Laparoscopic Salpingotomy Research Articles

Therapeutic effect of laparoscopic salpingotomy vs. salpingectomy on patients with ectopic pregnancy: A systematic review and meta-analysis.

Background and aimLaparoscopic treatment of ectopic pregnancy mainly includes laparoscopic salpingotomy and salpingectomy. We aimed to assess the therapeutic effect of laparoscopic salpingotomy and salpingectomy on patients with tubal pregnancy.MethodsFrom January 2000 through June 2022, the Cochrane Library, Medline, PubMed, Web of Science, EMBASE, and the Chinese Biomedicine Database were searched for studies that compared the therapeutic effect of laparoscopic salpingotomy vs. salpingectomy in the treatment of tubal pregnancy.ResultsTwenty-four randomized clinical trials (RCTs) studies were incorporated into this analysis. No statistical differences were found between the two groups in terms of operation duration and postoperative hospitalize length, but the volume of intraoperative blood loss in patients with laparoscopic salpingotomy was less than that in salpingectomy. Importantly, the natural intrauterine pregnancy rate after laparoscopic salpingotomy was significantly higher than those who underwent salpingectomy. In addition, laparoscopic salpingotomy can better protect the ovarian reserve function and endocrine function and provide favorable conditions for the second pregnancy.ConclusionPatients with ectopic tubal pregnancy should give priority to laparoscopic salpingotomy for embryo extraction.

Preliminary hysteroscopic tubal hydrotubation improves fertility outcomes after laparoscopic salpingotomy for tubal ampullary pregnancy

BackgroundSalpingotomy may change the anatomical structure and patency of the fallopian tube, which may affect the fallopian function. This study is to investigate the clinical efficacy of preliminary hysteroscopic tubal hydrotubation (HTH) after laparoscopic salpingotomy for tubal ampullary pregnancy.MethodsA retrospective study was carried out, 140 women underwent laparoscopic salpingotomy for ampullary pregnancy from March 2013 to March 2017. Some patients received HTH in the 1st month and hysterosalpingography (HSG) in the 3rd month after salpingotomy (HTH group; n = 95), and some patients only received HSG in the 3rd month after salpingotomy (control group; n = 45). Clinical data, tubal patency and fertility outcome were evaluated after follow-up of 15 months.ResultsThe tubal patency rate of the operated side was significantly higher in the HTH group than that in the control group (89.47% vs 68.89%, P < 0.05). The intrauterine pregnancy (IUP) rate was significantly higher in the HTH group (76.47% vs 51.11%, P < 0.05), and the recurrent ectopic pregnancy rate in the operated side was significantly lower in the HTH group than in the control group (9.41% vs 22.22%, P < 0.05). Logistic regression analysis showed that the positive factor for IUP was HTH (OR = 3.109, 95% CI 1.439–6.714, P = 0.004), while the negative factors were history of pelvic inflammatory disease (PID) (OR = 0.167, 95% CI 0.074–0.377, P < 0.001) and history of tubal infertility (OR = 0.286, 95% CI 0.113–0.723, P < 0.05).ConclusionPreliminary HTH after laparoscopic salpingotomy for ampullary pregnancy could improve reproductive function and lead to a better fertility outcome. Patients without history of PID or tubal infertility may be the most suitable ones for HTH after salpingotomy.

Vaginal birth after laparoscopic management of heterotopic pregnancy at the Douala general hospital, Cameroon: A case report

Heterotopic pregnancy is the simultaneous presence of an intrauterine and ectopic pregnancy. The prevalence of the condition is unknown in Cameroon. We report a case of heterotopic pregnancy managed by laparoscopy. MS a 33-year-old G2P0010 woman was admitted to our department because of 7 2/7 weeks' amenorrhea, mild vaginal bleeding, and severe lower abdominal pain. She has a 6 years' history of secondary infertility, one induced abortion, and chlamydia infection treated with doxycycline. Furthermore, she has a history of left laparoscopic salpingotomy for tubo-ovarian abscess. She became pregnant after receiving clomiphene citrate and timed intercourse. Her beta hCG assay was 97000 mIU/mL and transvaginal sonography confirmed ruptured heterotopic pregnancy. She underwent laparoscopic left salpingectomy and the intrauterine pregnancy evolved normally and she gave birth to a healthy female that weighed 3050 g at 38 5/7 weeks gestation. The diagnosis of heterotopic pregnancy needs a high index of suspicion. Laparoscopic treatment of heterotopic pregnancy needs to become widespread in Cameroon.

Effect of laparoscopic salpingotomy on ovarian reserve function in patients with tubal pregnancy

Objective To investigate the effect of laparoscopic salpingotomy and salpingectomy on ovarian reserve function in patients with tubal pregnancy. Methods From October 2014 to March 2017, 201 cases of tubal pregnancy in Jizhong energy Fengfeng Group Hospital were selected and divided into observation group (112 cases) and control group (89 cases) according to different treatment methods.The observation group was treated with laparoscopic salpingectomy, while the control group was treated with laparoscopic salpingectomy.The number of sinus follicles and ovarian volume were measured by color Doppler ultrasound at third days of menstruation on first, third, sixth months after the operation respectively and the ovulation was detected in 6 months after the operation.The intrauterine pregnancy of the two groups was observed one year after operation. Results There was no significant difference in the number and volume of healthy ovarian antral follicles between the two groups in 1, 3 and 6 months after operation respectively (all P>0.05). The number of sinus follicles in the 1, 3 and 6 months after the operation were (7.71 ± 3.12), (7.86 ± 2.03) and (7.65 ± 1.89) in observation group respectively, while that in the control group were (4.06 ± 1.05), (3.91 ± 1.14) and (4.89±2.03)respectively.There was no significant difference in the number of sinus follicles in different time groups (Fintra-group=0.573, P>0.05). The difference between the groups was statistically significant (F inter-grouP=634.306, P 0.05). The difference between the groups was statistically significant (Finter-group=449.106, P< 0.01), F interaction=261.017, P< 0.01). The ovulation rate at 6 months (82.1%, 92/112) and intrauterine pregnancy rate at 1 year (71.8%, 79/110) in the observation group were higher than those in the control group (56.2%, 50/89) and (31.0%, 27/87). There were significant differences between the two groups(χ2=12.601, 28.753, all P<0.05). Conclusion Laparoscopic salpingotomy is better than salpingectomy in the treatment of tubal pregnancy.The ovulation rate and intrauterine pregnancy rate are also superior to salpingectomy.It shows that laparoscopic fenestration can protect the ovarian reserve reserve function and reproductive function of patients. Key words: Tubal pregnancy; Laparoscopy; Oviduct fenestration; Salpingectomy; Number of sinus follicles; Ovarian volume

Effect of laparoscopic salpingotomy with suturing on prognosis of patients

Objective To investigate the effect of laparoscopic salpingotomy with suturing on prognosis of patients. Methods One hundred and thirty two cases patients of laparoscopic salpingotomy and embryo extraction in our hospital from October 2015 to Febrary 2017 were were divided into observation group (68 cases) with suturing and control group (64 cases) without suturing according to the operation procedure.The patency of fallopian tube was observed at 3 months after operation and the intrauterine gestation rate and recurrent ectopic pregnancy rate were observed 1 years after operation in two groups. Results The fallopian tube patency in the observation group and the control group was 58 cases (85.3%) and 39 cases (60.9%) respectively at 3 months after operation.7 cases (10.3%) and 12 cases (18.8%) of the fallopian tube were not smooth in the observation group and the control group respectively at 3 months after operation.The fallopian tube obstruction in the observation group and the control group was 3 cases (4.4%) and 13 cases (20.3%) respectively at 3 months after operation.The patency rate of fallopian tube in the observation group was higher than that in the control group (Z=6.215, P<0.05). The intrauterine gestation rate (69.1%(47/68)) in the observation group was significantly higher than that in the control group (37.5%(24/64))1 years after operation and the difference between the two groups was statistically significant (χ2=5.41, P<0.05). The rate of recurrent ectopic pregnancy in the observation group (10.3%(7/68)) was significantly lower than that in the control group (26.6%(17/64)) and the difference between the two groups was statistically significant (χ2=4.826, P<0.05). Conclusion The laparoscopic salpingotomy with suturing can improve the patency rate of the fallopian tube and the rate of intrauterine gestation and reduce the rate of recurrent ectopic pregnancy in the patients after the operation. Key words: Tubal pregnancy; Laparoscopy; Salpingotomy with suturing; Intrauterine gestation; Recurrent ectopic pregnancy.

Factors Predicting Persistent Ectopic Pregnancy After Laparoscopic Salpingostomy or Salpingotomy for Tubal Pregnancy: A Retrospective Cohort Study

To identify factors predictive of persistent ectopic pregnancy (PEP) in women who have undergone laparoscopic salpingostomy or salpingotomy for tubal pregnancy. Retrospective cohort study (Canadian Task Force classification II-2). Tertiary referral center. Ninety-nine women who underwent laparoscopic tubal preservation surgery for ectopic pregnancy. Seventy women underwent laparoscopic salpingostomy, and the remaining 29 women underwent laparoscopic salpingotomy. Factors predicting PEP were evaluated. The change in serum beta human chorionic gonadotropin (β-hCG) levels from baseline observed between postoperative days 5 and 10 (ChCGD5-10) was a predictor of PEP (odds ratio [OR], 0.80; p = .01). Based on receiver operating characteristic (ROC) curve analysis, a cutoff value of 93.1% was determined, with an area under the ROC curve of 0.95 (sensitivity, 85.7%; specificity, 100%). Nonetheless, when considering perioperative variables only, body mass index (BMI) was identified as a predictor of PEP (OR, 0.71; p = .03). Based on the ROC analysis, a BMI cutoff value of ≤22 kg/m2 was determined, with an ROC area of 0.73 (sensitivity, 43.2%; specificity, 100%). In addition, a higher baseline β-hCG level (hazard ratio [HR], 1.0002; p = .009) and left tubal pregnancy (HR, 6.46; p = .03) were predictive of recurrent ectopic pregnancy. There were no differences in the perioperative outcomes, PEP rates, or subsequent intrauterine pregnancy rates between the salpingostomy and salpingotomy groups. In addition, surgical method was not a predictor of recurrent ectopic pregnancy. ChCGD5-10 was identified as a predictor for PEP, suggesting that it might be more clinically useful for the follow-up of PEP. When considering perioperative variables only, BMI was a predictor for PEP. In addition, there was no significant difference in clinical outcomes between the salpingostomy and salpingotomy groups.

Endometriosis and Beta-hCG > 775 IU/l Increase the Risk of Non-tube-preserving Surgery for Tubal Pregnancy.

Introduction Tubal pregnancy is the most clinically relevant form of ectopic pregnancy. Surgery consisting of laparoscopic salpingotomy is the therapeutic gold standard. This study looked at risk factors for non-tube-preserving surgery. The aim was to determine a cut-off value for beta-hCG levels, which could be used to predict the extent of tubal surgery. Materials and Method 97 patients with tubal pregnancy who underwent primary salpingotomy in the Department of Gynecology and Obstetrics of Jena University Hospital between 2010 and 2016 were retrospectively analyzed. A prior medical history of risk factors such as adnexitis, ectopic pregnancy, tubal surgery, treatment for infertility and intrauterine pessary was included in the analysis. The study population was divided into two subgroups: (1) a group which underwent laparoscopic linear salpingotomy, and (2) a group which had laparoscopic partial tubal resection or salpingectomy. Risk factors for salpingectomy were determined using binary logistic regression analysis. Statistical analysis was done using SPSS, version 24.0, to identify risk factors for non-tube-preserving surgery. Results 68 patients (70.1%) underwent laparoscopic salpingotomy and 29 patients (29.9%) had laparoscopic salpingectomy. The two groups differed with regard to age (p = 0.01) but not with regard to the parameters ‘gestational age’, ‘viability and rupture status of the ectopic pregnancy’ or ‘symptoms at presentation’. Patients who were known to have endometriosis prior to surgery or who were diagnosed with endometriosis intraoperatively were more likely to undergo salpingectomy (OR: 3.28; 95% CI: 0.9 – 10.8; p = 0.05). Calculated mean beta-hCG levels were higher in the salpingectomy group compared to the group who had tube-preserving salpingotomy (3277.8 IU/l vs. 9338.3 IU/l, p = 0.01). A cut-off beta-hCG value of 775 IU/l prior to surgery was predictive for salpingectomy with a true positive rate of 86.2% and increased the probability that salpingectomy would be necessary (OR: 5.23; 95% CI: 0.229 – 0.471; p = 0.005). Conclusion Endometriosis and a beta-hCG value of more than 775 IU/l significantly increased the risk for non-tube-preserving surgery in women with tubal pregnancy.

Successful Management of Heterotopic Intramural Pregnancy Leading to a Live Birth of the Intrauterine Pregnancy

A 26-year-old woman was admitted for a presumed heterotopic pregnancy (HP). She denied a history of sexually transmitted diseases. She underwent tube catheterization for proximal tubal obstruction under the guidance of fluoroscopy 5 years ago because of primary infertility. Two months later, she had a right tubal pregnancy and received laparoscopic salpingotomy. She did not conceive since then and turned to assisted reproduction technology.

Laparoscopic salpingotomy for tubal pregnancy: comparison of linear salpingotomy with and without suturing

To clarify the advantages and the influence to reproductive outcome after laparoscopic salpingotomy with and without suturing for tubal pregnancy. We retrospectively analyzed the clinical data of patients underwent laparoscopic salpingotomy from March 2012 to October 2014 who were willing to reserve their reproductive function and were able to be followed up. Based on the operation procedure, the patients were assigned to undergo laparoscopic salpingotomy with suturing (group A; n=49) or without suturing (group B; n=69). An amount of 50 mg methopterin was injected at mesosalpinx during operation in all cases. Tubal patency of the trouble side was evaluated by liquid instillation. The operation time, amount of bleeding, the trouble side tubal patency rate 3 months after the surgery, pregnancy outcome 12 months after the surgery was compared between two groups. Three months after the surgery the tubal patency rate of trouble side was 85.71% (42/49) in group A and 62.32% (43/69) in group B. There was significant differences (P<0.05) between two groups. Within twelve months of the surgery, the intrauterine gestation rate was 69.39% (34/49) in group A and 42.03% (29/69) in group B. Ectopic re-pregnancy rate of the trouble side was 10.20% (5/49) in group A and 27.54% (19/69) in group B. Secondary infertility rate was 14.29% (7/49) in group A and 27.54% (19/69) in group B. There was significant differences (P<0.05) between two groups. The trouble side tubal patency rate and intrauterine gestation rate of group A was significantly higher than that of group B, while the ectopic re-pregnancy rate of the trouble side and secondary infertility rate of group A was significantly lower than that of group B. Suturing after laparoscopic salpingotomy can decrease the damage to fallopian tube and recover its normal anatomic structure. So the procedure involving suturing can effectively reserve reproductive function for the patients.

Clinical analysis of laparoscopic salpingotomy combined with pituitrin in the treatment of tubal pregnancy

Objective To investigate clinical effects of laparoscopic salpingotomy combined with pituitrin in the treatment of tubal pregnancy. Methods 160 children with tubal pregnancy were chosen in our hospital in the period and randomly divided into two groups including control group(80 children)with laparoscopic salpingotomy treatment and treatment group(80 children)with pituitrin adjunct treatment before operation on the basis of control group. And the operation time, intraoperative bleeding volume, postoperative body temperature, hospitalization time, the retention rate of fallopian tube, fallopian tube patency rate, persistent ectopic pregnancy rate, intrauterine pregnancy rate and fertility rate of both groups were compared. Results The operation time,intraoperative bleeding volume, postoperative body temperature and hospitalization time of the control group were separately(20.33±2.70)min,(52.76±7.42)m L,(37.52±0.54)℃and(7.56±1.98)d;the operation time, intraoperative bleeding volume, postoperative body temperature and hospitalization time of the treatment group were separately(8.94±1.61)min,(16.33±2.15) mL,(37.46±0.50)℃and(5.91±1.42)d; the operation time, intraoperative bleeding volume and hospitalization time of the treatment group were significantly better than those of the control group(t=2.26,2.60,2.08,all P 0.05).The retention rate of fallopian tube and fallopian tube patency rate of the control group were separately 75.00%(60/80)and 52.50%(42/80);the retention rate of fallopian tube and fallopian tube patency rate of the control group were separately 93.75%(75/80)and 81.25%(65/80);the retention rate of fallopian tube and fallopian tube patency rate of treatment group were significantly better than those of the control group(χ2=9.71,10.14,all P 0.05);the intrauterine pregnancy rate and fertility rate of treatment group were significantly better than those of the control group(χ2=11.84,12.52,all P<0.05). Conclusion Laparoscopic salpingotomy combined with pituitrin in the treatment of tubal pregnancy can efficiently decrease operation time the amount of bleeding, shorten hospitalization time and be helpful to improve the reproductive outcome. Key words: Laparoscopic; Salpingotomy; Pituitrin; Pregnancy; Tubal

Laparoscopic salpingotomy using the floseal hemostatic sealant in patients with tubal pregnancy.

To present our initial experience with laparoscopic salpingotomy using the Floseal™ (Baxter International Corp., Deerfield, IL) hemostatic matrix for tubal pregnancy and to evaluate the efficacy and tubal patency after salpingotomy. A prospective study was conducted on 20 consecutive patients with tubal pregnancy undergoing laparoscopic salpingotomy using the Floseal hemostatic matrix. The outcome measures were treatment success rates and homolateral patency rates. Of 20 cases, 19 cases (95%) were successfully performed without any additional intervention, and 1 case was switched to salpingectomy during the initial surgery. During the mean β-human chorionic gonadotropin resolution time of 17.9±6.4 days, postoperative complications or persistent trophoblasts did not occur. Of 19 salpingotomy patients, only 12 patients received a tubal patency test using hysterosalpingography, and the homolateral tubal patency rate was 75% (9 of 12). The use of Floseal allows laparoscopic salpingotomy to be performed successfully and easily with comparable outcomes.

Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy

Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue. Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG) confirmed tubal patency. The patient subsequently had an intrauterine pregnancy. Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.

Salpingotomy vs salpingectomy – a comparison of women’s fertility after surgical treatment of tubal ectopic pregnancy during a 24-month follow-up study

Ectopic pregnancy (EP) is usually located in the Fallopian tube and it has a significant adverse effect on womens fertility Three types of EP treatment include: expectant, medical, and surgical radical (salpingectomy) or conservative (salpingotomy) management. The aim of the study was to compare women's fertility after surgical radical or conservative treatment of tubal ectopic pregnancy Out of the 58 patients operated because of tubal EP pregnancy 22 underwent laparoscopic salpingotomy (group 1) and 36 laparoscopic salpingectomy (group 2). EP-related data were obtained from medical documentation (the symptoms, diagnostic tests, EP risk factors, medical reproductive and surgical history clinical status during EP surgery). Follow-up data were collected by means of a telephone interview. The survey included questions focused on women's fertility during a 24-month period following the surgical treatment of EP (conception, subsequent intrauterine pregnancies and ectopic pregnancy). A 24-month follow-up period revealed that the cumulative intrauterine pregnancy rate was higher in group 1 (salpingotomy) as compared to group 2 (salpingectomy), i.e. 50% vs. 41.5%, respectively. Tubal EP returned in 13.6% cases (group 1) vs. 19.4% (group 2). All submitted results are statistically insignificant. Our findings are consistent with the literature which reports a trend of higher odds for intrauterine pregnancy after salpingotomy for surgical treatment of EP as compared to salpingectomy Moreover the risk for recurrent tubal EP is comparable for both methods. Regardless, the decision about the operating range in case of EP always depends on the actual clinical state of the patient.

A case of ectopic pregnancy within the tubal isthmus treated with laparoscopic salpingotomy

It is widely accepted that interstitial pregnancy presents a difficult problem to manage (Moawad et al. 2010) with a mortality rate of up to 2% (Tulandi and Al-Jaroudi 2004; Lau and Tulandi 1999). ...

Surgical Outcomes of Laparoscopic Salpingotomy for Ampullary Tubal Pregnancy

Surgical Outcomes of Laparoscopic Salpingotomy for Ampullary Tubal Pregnancy

Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial

To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery. Prospective, randomized, open multicenter study. Seven Danish departments of obstetrics and gynecology. A total of 106 women diagnosed with ectopic pregnancy (EP). Between March 1997 and September 2000, 1,265 women were diagnosed with EP, 395 (31%) were eligible, 109 (9%) were randomized of whom 106 had an EP. The study was originally powered to a sample size of 422 patients. The women were randomized to either medical (MTX; 53) or surgical (laparoscopic salpingotomy; 53) treatment. Follow-up by questionnaire and through national patient databases for a maximum of 10 years. Uneventful decline of plasma-human chorionic gonadotropin to less than 5 IU/L, rates of spontaneous, subsequent intrauterine, and recurrent ectopic pregnancies. The success rates were 74% following MTX treatment and 87% after surgery (n.s.); the subsequent spontaneous intrauterine pregnancy rate was 73% after MTX and 62% after surgery; and the EP rate was 9.6% after MTX and 17.3% following surgery (n.s.). In women with an EP, who are hemodynamically stable and wishing to preserve their fertility, medical treatment with single dose MTX tends to be equal to treatment with laparoscopic surgery regarding success rate, complications, and subsequent fertility. Although the two treatment modalities seemed to be similar in outcome, it is crucial that the diagnosis is based on a high-quality ultrasonographic evaluation, as two patients had intrauterine pregnancies despite fulfilling the diagnostic algorithm for EP.

Optimal treatment for patients with ectopic pregnancies and a history of fertility-reducing factors

With most ectopic pregnancy (EP) cases now diagnosed and treated early, a major concern has become future reproductive outcome. The aim of this study was to evaluate long-term reproductive outcome after salpingotomy versus salpingectomy in patients with and without additional fertility-reducing factors. As part of a prospective follow-up study, 261 patients underwent laparoscopic management of EP at our institution. History was taken specifically looking at preexisting risk factors for reduced fertility. Patients were then followed with regard to future reproductive events. Of 261 patients, 196 (75%) reported a subsequent desire for pregnancy. 145 patients had undergone salpingotomy and 51 salpingectomy. In patients without prior history of fertility-reducing factors, the subsequent intrauterine pregnancy rates were >90% for both salpingotomy and salpingectomy groups irrespective of the surgical approach. In patients with preexisting fertility-reducing factors, postoperative intrauterine pregnancy rates were 75% in the salpingotomy group, but only 40% in the salpingectomy group (p<0.05), showing maximal effect for conservative surgery. Laparoscopic salpingotomy is of particular benefit for patients with additional fertility-reducing factors desirous of future pregnancy. Reproductive outcome is excellent in patients without such risk factor, irrespective of the surgical approach.

Relevance of declines in serum human chorionic gonadotropin levels to the management of persistent ectopic pregnancy

To evaluate postoperative declines in serum human chorionic gonadotropin (hCG) levels (percentages of preoperative hCG levels) to rule out persistent ectopic pregnancy (PEP). A retrospective study was conducted on 50 patients who underwent laparoscopic salpingotomy between April 1995 and March 2008. The postoperative course was divided into four periods: (period A: days 1-2; period B: days 3-4; period C: days 5-6; and period D: days 7-8), and the postoperative serum hCG declines in the PEP and control groups (successfully treated patients) were compared. A cutoff value of serum hCG decline to rule out PEP was established by receiver operating characteristic (ROC) analysis. Ten of the 50 patients (20%) were diagnosed with PEP. There were no differences in clinical findings or preoperative serum hCG levels between the two groups. From period C, the serum hCG decline in the control group was significantly greater than in the PEP group, and all individual serum hCG declines in the PEP group were outside the 95% confidence interval of the control group. Furthermore, analysis by ROC using a 14% decline in postoperative serum hCG as a cutoff revealed that the specificity and sensitivity of the test were equal to 100% from period C. Declines in serum hCG during period C (days 5-6) constitute an important marker of the presence or absence of PEP. Decisions regarding a second intervention for PEP should be made by this time postoperatively.

Salpingotomy or salpingectomy in tubal ectopic pregnancy: what do women prefer?

OBJECTIVE: There is an ongoing debate whether tubal ectopic pregnancy (EP) should be treated by salpingotomy or salpingectomy from the perspective of future natural conception chances. It is unknown which treatment women prefer in view of the potentially better fertility outcome after salpingotomy and the disadvantages of this treatment, i.e. persistent trophoblast (PT) necessitating additional treatment with methotrexate (MTX) and an increased risk for repeat EP. We investigated women's preferences for laparoscopic salpingotomy relative to laparoscopic salpingectomy.DESIGN: Discrete choice experiment (DCE).MATERIALS AND METHODS: Participants were women surgically treated for tubal EP (patient group) as part of an ongoing RCT and women first visiting an infertility clinic (subfertile group) representative for women at future risk of EP. A web based DCE of 16 choice sets was offered. They had to choose repetitively between two alternatives representing hypothetical scenarios of salpingostomy that differed in three attributes: spontaneous intra uterine pregnancy (IUP) chance, risk of PT and risk of repeat EP in the same tube. A multinomial logistic regression model was used to analyze relative importance of the attributes.RESULTS: Responses of 51 patients and 43 subfertile women were included. Women weighed the negative effect of repeat EP 1.6 times stronger compared to the positive effect of the spontaneous IUP rate in their decision making. Women who had been treated with salpingostomy weighed the risk of a repeat EP stronger than the other participants (against a 2.6 fold increased spontaneous IUP rate). The risk of additional treatment with MTX for PT was acceptable if compensated by a small rise in the spontaneous IUP rate.CONCLUSIONS: In the assessment of outcomes after treatment of salpingostomy and salpingectomy the negative impact of repeat EP is valued stronger than the positive impact of IUP. These data should be used in the interpretation of clinical trials. OBJECTIVE: There is an ongoing debate whether tubal ectopic pregnancy (EP) should be treated by salpingotomy or salpingectomy from the perspective of future natural conception chances. It is unknown which treatment women prefer in view of the potentially better fertility outcome after salpingotomy and the disadvantages of this treatment, i.e. persistent trophoblast (PT) necessitating additional treatment with methotrexate (MTX) and an increased risk for repeat EP. We investigated women's preferences for laparoscopic salpingotomy relative to laparoscopic salpingectomy. DESIGN: Discrete choice experiment (DCE). MATERIALS AND METHODS: Participants were women surgically treated for tubal EP (patient group) as part of an ongoing RCT and women first visiting an infertility clinic (subfertile group) representative for women at future risk of EP. A web based DCE of 16 choice sets was offered. They had to choose repetitively between two alternatives representing hypothetical scenarios of salpingostomy that differed in three attributes: spontaneous intra uterine pregnancy (IUP) chance, risk of PT and risk of repeat EP in the same tube. A multinomial logistic regression model was used to analyze relative importance of the attributes. RESULTS: Responses of 51 patients and 43 subfertile women were included. Women weighed the negative effect of repeat EP 1.6 times stronger compared to the positive effect of the spontaneous IUP rate in their decision making. Women who had been treated with salpingostomy weighed the risk of a repeat EP stronger than the other participants (against a 2.6 fold increased spontaneous IUP rate). The risk of additional treatment with MTX for PT was acceptable if compensated by a small rise in the spontaneous IUP rate. CONCLUSIONS: In the assessment of outcomes after treatment of salpingostomy and salpingectomy the negative impact of repeat EP is valued stronger than the positive impact of IUP. These data should be used in the interpretation of clinical trials.

Intratubal Methotrexate versus Laparoscopic Salpingotomy

Introduction: Though laparoscopic salpingotomy is the preferred conservative surgery of choice in patients desirous of future fertility, the management of ectopic pregnancy has changed extensively. Other modalities like medical management with Methotrexate are being reviewed for conservative management of tubal pregnancy. Objectives: To compare intratubal Methotrexate instillation with laparoscopic salpingotomy for conservative management of tubal pregnancy. Methods: A literature review was conducted using search engines Google, Highwire press. Success rate after treatment and future reproductive outcome were analyzed. Conclusion: Laparoscopic salpingotomy was more superior to with Methotrexate as conservative treatment of ectopic pregnancy.