Abstract
As there is little information about fertility outcomes among women following clinical treatment (methotrexate and expectant management) and surgery (salpingectomy) 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. This was a prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. 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/m(2)), 50 were followed up expectantly and 35 underwent salpingectomy. 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. The findings from this study suggest similar contralateral tubal patency rates following salpingectomy, methotrexate treatment and expectant management.
Highlights
The incidence of ectopic pregnancy (EP) has been increasing recently.[1]
The findings from this study suggest similar contralateral tubal patency rates following salpingectomy, methotrexate treatment and expectant management
HSG was performed on 115 patients, who were divided into three groups: 30 treated with a single dose of methotrexate (MTX), 50 with expectant management and 35 with salpingectomy
Summary
The incidence of ectopic pregnancy (EP) has been increasing recently.[1] Diagnosis has improved through evaluation of the levels of beta-human choriongonadotropin hormone (beta-hCG) and through transvaginal ultrasound.[2] Early detection makes it possible to perform conservative treatment, such as expectant management or medical treatment with methotrexate. In spite of the advances in diagnosis, in some latent cases, the diagnosis is delayed, and in most of them surgery to remove the tube is necessary These patients’ reproductive future depends on certain factors such as the patient’s age, history of infertility, previous ectopic pregnancy, previous tubal rupture and involvement of the contralateral tube. The fertility outcome for these patients can be evaluated by hysterosalpingography or future pregnancy.[3,4] Hysterosalpingography (HSG) is an important diagnostic method following treatment of ectopic pregnancy.[5,6] If the results demonstrate obstruction in both tubes, spontaneous pregnancy is not possible
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