Monitoring ß-hCG levels can predict spontaneous resolution of an ectopic pregnancy

The goal of a new study was to identify accurate predictors of the spontaneous resolution of tubal ectopic pregnancy and to assess the feasibility of expectant management.

This was a retrospective cohort analysis conducted at a tertiary, university-affiliated medical center. Patients admitted from 2015-2022 who met the expectant management criteria were included. Beta-human chorionic gonadotropin (ß-hCG) levels were monitored for the participants. Patients achieving spontaneous resolution constituted the "spontaneous resolution group," while those requiring intervention formed the "failure group." The analysis involved comparing demographic, clinical, laboratory, and ultrasound parameters between these groups.

Overall, 210 patients were assessed and 7 women were not available for follow-up, 161 had spontaneous resolution, and 42 required further intervention. Multivariate logistic regression analysis depicted that the last ß-hCG level before discharge and the discharge-to-admission ß-hCG ratio were independent predictors of the outcomes. Patients with ß-hCG <650 IU/L at discharge and a ≥50% decline during hospitalization had a 97% success rate with expectant management. Those with ß-hCG discharge levels ≥1,000 IU/L had a 50% chance of success, irrespective of ß-hCG decline. Other patients showed a 76% success rate. 

Therefore, short-term, serial ß-hCG follow-up at the initial presentation effectively predicts spontaneous resolution – supporting the feasibility of expectant management for ectopic pregnancies. The ideal candidates for this approach are asymptomatic individuals with ß-hCG <650 and a ≥50% ß-hCG fall.

Source: Shulman Y, Cohen A, Bercovich O, Cohen Y, Gil Y, Levin I. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2023 Dec 1;291:235-9.