Laparoscopic instillation of hyperosmolar glucose vs. expectant management of tubal pregnancies with serum hCG ≤ 2500 mIU/mL

Abstract

Objective. To compare expectant management with local instillation of 50% glucose solution for tubal pregnancies with a serum hCG level ≤ 2500 mIU/mL. Design. Prospective, non-randomized, comparative clinical study. Setting. Two university departments. Patients. One hundred and twenty-eight patients with laparoscopically-confirmed tubal pregnancy and serum hCG ≤ 2500 mIU/mL. Interventions. Eighty patients in Graz were treated with laparoscopic instillation of 50% glucose solution and 48 patients in Turku were followed expectantly. Main outcome measures. Resolution of hCG excretion, need for further interventions. Results. Seventy-four of the 80 patients (92%) in the glucose group (32 of 33 with an initial hCG ≤ 250 mIU/mL and 42 of 47 with hCG 251-2500 mIU/mL) and 36 of 48 (75%) patients in the expectant group (19 of 23 with an initial hCG ≤ 250 mIU/mL and 17 of 25 with hCG 251-2500 mIU/mL) had resolution of the pregnancy with no further intervention (p = 0.008, chi-square test, odds ratio 0.24). Conclusions. Glucose instillation is superior to expectant management for patients with early tubal pregnancy.