Physical resolution of tubal ectopic pregnancy on ultrasound imaging following successful expectant management

Abstract

What is the time required for complete physical resolution of tubal ectopic pregnancies diagnosed on ultrasound imaging in women undergoing successful expectant management? DesignA prospective observational cohort study of 177 women who had successful expectant management of tubal ectopic pregnancy, who attended a single Early Pregnancy Unit between January 2014 and Downloaded for Anonymous User (n/a) at University College London Hospitals NHS Foundation 2020. For personal use only. No other uses without permissio December 2018. All participants were monitored until their serum β-hCG dropped to non-pregnant levels and with two-weekly follow-up ultrasound scans until resolution of the pregnancy. Results112/177 (63.8%, 95% CI 56.3-70.9) of tubal ectopic pregnancies were indiscernible on ultrasound 2 weeks after serum β-hCG had returned to non-pregnant levels. In 8/177 (4.5%, 95% CI 2.0-8.7) physical resolution took longer than 78 days. There was a positive correlation between biochemical and physical resolution of tubal ectopic pregnancy (r=0.21, p=0.006). ConclusionsPhysical resolution of tubal ectopic pregnancy is often prolonged and is positively correlated with initial and maximum β-hCG levels. Our results indicate that β-hCG resolution cannot be used as the end-point of expectant management of tubal ectopic pregnancy, which should be considered when counselling women and planning for future pregnancies.

Efficacy and safety of expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis

“…Two studies were excluded as they were not RCTs. Four studies were excluded as the comparison was inappropriate: three of these included prostaglandins as part of the medical management and the other compared placebo to oral methotrexate, which is not considered a viable treatment strategy ( Elson et al , 2016 ; American College of Obstetrics and Gynecology (ACOG), 2018). Two studies were not included as they were unfinished studies.…”

“…A further potential advantage of EM is that there is the possibility to attempt to conceive again more quickly than patients treated with methotrexate, who are advised to wait 3 months ( Elson et al , 2016 ). However, a recent prospective observational cohort study found that in 5% of patients with tubal EP managed expectantly, it took longer than 3 months for the physical resolution on transvaginal ultrasonography after the β-hCG had normalised ( Dooley et al , 2020 ).…”

Methotrexate vs expectant management for treatment of tubal ectopic pregnancy: An individual participant data meta‐analysis

“…Several studies on MTX noted a higher treatment success with lower hCG levels. 20,[24][25][26][27] Similarly, studies on expectant management favor a lower hCG for successful resolution, 6,14,22,23,28 with the subgroup of women with initial hCG <1500 IU/L having a 77% success rate. 8 Our mean time to resolution of 19.7 days with MTX and 21.2 days with expectant management was similar to that of other studies.…”

Pseudoaneurysm complicating expectantly managed tubal ectopic pregnancy

“…Improvements in diagnostic ultrasound have resulted in the detection of small failing tubal ectopic pregnancies, which can be managed successfully expectantly, with appropriate case selection [1][2][3][4] . We report a case of pseudoaneurysm complicating expectant management of a tubal ectopic pregnancy.…”