Could serum β-hCG levels and gestational age be the indicative factors for the prediction of the degree of trophoblastic invasion into tubal wall in unruptured ampullary pregnancies?

• Published in: Archives of gynecology and obstetrics 2013-02, Vol.287 (2), p.323-328
• Main Authors: Turgut, Emre Niyazi, Celik, Ebru, Celik, Serdar, Arikan, Deniz Cemgil, Altuntas, Huseyin, Leblebici, Cem, Purisa, Sevim, Dansuk, Ramazan
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers - blood; Chorionic Gonadotropin, beta Subunit, Human - blood; Endocrinology; Female; General Gynecology; Gestational Age; Gynecology; Human Genetics; Humans; Logistic Models; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Predictive Value of Tests; Pregnancy; Pregnancy, Tubal - blood; Pregnancy, Tubal - pathology; Pregnancy, Tubal - surgery; Preoperative Period; Retrospective Studies; ROC Curve; Salpingectomy; Sensitivity and Specificity; Single-Blind Method; Trophoblasts - pathology
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-012-2566-1

Objective To evaluate the predictive value of gestational age and maternal serum β-hCG concentration for the determination of the depth of trophoblastic invasion into the tubal wall. Methods This is a retrospective trial conducted on women with a diagnosis of ampullary pregnancy (71) who were submitted to salpingectomy. Serum β-hCG measurements were obtained at the initial admission of hospital. Histological investigation was performed by a single well-experienced pathologist who was blind to the clinical and laboratory characteristics of the patients. Ampullary pregnancy was classified histologically according to the depth of trophoblastic infiltration into tubal wall: trophoblast limited to the tubal mucosa (stage I), extended to muscularis layer (stage II) and complete tubal wall infiltration up to serosal layer (stage III). Results There was a significant difference in maternal serum β-hCG concentrations regarding the histological stages of trophoblastic invasion. The serum β-hCG concentrations that the best predicted for stage III trophoblastic invasion was 6,475 mIU/ml, with a sensitivity of 100 %, a specificity of 92 %. Conclusion The depth of trophoblastic tissue infiltration into tubal wall is correlated with serum β-hCG levels, but not with gestational age. These findings may explain the reason for conservative management failure of EP in women with high β-hCG concentrations.