Early diagnosis and surgical management of heterotopic pregnancy following in vitro fertilization-embryo transfer: A retrospective cohort study

Abstract

Abstract Objective: The purpose of this study was to evaluate the efficacy of laparoscopic surgery for heterotopic pregnancy (HP), and to compare the clinical characteristics between HP, twin pregnancy and single pregnancy. The ROC curve was constructed to provide help for the early diagnosis of HP. Design: This was a retrospective cohort study. Setting: Reproductive Medicine Hospital of the First Hospital of Lanzhou. Patients: Cases of HP (n=30), twin pregnancy (n=467) and single pregnancy (n=1127) were retrieved from the registry database. Intervention: All patients diagnosed with HP underwent laparoscopic surgery. Measurements: Clinical characteristics including age, body mass index (BMI), infertility type, menarche age, gravidity, parity, history of EP, number of retrieved oocytes, number of transferred embryos, surgery (initial symptom, EP site, surgical management), and pregnancy outcome (neonatal weight, live birth, miscarriage rate, preterm delivery rate) were recorded. Serum β-hCG, serum estradiol(E2) and serum progestin(P) were tested at 14 days after ET. Main results: The live birth rate of HP was 66.6% and the miscarriage rate was 33.3%. Fourteen days after embryo transfer, the serum levels of β-human chorionic gonadotropin(β-hCG), estradiol(E2) and progestin(P) were lower in the HP group than in the twin pregnancy group(P<0.05). But there were no differences in the level of serum β-hCG, E2 between HP group and single group(P>0.05). The area under receiver operating characteristic (ROC) curve (AUC) of serum β-hCG-ET14d between HP and twin pregnancy were 0.80, 95% confidence interval (0.73-0.87), the cut-off value of β-hCG-ET14d was 1117 mIU/ml. The area under receiver operating characteristic (ROC) curve (AUC) of serum β-hCG-ET14d between HP and single pregnancy were 0.53, 95% confidence interval (0.44-0.62), the cut-off value of β-hCG-ET14d was 404.4 mIU/ml. The history of ectopic pregnancy in HP group was higher than that that in twin pregnancy group and single group (P <0.05). There were no differences in the intraoperative blood loss between live birth group and abortion group. The birth weight in HP group was similar with the single group(P>0.05), both all lower than the twin group(P<0.05). Conclusion: This retrospective study suggested that a history of ectopic pregnancy may increase the risk of HP. β-hCG could not be an predictor for HP in the early stages. Intraoperative blood loss in laparoscopic surgery had no influence on the pregnancy outcomes.