PERSISTENT TUBAL PREGNANCY

Persistent tubal pregnancy may be manifest by either acute symptoms or a persistent or rising beta-hCG titer following conservative surgery. This condition is a relatively new complication, related to the recent practice of conservative surgical management of tubal pregnancy. Much has been written on the identification and possible therapy for this condition but little is known about its pathophysiology. Eight cases of persistence were studied, as well as three cases of failed conservative procedures. In nine instances, the surgeon had concentrated appropriately on the maximally dilated portion of the tube, which contained the blood clot and aborted products of conception. Unfortunately, the implantation site was located medially, toward the uterus. Ways of avoiding this complication include medial exploration or possibly the use of mesosalpingeal injection of vasopressin. An understanding of the natural history of the pathologic process might also be valuable in the management of cases of "persistence" identified solely by a continuing beta-hCG titer.