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Ectopic pregnancies: beta-hCG level may be useful

OB/GYN News, Dec, 2009 by Patrice Wendling

HAMBURG, GERMANY — The percent change in beta-human chorionic gonadotropin over a 48-hour period can help predict the need for a second dose of methotrexate or emergency laparoscopy when managing ectopic pregnancies, results of a retrospective study showed.

Predictors of these outcomes are scarce, although beta-human chorionic gonadotropin (hCG) is currently preferred for this purpose.

Beta-hCG levels vary considerably throughout a pregnancy and can be normal initially in an ectopic pregnancy before eventually falling.

In the current retrospective analysis, beta-hCG levels ranged from 22 IU/L to 6,778 IU/L in 101 women with ectopic pregnancies confirmed on transvaginal ultrasound and 48 women with pregnancies of unknown location.

Absolute progesterone tested in 145 cases ranged from 2 nmol/L to 111 nmol/L in this study.

Fifty-one women (34%) required a second dose of methotrexate and 12 (8%) had a laparoscopy.

The percent change in beta-hCG in the 48 hours prior to the administration of methotrexate was significantly better at predicting the need for a second dose than absolute progesterone or beta-hCG levels, Dr. Litha Pepas wrote in a poster presentation at the World Congress on Ultrasound in Obstetrics and Gynecology.

The areas under the receiver operating characteristic (ROC) curves were 0.72, 0.40, and 0.56, respectively.

Larger percent changes in beta-hCG levels correlated with needing laparoscopy, but this association did not reach statistical significance.

The ROC areas were 0.75 for percent change in beta-hCG, 0.60 for absolute progesterone level, and 0.56 for beta-hCG levels, reported Dr. Pepas of the obstetrics and gynecology department, Guy’s and St. Thomas’ National Health Service (NHS) Trust, London.

“Knowledge of the percentage change in beta-hCG prior to administering methotrexate can help clinicians counsel women about the possible need for a second dose of methotrexate and possible prolongation of their follow-up,” Dr
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