**3. Results**

98 Ectopic Pregnancy – Modern Diagnosis and Management

fetal heart beat; and 7) absence of a recurrent ectopic pregnancy in the ipsilateral fallopian tube. For patient selection, we did not limit the gestational age or pre-operative serum hCG

Following confirmation of indication criteria for laparoscopy, 5 IU of vasopressin was injected into the mesosalpinx. After making a linear incision on the distended portion of the fallopian tube with electrocautery, the products of conception were removed *en bloc* using forceps or by hydrodissection. Trophoblasts were macroscopically confirmed in water and sent for pathologic evaluation. The diagnosis of ectopic pregnancy was pathologicallyconfirmed in all cases. Surgery was performed using an identical technique by several

Preoperative serum hCG levels were obtained < 24 hours before surgery. Serum hCG levels during the first postoperative week were measured at 2-3 day intervals. The intervals between hCG measurements were determined by the attending physician based on clinical symptoms. Serum hCG levels were followed postoperatively until serum hCG levels < 5

Serum hCG levels were determined by an electrochemiluminescence immunoassay (ECLIA), which is based on a sandwich antibody principle (Elecsys 2010 Systems; Roche Tokyo, Japan). The inter-assay coefficient of variation was 5.8; the intra-assay coefficient of

Patients were divided into two groups (prophylaxis and control groups). In the prophylaxis group, MTX (50 mg) was serially administered into the tubal wall near the lesion immediately after linear salpingostomy. Patients who underwent surgery without MTX administration were assigned to the control group. All patients gave informed consent to the procedures, and

PEP was defined as an increase in the serum hCG level or a decline of < 20% between

The incidence of PEP between groups was analyzed using Fischer's exact test. In addition, statistical analysis for both groups used the Student's t-test or the Mann-Whitney test, as

The 53 patients without prophylactic MTX injection were divided into two groups, as follows: patients with an increase in the serum hCG level or a decline in the serum hCG level < 20% between measurements taken 3 days apart (PEP group); and successfullytreated patients with a marked decrease in hCG (control group). The clinical and laboratory characteristics of both groups were compared with respect to maternal age, parity, gestational age at enrollment, specimen diameter, and pre-operative serum hCG levels. The postoperative course was divided into 4 periods, as follows: period A, days 1–2; period B, days 3–4; period C, days 5–6; and period D, days 7–8. The serum hCG declines during

this study was approved by the Nippon Medical School Hospital Ethics Committee.

appropriate (STATMATE for Windows). Significance was defined as a P < 0.05.

each period in the PEP and control groups were compared.

physicians under the guidance of a supervising physician.

level.

**2.2 Surgical procedure** 

**2.3 Serum hCG measurement** 

IU/ml or until the diagnosis of PEP.

measurements taken 3 days apart.14

**2.5 Early detection of PEP** 

variation was 4.5.

**2.4 Prevention of PEP** 
