Spontaneous resolution of ectopic tubal pregnancy: Natural history

Objective: To determine the characteristics and long-term outcome of women succeeding or failing expectant management of ectopic pregnancy (EP). Design: Prospective, defined protocol. Setting: University-affiliated gynecology department. Patients: We used a protocol that selected women with laparoscopic confirmed ectopic tubal pregnancy and declining plasma hCG values. Over a 5-year period, 60 women representing 20.1% of EPs fulfilled the inclusion criteria. Women were followed with serial hCG testing and transvaginal ultrasound. Main Outcome Measure: Success or failure of expectant management. Results: Expectant management was successful in 28 (47.7%) of the patients. Thirty-two (53.3%) failed expectant management, and a treatment procedure was required. There was no difference in the resultant ipsilateral tubal patency or 1-year fertility rates of those women succeed- ing or failing expectant management. Analysis showed that in the face of declining values and with a starting hCG > 2,000 mIU/mL (conversion to SI unit, 1.00), 93.3% failed expectant management, whereas <2,000 mIU/mL, 60.0% succeeded. Conclusion: We conclude that expectant management should be offered as a treatment option only in those women fulfilling the criteria for a good prognosis.