BETA-HCG REGIME FOLLOWING PELVISCOPIC LINEAR SALPINGOTOMY IN THE THERAPY OF TUBAL PREGNANCY

From 1987 until 1993 a total of 337 patients underwent a therapy for tubal pregnancy at the Department of Gynaecology and Obstetrics of the University of Kiel. The percentage of cases treated by tubal-preserving pelviscopic linear salpingotomy and subsequent extraction of the conceptus, increased from 59 % in 1987 to 88 % in 1993. In 6.5 % a second look pelviscopy was performed for suspected remnants of trophoblastic tissue. Remaining trophoblastic cells can be recognised by serial determination of serum beta-hCG titers postoperatively. However, the interval of the postoperative beta-hCG decline reveals considerable interindividual variation. A regression following the ,,Cox Proportional Hazard'' model shows that the period of the beta-hCG decline depends on the initial titer. The Kaplan Meier. curve obtained via beta-hCG determination in 98 patients following pelviscopic linear salpingotomy until values reached 20 mIU/ml or less, shows that 50 % of the patients had to be controlled for more than 7 days, 10 % for more than 28 days and individual patients even for more than 70 days. The relative beta-hCG titers differ significantly from the unresolved group compared to the group with resolved ectopic pregnancy starting at postoperative day 2 (p < 0.01). At postoperative day 3/4 10 % of the initial beta-hCG value is attained in 50 % of cases. Even then a serial beta-hCG follow-up should be obtained down to the detection limit to ensure complete resolution of viable trophoblastic cells.