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Hum. Reprod. Advance Access originally published online on May 17, 2006
Human Reproduction 2006 21(9):2426-2431; doi:10.1093/humrep/del170
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Predictive factors of trophoblastic invasion into the ampullary region of the tubal wall in ectopic pregnancy

F.R. Cabar1,3, P.P. Pereira1, R. Schultz2 and M. Zugaib1

1 Department of Obstetrics and Gynecology and 2 Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

3 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Hospital das Clínicas, University of São Paulo, Av Dr Enéas de Carvalho Aguiar, 255–10° andar, São Paulo—SP, 05403-000, Brazil. E-mail: fabiocabar{at}uol.com.br

BACKGROUND: Predictive factors of damage to the Fallopian tube may guide the treatment for patients with tubal pregnancy. The aim of this study was to assess the predictive value of the following parameters: gestational age, serum beta-hCG concentrations and ultrasound findings. METHODS: A total of 105 patients with ampullary pregnancy undergoing salpingectomy were analysed. Trophoblastic invasion was histologically classified as stage I when limited to the tubal mucosa, stage II when extending to the muscle layer and stage III in the case of complete tubal wall infiltration. We correlated the depth of trophoblastic infiltration into the tubal wall with gestational age, beta-hCG concentration on the day of surgery and the type and size of the ectopic mass upon ultrasound. RESULTS: No association was observed between the depth of trophoblastic invasion and gestational age (P = 0.53) or tubal mass diameter (P = 0.43). Trophoblastic invasion was, however, associated with beta-hCG concentration (P < 0.001) and with the type of ultrasonographic image (P = 0.001). beta-hCG levels of 2400 mIU/ml showed 82.8% sensitivity and 85.5% specificity for stage I, and levels of 5990 mIU/ml showed 82.6% sensitivity and 74.6% specificity for stage III. CONCLUSIONS: Depth of trophoblastic penetration into the tubal wall of the ampullary region of Fallopian tube is correlated with beta-hCG concentration and the type of ultrasonographic image; serum beta-hCG is the best predictor of the depth of penetration.

Key words: beta-hCG/ampullary pregnancy/ectopic pregnancy/first trimester haemorrhage/trophoblastic tissue


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