Monitoring
Following treatment (medical or surgical), women are reviewed weekly and serial human chorionic gonadotropin (hCG) levels should be taken until the levels are <10 mIU/mL. If the levels do not decline, the woman can be treated with a second course of methotrexate or with a postsurgical course of methotrexate; in this case subsequent monitoring is with weekly serial hCG until hCG is <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]
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