expectant management. This cutoff could be higher, but interpretation is limited due to censure in follow-up inherent to the predefined clinical protocol. There is no gain in including patients for expectant management with initial serum beta-hCG level >3,000 IU/l. Springer-Verlag 2012-03-06 2012 /pmc/articles/PMC3491186/ /pubmed/23144641 http://dx.doi.org/10.1007/s10397-012-0736-6 Text en © The Author(s) 2012 https://creativecommons.org/licenses/by/4.0/ This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. |
spellingShingle | Original Article Rodrigues, Sharon P. de Burlet, Kirsten J. Hiemstra, Ellen Twijnstra, Andries R. H. van Zwet, Erik W. Trimbos-Kemper, Trudy C. M. Jansen, Frank W. Ectopic pregnancy: when is expectant management safe? |
title | Ectopic pregnancy: when is expectant management safe? |
title_full | Ectopic pregnancy: when is expectant management safe? |
title_fullStr | Ectopic pregnancy: when is expectant management safe? |
title_full_unstemmed | Ectopic pregnancy: when is expectant management safe? |
title_short | Ectopic pregnancy: when is expectant management safe? |
title_sort | ectopic pregnancy: when is expectant management safe? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491186/ https://www.ncbi.nlm.nih.gov/pubmed/23144641 http://dx.doi.org/10.1007/s10397-012-0736-6 |
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