title: Salpingotomy or salpingectomy in tubal ectopic pregnancy: what do women prefer?
abstract: There is an ongoing debate whether tubal ectopic pregnancy should be treated by salpingotomy or salpingectomy. It is unknown which treatment women prefer in view of the potentially better fertility outcome but disadvantages of salpingotomy. This study investigated women surgically treated for tubal ectopic pregnancy and subfertile women desiring pregnancy and their preferences for salpingotomy relative to salpingectomy by means of a web-based discrete choice experiment consisting of 16 choice sets. Scenarios representing salpingotomy differed in three attributes: intrauterine pregnancy (IUP) chance, risk of persistent trophoblast and risk of repeat ectopic pregnancy. An 'opt out' alternative, representing salpingectomy, was similar for every choice set. A multinomial logistic regression model was used to analyse relative importance of the attributes. This study showed that the negative effect of repeat ectopic pregnancy was 1.6 times stronger on the preference of women compared with the positive effect of the spontaneous IUP rate. For all women, the risk of persistent trophoblast was acceptable if compensated by a small rise in the spontaneous IUP rate. The conclusion was that women preferred avoiding a repeat ectopic pregnancy to a higher probability of a spontaneous IUP in the surgical treatment of tubal ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg gets stuck inside the Fallopian tube where it starts growing instead of passing on to the uterus. This may lead to serious problems, such as internal bleeding and pain. Therefore, in the majority of women, it is necessary to remove the ectopic pregnancy by means of an operation. Two types of surgery are being used in removing the ectopic pregnancy. A conservative approach, salpingotomy, preserves the tube but bears the risk of incomplete removal of the pregnancy tissue (persistent trophoblast), which then needs additional treatment, and of a repeat ectopic pregnancy in the same tube in the future. A radical approach, salpingectomy, bears no risk of persistent trophoblast and limits the risk of repeat tubal pregnancy, but leaves only one tube for reproductive capacity. It is unknown which type of operation is better, especially for future fertility. We investigated women's preferences between these two treatments for ectopic pregnancy, i.e. does a better fertility prognosis outweigh the potential disadvantages of persistent trophoblast and an increased risk for ectopic pregnancy in the future? The study results show in the surgical treatment of tubal ectopic pregnancy that women preferred avoiding a repeat ectopic pregnancy to gaining a higher chance of a spontaneous intrauterine pregnancy. The risk of additional treatment in the case of persistent trophoblast after salpingotomy was acceptable if compensated by a small rise in intrauterine pregnancy rate.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: N M
authors.initials: NM
authors.lastname: van Mello
authors.forename: F
authors.initials: F
authors.lastname: Mol
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: E W
authors.initials: EW
authors.lastname: de Bekker-Grob
authors.forename: M L
authors.initials: ML
authors.lastname: Essink-Bot
authors.forename: W M
authors.initials: WM
authors.lastname: Ankum
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.forename: F
authors.initials: F
authors.lastname: van der Veen
authors.forename: P J
authors.initials: PJ
authors.lastname: Hajenius
mesh_terms: D002755:Choice Behavior; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D016015:Logistic Models; D008727:Methotrexate / Q000627:therapeutic use; D057240:Patient Preference; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000517:prevention & control* / Q000601:surgery; D011274:Pregnancy, Tubal / Q000601:surgery*; D058994:Salpingectomy; D011795:Surveys and Questionnaires; D014328:Trophoblastic Neoplasms / Q000188:drug therapy; D014327:Trophoblasts / Q000473:pathology
chemical_list: D008727:Methotrexate