Ectopic pregnancy

Following treatment (medical or surgical) women are reviewed weekly and serial human chorionic gonadotrophin (hCG) levels should be taken until the levels are <10 IU/L (<10 mIU/mL). If the levels do not decline, the woman can be treated with a second course of methotrexate or with a post-surgical course of methotrexate; in this case subsequent monitoring is with weekly serial hCG until hCG is <10 IU/L (<10 mIU/mL). Once the serum hCG levels are undetectable, no further monitoring is needed.

While some experts recommend follow-up hCG only after medical management or salpingostomy, persistent trophoblastic tissue has been reported after salpingectomy as well. Therefore, it is good practice to confirm a negative urine hCG 3 weeks after salpingectomy, and follow up with a serum hCG where it is found to be positive.[63]National Institute for Health and Care Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. Nov 2021 [internet publication]. https://www.nice.org.uk/guidance/ng126