Tubal patency following surgical and clinical treatment of ectopic pregnancy
Keywords:
Ectopic pregnancy, Methotrexate, Beta-hCG, Hysterosalpingography, Chorionic gonadotropin, InfertilityAbstract
CONTEXT AND OBJECTIVE: As there is little infor- mation about fertility outcomes among women following clinical treatment (methotrexate and expectant management) and surgery (salpin- gectomy) consequent to ectopic pregnancy, we evaluate the results from hysterosalpingography subsequent to treatment. The objective was to evaluate contralateral tubal patency using hysterosalpingography following surgery and clinical treatment of tubal pregnancy. DESIGN AND SETTING: This was a prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. METHOD: Among 115 patients who underwent hysterosalpingography following surgery and clinical treatment of tubal pregnancy between April 1994 and February 2002, 30 were treated with a single intramuscular dose of methotrexate (50 mg/m2), 50 were followed up expectantly and 35 underwent salpingectomy. RESULTS: The patency of the ipsilateral tube was 84% after methotrexate treatment and 78% after expectant management. In addition, contralateral tubal patency was 97% after methotrexate treatment, 92% after expectant management and 83% after salpingectomy. There were no statistically significant differences between the clinical treatment and surgery groups. CONCLUSIONS: The findings from this study suggest similar contralateral tubal patency rates following salpingectomy, methotrexate treatment and expectant management.
Downloads
References
Center for Disease Control and Prevention (CDC). Ectopic pregnancy -- United States, 1990-1992. MMWR Morb Mortal Wkly Rep. 1995;44(3):46-8.
Ankun WM, Van der Veen F, Hamerlynck JV, Lammes FB. Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: a detailed analysis of a diagnostic approach. Hum Reprod. 1993;8(8):1307-11.
Debby A, Golan A, Sadan O, Zakut H, Glezerman M. Fertility outcome following combined methotrexate treatment of unrup- tured extrauterine pregnancy. BJOG. 2000;107(5):626-30.
Rantala M, Makinen J. Tubal patency and fertility outcome after expectant management of ectopic pregnancy. Fertil Steril. 1997;68(6):1043-6.
Mol BW, Swart P, Bossuyt PM, van der Veen F. Is hysterosal- pingography an important tool in predicting fertility outcome? Fertil Steril. 1997;67(4):663-9.
Stovall TG, Ling FW, Gray LA, Carson SA, Buster JE. Metho- trexate treatment of unruptured ectopic pregnancy: a report of 100 cases. Obstet Gynecol. 1991;77(5):749-53.
Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999;341(26):1974-8.
Elito J Jr, Reichmann AP, Uchiyama MN, Camano L. Predic- tive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate. Int J Gynaecol Obstet. 1999;67(2):75-9.
Glatstein IZ, Sleeper LA, Lavy Y, et al. Observer variability in the diagnosis and management of the hysterosalpingogram. Fertil Steril. 1997;67(2):233-7.
Job-Spira N, Fernadez H, Bouyer J, Pouly JL, Germain E, Coste J. Ruptured tubal ectopic pregnancy: risk factors and reproduc- tive outcome: results of a population-based study in France. Am J Obstet Gynecol. 1999;180(4):938-44.
Mass JW, Evers JL, ter Riet G, Kessels AG. Pregnancy rate following normal versus abnormal hysterosalpingog- raphy findings: a meta-analysis. Gynecol Obstet Invest. 1997;43(2):79-83.
Zohav E, Gemer O, Segal S. Reproductive outcome after expect- ant management of ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 1996;66(1):1-2.
Elito J Jr, Han KK, Camano L. Tubal patency after clinical treatment of unruptured ectopic pregnancy. Int J Gynaecol Obstet. 2005;88(3):309-13.
