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Review
. 2023 Jan 22;15(1):e34063.
doi: 10.7759/cureus.34063. eCollection 2023 Jan.

The Utility of Monitoring Beta-Human Chorionic Gonadotropin Levels in an Ectopic Pregnancy

Affiliations
Review

The Utility of Monitoring Beta-Human Chorionic Gonadotropin Levels in an Ectopic Pregnancy

LauraAnne E Hirschler et al. Cureus. .

Abstract

Ectopic pregnancy, a rare complication involving embryo nidation outside the uterus, significantly impacts women's lives worldwide. About 95% of ectopic pregnancies occur in the Fallopian tubes. If not diagnosed early, the patient may suffer from tubal rupture, resulting in hemorrhage and lethal consequences. Transvaginal ultrasound (TVUS) is typically used to diagnose an ectopic pregnancy. However, over the last decade, monitoring beta-human chorionic gonadotropin (β-hCG) levels in ectopic pregnancy have evolved to detect ectopic pregnancy. But there are inconsistencies in its utility in monitoring or diagnosing ectopic pregnancy in clinical practice. This systematic review highlights the potential of monitoring β-hCG levels to accurately diagnose ectopic pregnancy. Furthermore, it showcases if β-hCG levels can determine effective treatment options to successfully resolve an ectopic pregnancy. We performed a literature search between January 2022 through December 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The clinical evidence demonstrated that monitoring β-hCG levels, combined with TVUS, accurately diagnosed an ectopic pregnancy. Moreover, pre-treatment β-hCG levels higher than 5000 international units per liter (IU/L), statistically significant, indicated surgical management for a successful resolution of an ectopic pregnancy. Whereas lower β-hCG levels showed successful management through expectant and methotrexate treatment. Interestingly, patients who failed non-surgical treatment developed increased β-hCG levels and required surgical intervention. However, there was conflicting evidence on whether β-hCG levels could indicate tubal rupture. Nevertheless, as highlighted in this review, monitoring β-hCG levels could be crucial in the early diagnosis of ectopic pregnancy. Besides, it might significantly aid in monitoring and deciding on effective treatment options for patients with ectopic pregnancy, which could be vital to saving their lives and preserving fertility.

Keywords: beta-human chorionic gonadotropin (β-hcg); ectopic pregnancy; pregnancy surveillance; transvaginal ultrasound; tubal ectopic pregnancy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Literature Search and Study Selection Process.
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [14] and utilized PubMed, BioMed Central, and EBSCO to search for clinical studies on beta-human chorionic gonadotropin (β-hCG) monitoring in patients with ectopic pregnancy. First, the keywords were limited to “Ectopic pregnancy + β-hCG,” “β-hCG,” “β-hCG, Pregnancy,” and “Ectopic Pregnancy + Diagnosis.” Then, by using filters and inclusion criteria, including articles written in English, complete clinical studies, retrospective clinical studies, and clinical observational and cross-sectional studies, with select patient demographics (patients in the reproductive age group and below 50, patients with patent ectopic pregnancy and tubal rupture), we selected relevant studies. Moreover, the literature search was not limited to studies published in the last 10 years, and as such there was no set year limit.

References

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