**6. References**

104 Ectopic Pregnancy – Modern Diagnosis and Management

completely outside the 95% CI of the control group. In addition, the subsequent increase in hCG was observed after period C in all PEP patients. Furthermore, once an increase in the serum hCG levels was observed, the serum hCG levels never decreased until the second intervention. Therefore, the decision to perform a second intervention, including MTX treatment, should be made by confirming a rise in the hCG levels from period A or B to period C. We also evaluated the appropriate duration of intensive hCG measurement to rule out a PEP. After period C, the hCG decline in all patients with PEP was completely outside the 95% CI of the control group. Furthermore, based on the results of the ROC analysis of the two groups, the specificity and sensitivity were equal to 100% from period C (Figure 4). These results indicate that intensive serum hCG monitoring after laparoscopic salpingostomy must be continued through period C; if the level of the hCG declines to < 14% of the preoperative level,

We suggest that prophylactic intratubal injection of MTX after a linear salpingostomy for tubal pregnancy is a safe and effective regimen for preventing PEP, enhances the possibility of tubal

The decision-making for a second intervention to PEP should be made by confirming an increase of the serum hCG levels from period A or B to period C. Intensive hCG follow-up after laparoscopic salpingostomy for tubal pregnancy must continue through period C; if the serum hCG decline is < 14%, a PEP can be ruled out and the serum hCG monitoring

In view of these findings, serum hCG follow-up after laparoscopic salpingostomy can be as

Fig. 5. Strategy for management of ectopic pregnancy after laparoscopic salpingotomy. hCG: human chorionic gonadotropin, MTX: methotrexate, PEP: persistent ectopic pregnancy.

preservation, and contributes to improvements in the postoperative QOL of patients.

PEP can be ruled out and the serum hCG monitoring interval can be extended.

**5. Conclusions** 

interval can be extended.

follows (Figure 5).


**Part 3** 

**Diagnosis of Ectopic Pregnancy** 

