Previous ectopic pregnancy should be considered a contraindication for microsurgery.

Abstract

To estimate the risk of subsequent ectopic pregnancy (EP) after tubal surgery, given that the woman becomes pregnant, by means of a logistic model, a retrospective study was initiated. During the period 1986-1990, 221 women with tubal infertility underwent microsurgery. Subsequent fertility was evaluated in 1991. Ninety women conceived, of whom 84 were included in the study (30 with EP and 54 with intra-uterine pregnancy as the only outcome). Clinical background factors of importance, surgical procedures used, scoring systems for tubal lesions, adnexal adhesions and risk of EP were analysed for possible correlation to subsequent EP. These factors were further used in a logistic model to estimate the risk of subsequent EP as only outcome. The risk of EP after microsurgery is minimum 15% without any risk factors. Previous EP and endometriosis could be identified as factors with prognostic power in the logistic model. One previous EP implies a 60% risk, whereas two previous EPs and endometriosis increase the risk to 95%. Patients with previous EP should generally not be considered for microsurgery owing to the high risk of recurrence and to the reduced chance of intra-uterine pregnancy.