Value of human chorionic gonadotropin levels in diagnosing cervical ectopic pregnancy

摘要

A 36-year-old, gravida 7 para 2, presented at 5 weeks of amenorrhea for vaginal bleeding and abdominal pain. She had two previous tubal ectopic pregnancies managed 11 and 12 years previously by medical therapy and laparoscopic salpingectomy, respectively, two cesarean deliveries and two surgical abortions. Abdominal and pelvic examination was unremarkable. Transva-ginal sonography (TVS) showed no evidence of intrauterine or ectopic pregnancy. Serum human chorionic gonadotropin (hCG) level was 5841 IU/L. Diagnostic laparoscopy was considered in view of the absence of an intrauterine gestation sac on TVS above the hCG discriminatory level (1500 IU/L in our institution) (1). After counseling, the patient decided not to undergo laparoscopy, but preferred inpatient monitoring as she was asymptomatic. Serum hCG 48 h later showed normal doubling (19 655 IU/L). TVS repeated three days after the initial scan showed a live cervical pregnancy with a mean sac diameter of 1.1 cm and a 3-mm fetal pole (Figure 1). She was treated with intralesional methotrexate; the usual treatment method for cervical pregnancy in our institution (2).