Relationship of Beta-Human Chorionic Gonadotropin to Ectopic Pregnancy Detection and Size
Authors: Duane M Eisaman, Nicole E Brown, Sarah Geyer
Published in: Western Journal of Emergency Medicine, May 2024
Conclusion:
The study highlights that β-hCG levels do not reliably indicate the presence or size of ectopic pregnancies, emphasizing the need for diagnostic imaging regardless of β-hCG levels in patients with clinical suspicion of ectopic pregnancy. The significant proportion of patients requiring surgical intervention and presenting with hemodynamic instability or rupture underscores the critical nature of prompt and accurate diagnosis.
Methods:
- Design: Retrospective case review
- Setting: Urban, academic emergency department with a specialization in obstetrical care
- Period: January 1, 2015, to December 31, 2017
- Participants: Patients diagnosed with ectopic pregnancy
- Data Collected: Presentation details, treatment methods, adverse outcomes, and rates of rupture
Results:
- Total Cases: 519 unique ectopic pregnancies
- Presentation with Rupture: 22.9% presented with evidence of rupture on ultrasound
- Hemodynamic Instability: 14.4% showed evidence of hemodynamic instability
- Medical Management Failure Rates:
- Single-dose methotrexate: 14.7% required surgical intervention
- Multi-dose methotrexate: 36.9% required surgical intervention
- Operative Management: 55.7% required surgical intervention
- β-hCG Levels:
- Mean: 7,096 mIU/mL (SD: 88,872 mIU/mL)
- Median: 1,289 mIU/mL
- 50.4% had β-hCG levels less than 1,500 mIU/mL
- 44% with rupture had β-hCG levels less than 1,500 mIU/mL
- Correlation: Weak correlation between size of ectopic pregnancy and β-hCG levels (r = 0.144, P < .001)
- Ultrasound Detection: Independent of β-hCG levels