Improved fertility following conservative surgical treatment of ectopic pregnancy.
OBJECTIVE
To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy.


METHODS
Retrospective cohort study.


METHODS
Clinical University Center, Hvidovre Hospital, Copenhagen.


METHODS
Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months.


METHODS
Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cumulative probabilities of pregnancy for each group were calculated by the Kaplan-Meier estimator and compared by Cox regression analysis to control for potential confounders.


METHODS
Intrauterine pregnancy rates and recurrence rates of ectopic pregnancy after surgery for ectopic pregnancy.


RESULTS
The cumulative intrauterine pregnancy rate was significantly higher after tubotomy (88%) than after salpingectomy (66%) (log rank P < 0.05) after correction for confounding factors. No difference was found in the recurrence rate of ectopic pregnancy between the treatments (16% vs 17%). In patients with contralateral tubal pathology, the chance of pregnancy was poor (hazard ratio 0.463) and the risk of recurrence was high (hazard ratio 2.25), assessed with Cox regression. The rate of persistent ectopic pregnancy was 8%.


CONCLUSIONS
Conservative surgery is superior to radical surgery at preserving fertility. Conservative surgery is not followed by an increased risk of repeat ectopic pregnancy, but by the risk of persistent ectopic pregnancy, which should be taken into account when deciding on the operative procedure. Management in case of contralateral tubal pathology is disputed and should ideally be addressed in a randomised clinical trial.
Bangsgaard
Nannie
N
Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Kettegaards Alle, DK-2650 Hvidovre, Denmark.
Lund
Claus Otto
CO
Ottesen
Bent
B
Nilas
Lisbeth
L
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011247:Pregnancy / Q000706:statistics & numerical data*; D011271:Pregnancy, Ectopic / Q000601:surgery*; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies