Role Of β-HCG Monitoring In The Treatment Of Ectopic Pregnancy

Objective:To evaluate the role of serum beta-human chorionic gonadotropin (β-hCG) levels as a predictor of therapy success or not and prognosis judgments for ectopic pregnancy.Methods:A retrospective study was conducted to evaluate the serum beta-hCG levels of 300 patients with ectopic pregnancy diagnosed in Zhaoyuan Hospital from December 2009 to December 2012, divided into two groups (conservative and surgical) according to different treatments. In conservative group (group A),129 patients were given methotrexate (MTX) intramuscular injection, dosage of 50mg/m2. Repeat the injection when the declining rate less than 25% on the 7th day and no more than a third dose in total. And 171 cases were in surgical treatment (group B), either by laparotomy or by laparoscopy, in which 105 cases underwent salpingostomy (36 by laparotomy and 69 by laparoscopy)and 66 salpingectomy (15 by laparotomy and 51 by laparoscopy). The serum β-hCG levels of all patients were monitored at pre-and post-treatment (day 3, 7,14 after MTX therapy), and the time it took to normalize circulating β-hCG levels was also recorded.Results:There were significant differences in serum β-hCG levels of post-treatment (day 3,7,14 after therapy) between conservative group (group A) and surgical treatment (group B) (P<0.05), while no significant differences of serum β-hCG levels were found between patients by laparotomy and by laparoscopy (P>0.05). When the initial serum β-hCG value was less than 1000mIU/mL, between 1000mIU/mL and 2000mIU/mL, or between 2000mIU/mL and 3000mIU/mL, the overall success rate of MTX treatment was determined to be 96.97%,93.62% and 85.71% respectively. Moreover, the success rate in conservative group (group A) was 96.49%,66.7% and 33.33% when the declining rate of β-hCG was more than 25%, between 15% and 25%, less than 15% a week later after MTX therapy. Given the multiple-dose of MTX, the success rate was 53.33%. Compared with salpingostomy, the salpingectomy can advance the normalize of serum β-hCG levels of post-treatment (day 3,7,14 after therapy) (P<0.05) except first day (P>0.05). Less than 50% decline in the value of the serum (3-hCG in the third day after salpingostomy stood a good chance of continuous ectopic pregnancy, and this happened to 5 cases (5/101) in this group. In addition, compared with MTX therapy, surgical treatment significantly shorten the time of β-hCG level normalization (P<0.05), and laparotomy enjoyed the shortest p-hCG normalization time.Conclusion:The changes of serum β-hCG levels have significant clinical value in predicting treatment effect of ectopic pregnancy. Decreased β-hCG level is highly predictive of treatment success or not in different therapeutic strategies for EP. In conservative treatment, beta-hCG level less than 2000mIU/ml or the declining rate more than 25% a week later is highly predictive of successful possibility for ectopic pregnancy while the declining rate less than 15% after a week indicates failure. In surgical, the decline in beta-HCG levels less than 50% in 3 days after salpingostomy indicates persistent ectopic pregnancy. The β-hCG levels may serve as an important clinical indicator to evaluate treatment outcome in ectopic pregnancy.