Expectant management of tubal ectopic pregnancy: Updated decision tree analysis for the prediction of successful outcomes.

OBJECTIVES

To re-analyse and update a decision tree developed 20 years ago to counsel women regarding the likelihood of successful expectant management of tubal ectopic pregnancies. The original model was developed using the data from 179 cases.

STUDY

DESIGN

A retrospective observational analysis spanning a 14-year period was undertaken at the early pregnancy unit of an inner-city teaching hospital. Data were collected for all women who had expectant management when first diagnosed with their tubal ectopic pregnancies. Initial serum human chorionic gonadotropin (hCG) and progesterone levels, gestational age, ectopic morphology and mean diameter of the ectopic were recorded. Data were analysed using decision tree analysis on SPSS (IBM).

RESULTS

A total of 798/1968 (40.5%) women with tubal ectopic pregnancies had expectant management and a new decision tree was developed using data from these 798 cases. Expectant management was successful in 512/798. This was 64% of women embarking on expectant management and 26% of all women with tubal ectopic pregnancies. Initial serum hCG level remains the best predictor of success for expectant management. Combined with progesterone level and diameter measurement, the decision tree has been updated.

CONCLUSION

Biochemical and clinical markers can be used to help counsel women about the likelihood of successful expectant management in our early pregnancy unit using decision tree analysis.