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Preoperative Serum hCG Level and Intraoperative Failure of Laparoscopic Linear Salpingostomy for Ectopic Pregnancy

MILAD, MAGDY P. MD; KLEIN, EREZ; KAZER, RALPH R. MD
Obstetrics & Gynecology: September 1998
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Objective To identify factors that predict failure of linear salpingostomy requiring salpingectomy for ectopic pregnancy.

Methods Using a retrospective cohort, we examined the various risk factors of women with ectopic pregnancies presenting for conservative laparoscopic management. Success or failure of laparoscopic linear salpingostomy was the primary end point.

Results One hundred fifty-seven women underwent laparoscopic linear salpingostomy for ectopic pregnancy, of whom 120 had successful procedures and 36 had unsuccessful operations because of bleeding and needed subsequent salpingectomy either by laparoscopy or laparotomy. The likelihood of success of laparoscopic linear salpingostomy was unrelated to gestational age, size of the ectopic pregnancy, surgical technique, or experience of the surgeon or resident. However, median (quartiles) serum beta hCG levels were significantly higher in patients who underwent failed salpingostomy (10,103 [3549-19, 962] IU/L) compared with those who underwent successful salpingostomy (1692 [565-3971] IU/L, P < .01). Median blood loss (225 [181-562] mL versus 100 [50-200] mL, respectively, P < .01) and mean (± standard error of the mean [SEM]) operating times (111.1 ± 6.1 minutes versus 76.8 ± 2.3 minutes, P < .01) were significantly greater with failed salpingostomy followed by salpingectomy, compared with successful salpingostomy.

Conclusion Preoperative serum beta hCG level was the only significant determinant of failure of laparoscopic linear salpingostomy for ectopic pregnancy. Morbidity due to intraoperative blood loss and operating time was significantly increased as a result of attempting and failing to complete laparoscopic linear salpingostomy.

Address reprint requests to: Magdy Milad, MD, Northwestern University Medical School, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, 333 East Superior Street, #1504, Chicago, IL 60611-3095. E-mail: milad@nwu.edu

© 1998 The American College of Obstetricians and Gynecologists