Recurrent Ectopic Pregnancy Rate Research Articles

Pregnancy outcomes following in vitro fertilization treatment in women with previous recurrent ectopic pregnancy.

ObjectivesThe aim of this study was to investigate the impact of a history of recurrent ectopic pregnancy (EP) on pregnancy outcomes of subsequent in vitro fertilization (IVF) treatment.MethodsA retrospective cohort study involving 457 women with a history of recurrent EP (REP group), 912 women with a history of single EP (SEP group), and 1169 women with a history of intrauterine pregnancy (IUP group) as the control group, was conducted. IVF outcomes were compared for each cohort.ResultsThe incidence of EP in the REP group after IVF treatment was significantly lower than those in the SEP group (2.4% vs. 6.8%, P = 0.011), and similar to those in the IUP group (2.4% vs. 2.1%, P = 0.830). No significant differences were observed in the clinical pregnancy rate, miscarriage rate, and live birth rate among the three groups. There was no statistically significant difference in the recurrent EP rate between the salpingectomy and salpingostomy treatments. Adjusting for maternal and treatment factors did not influence live birth rates for women with previous REP compared with women with previous SEP and those with IUP. The odds of EP were 82.2% lower (OR 0.178, 95% CI 0.042–0.762; P = 0.020) in women who had blastocyst transfer compared with cleavage embryo transfer in the SEP group. The odds of EP were over six times (OR 6.260, 95% CI 1.255–31.220; P = 0.025) in women who underwent double embryo transfer as opposed to single embryo transfer in the IUP group.ConclusionOur results indicate that women with previous recurrent EP have a lower risk of EP after IVF in comparison with women with previous single EP. Previous EP has no significant adverse effect on the main IVF outcomes. The salpingostomy and salpingectomy treatments of EP do not significantly affect the incidence of recurrent EP after IVF.

Comparisons of Fertility Outcomes Following a Salpingectomy and a Salpingotomy with or Without Suturing for a Tubal Ectopic Pregnancy.

ObjectiveThis study aimed to compare fertility outcomes in patients who underwent different laparoscopic surgeries and to determine the most beneficial surgical treatment for tubal ectopic pregnancy (EP) patients who wished to become pregnant in the future.MethodsIn this retrospective study, patients aged 18–36 years, who had been diagnosed with a tubal EP in our hospital, were enrolled. Based on the treatment methods, the patients were divided into three groups, ie a salpingectomy group, a salpingotomy with suturing group and a salpingotomy without suturing group. The follow-up time for the enrolled patients was more than three years. Serum beta (β)-human chorionic gonadotropin (β-HCG) levels were monitored after surgery. The intrauterine pregnancy (IUP) rate at 12, 24 and 36 months postoperatively, and recurrent EP rate were compared.ResultsThe median time for β-HCG level returning to normal in the salpingectomy group was much shorter than in the salpingotomy with suturing or salpingotomy without suturing groups (P < 0.001). The 12, 24 and 36-month IUP rates among the three groups were not significantly different. A recurrent EP was found in only one patient in the salpingotomy with suturing group and two patients in the salpingotomy without suturing group.ConclusionIn this study, we found that salpingectomy and salpingotomy with or without suturing methods reflected no significant differences in fertility outcomes for tubal EP patients.

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.

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.

A new tubal classification system for fertility prognosis after laparoscopic salpingostomy for tubal pregnancy

ObjectiveTo assess the objectivity and accuracy of a new system that predicts the pregnancy outcomes in patients with tubal pregnancy after laparoscopic salpingostomy. Study design480 tubal pregnancy patients were retrospectively stratified as mild, moderate, or severe group according to the new tubal classification system in which pelvic adhesions, tubal morphology, structure, and patency were included. The follow-up was performed for 24 months to determine spontaneous pregnancy outcomes. ResultsThe tubal classification was significantly associated with intrauterine pregnancy rates (mild 70.9% vs. moderate 66.0% vs. severe 41.8%, P=0.001) and recurrent ectopic pregnancy rates (mild 2.8% vs. moderate 4.2% vs. severe 10.9%, P=0.047). The 24-month cumulative rate of intrauterine pregnancy was 73.5% in the mild group, 68.5% in the moderate group, and 45.8% in the severe group (P=0.002). The 24-month cumulative repeat ectopic pregnancy rate was 6.6% in the mild group, 9.1% in the moderate group, and 15% in the severe group (P=0.154). In Cox multivariate regression analysis, a lack of a history of infertility [hazard ratio (HR)=0.633, P=0.001] and tubal scoring (mild HR=2.408, P=0.008; moderate HR=2.147, P=0.010) were significantly associated with a higher rate of spontaneous intrauterine pregnancy. Having a history of infertility (HR=0.351, P=0.037) and no prior abdominopelvic surgery (HR=2.907, P=0.014) were significantly associated with a lower ectopic pregnancy rate. ConclusionThe new tubal classification system significantly correlated with spontaneous pregnancy outcomes in patients with tubal pregnancy following laparoscopic salpingostomy.

Injection Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location – An Audit of Cases at Princess Alexandra Hospital, UK

Injection Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location – An Audit of Cases at Princess Alexandra Hospital, UK Ectopic pregnancy is usually treated with surgery. Injection methotrexate is a treatment option for ectopic pregnancy and for Pregnancy of Unknown Location. Meta-analysis of studies have not shown a statistical difference in the success rate or future pregnancy rate or recurrent ectopic pregnancy rate when comparing injection methotrexate with surgery.

P02.15: Recurrent ectopic pregnancy in the tubal remnant stump after ipsilateral total salpingectomy

The incidence of ectopic pregnancy is 2% of all pregnancies and has increased. It is reported that a recurrent ectopic pregnancy rate is 10–15% after salpingotomy compared with 10% after salpingectomy. Corneal pregnancy after ipsilateral total salpingectomy or remnant tubal pregnancy after ipsilateral partial salpingectomy is reported but recurrent ectopic pregnancy in the tubal remnant stump after ipsilateral total salpingectomy is rare and exact incidence is unknown. We present a case of spontaneous ectopic pregnancy occurring in the stump of a remnant fallopian tube following ipsilateral total salpingectomy for an ectopic pregnancy.

Controversies in the management of ectopic pregnancy

Ectopic pregnancy is a common clinical problem, but there appears to be much controversy surrounding the surgical management of its occurence. This paper reviews the available evidence on the management of ectopic pregnancy. The discussion focuses initially around the choice of medical versus surgical treatment. Next, the question is addressed that if surgical management is deemed necessary, whether the approach should be laparoscopic or via open laparotomy. Lastly, if surgery is undertaken, should salpingectomy or salpingotomy be performed? Laparoscopy will remain the main method of treatment for women with ectopic pregnancy, as it provides obvious advantages over open surgery. On balance, salpingotomy should be the surgical treatment of choice for the majority of women with ectopic pregnancy, as it results in a higher subsequent pregnancy rate, although there is a slightly higher recurrent ectopic pregnancy rate and persistent trophoblastic disease rate when compared with women treated with salpingectomy. There is also a place for medical treatment of women with low concentrations of human chorionic gonadotrophin. A variable dosing methotrexate regimen is more effective compared with single dose regimen, and the fixed multiple regimen is associated with a high rate of side effects.

P105: Medical treatment of ectopic pregnancy: experience of a third referral centre

To evaluate the efficacy of single dose systemic methotrexate (MTX) in the treatment of ectopic pregnancy. We retrospectively reviewed the cases of tubal pregnancy occurred in our Department from 1990 to 1999. Conservative non-surgical management has been proposed according to Stovall and Ling. Single dose MTX regimen, 50 mg/m2 of body surface, has been used for medical treatment. Serial evaluations of serum hCG were made at days 0–2–4–7 and weekly thereafter until hCG values felt below 5–10 mUI/mL (resolution). Primary success was defined if resolution of tubal pregnancy occurred after single dose treatment. The need of surgical treatment indicated the failure of conservative management. The following reproductive outcome variables were also evaluated: 1. Tubal patency (hysterosalpingogram); 2. Subsequent intrauterine pregnancy rate; 3. Recurrent ectopic pregnancy rates. During the study period we observed 57 cases eligible for non-surgical treatment. 20 cases were managed expectantly, while 37 cases were treated with systemic MTX. The following were the characteristics of MTX-treated group: mean value of hCG on day of treatment 2626 ± 2619 mUI/mL, embryo/yolk sac present in 6 cases (16.2%). Resolution occurred in 94.5% of the cases with a primary success rate of 91.8%. Only one case required multiple doses (2.8%). The mean time of resolution was 21.03 ± 8.95 days. Surgical treatment (salpingectomy) was necessary in 2 cases (5.4%). As for the reproductive outcome, 27 cases were eligible for the analysis. The overall pregnancy rate was 44.4% (12/27) with a 3.7% rate of recurrent ectopic pregnancy. Tubal patency was assessed in 19 cases. It was preserved in 84.2% (16/19). According to the studies in literature, our results support the use single dose MTX for the treatment of unrupted tubal pregnancy in carefully selected cases.

Surgical Management of Ectopic Pregnancy

Laparoscopic salpingostomy remains the definitive and universal treatment of ectopic pregnancy in patients who are hemodynamically stable and who wish to preserve their fertility. The reproductive performance after salpingostomy appears to be equivalent or better than salpingectomy, but the recurrent ectopic pregnancy rate may be slightly greater. Expectant management has a poor efficacy and unproven benefit in subsequent reproductive outcome. Its use should be limited to situations in which the ectopic pregnancy is suspected but cannot be detected by transvaginal ultrasound. Methotrexate is an alternative to surgical treatment in selected patients who fulfill strict inclusion criteria, including compliance with follow-up evaluation. A large, prospective, randomized trial with significant power is needed, however, to study the prognostic factors for methotrexate success. The most practical and efficient method of methotrexate administration is a single intramuscular injection. Those who do not meet the criteria for methotrexate therapy should be treated surgically, which can be done by laparoscopy. Interstitial pregnancy also can be treated with methotrexate. Otherwise, a cornual resection or salpingotomy can be done. Although, it is feasible by laparoscopy, the laparoscopic approach should be done only by those who have an expertise in laparoscopic suturing. Abdominal and ovarian pregnancies are best treated surgically. Further, the diagnosis usually is established by laparoscopy, and an appropriate surgical treatment can be conducted at the same time.

Ectopic pregnancy—laparoscopic management in a district general hospital

A 2-year retrospective study was carried out in a district general hospital to review the outcome of laparoscopic management versus laparotomy for the management of ectopic pregnancy. Outcome measures included operating time, postoperative analgesia requirements, complications, length of hospital stay, the post-ectopic intrauterine pregnancy rates and the recurrent ectopic pregnancy rates over an observational period of 16 months. Forty-nine consecutive women were seen. Twenty-six were managed laparoscopically and 23 were managed by laparotomy. There was no significant difference between the operating times and complications but the laparoscopy group had significantly fewer doses of opiate analgesia (P<0.05), shorter length of stay (P<0.05), and significantly higher post-ectopic intrauterine pregnancy rates (P<0.05) compared with the laparotomy group. Laparoscopic management of ectopic pregnancy is a viable alternative to conventional laparotomy in district general hospitals.

Current status of surgical and nonsurgical management of ectopic pregnancy

To review the efficacy, safety, costs, and subsequent reproductive outcome of surgical and nonsurgical management of ectopic pregnancy (EP). Pertinent studies were identified through computer Medline search. The rates of intrauterine pregnancy (IUP) and EP were calculated from the raw data in the original publications so that the denominator would be consistent. The efficacy of laparoscopic treatment of EP is similar to that by laparotomy. The rate of persistent EP after conservative surgery ranges from 3% to 20%. Based on a review of 1,514 patients attempting to conceive after linear salpingostomy, the IUP and recurrent EP rates were 61.4% and 15.4%, respectively, among patients who had laparotomy, and 61% and 15.5%, respectively, among patients who had laparoscopic procedure. Of 3,584 patients who had partial or total salpingectomy, the subsequent IUP rate was 38.1% and the recurrent EP rate was 9.8%. Of 540 patients treated with a single-dose methotrexate, 84% did not require further treatment and, among 215 patients who attempted to conceive, 54% had subsequent IUP and 8% had recurrent EP. The success rate of expectant management was 69.2% in 347 patients reviewed. There is no difference in the reproductive outcome after treatment of EP by laparotomy and by laparoscopy. Salpingostomy is associated with higher subsequent IUP and recurrent EP rates compared with salpingectomy. Methotrexate is a viable alternative to laparoscopic salpingostomy for a selected group of patients.

2 Endoscopic management of ectopic pregnancy

The rationale for the conservative management of ectopic pregnancy is the preservation of reproductive potential. Removal of trophoblast through a linear incision (salpingotomy) can be easily performed by endoscopy. The injection of vasopressin into the broad ligament is required in less than 10% of cases and its routine use is not recommended because of the risk of severe side-effects. The techniques in cases of isthmic or cornual tubal pregnancy are also described. Other alternatives such as expectant management, methotrexate, RU 486 and prostaglandins have also recently been proposed. Although methotrexate therapy has been demonstrated to be effective in cases of unruptured tubal pregnancy, further studies are needed to determine whether or not this medical therapy is a safer option than laparoscopic surgery and to compare the subsequent intrauterine and recurrent ectopic pregnancy rates. Endoscopic salpingotomy is an efficacious procedure. Indeed, residual trophoblast is found in only 5% of cases after this surgical procedure. In these cases of persistent trophoblast, methotrexate is proposed as the medical approach of choice. Evaluation of the postoperative fertility after linear salpingotomy demonstrates an intrauterine pregnancy rate of 63% and a recurrent ectopic pregnancy rate of 8%. In conclusion, endoscopic management of tubal pregnancy is a safe and efficacious therapy. The contraindications are relative and depend essentially on the surgeon's experience.

Reproductive performance following a second ectopic gestation

OBJECTIVES: Our purpose was to determine the obstetric outcome following a second ectopic gestation in women actively trying to conceive, with a review of the literature. METHODS: Charts of 37 patients coded for having at least two ectopic pregnancies between 1986 and 1989 were reviewed. Duration of follow-up ranged from 7 months to 7 years with a mean follow-up time of 25 months. RESULTS: We report a 45.4% intrauterine pregnancy rate, 27.3% live birth rate, and 36.4% recurrent ectopic pregnancy rate. Review of the literature shows an intrauterine pregnancy rate of 26–50%, live birth rate of 25–31.2%, and recurrent ectopic pregnancy rate of 7.7–40%. CONCLUSIONS: Four of five studies report the risk of a third ectopic gestation is less than an intrauterine gestation. This may prove helpful in counceling patients with a history of recurrent ectopic gestation in choosing IVF or attempting conception naturally.

Fertility outcome after treatment of tubal pregnancy by laparoscopic laser surgery.

In 150 women with tubal pregnancy consecutively treated over a two year period by laparoscopic techniques, 74 were treated conservatively by linear salpingotomy with carbon dioxide laser laparoscopy and 76 cases non-conservatively through the laparoscope by salpingectomy. Between 15 and 37 months later all patients were contacted by means of questionnaires to evaluate subsequent fertility outcome. Sixty-six percent (38/58) of those women who desired pregnancy after conservative laparoscopic treatment achieved an intrauterine pregnancy. The corresponding rate for women who desired pregnancy after salpingectomy was 45% (18/40). The recurrent ectopic pregnancy rates in the two groups were 7% (4/58) and 10% (4/40), respectively. This study confirms that tubal pregnancy can be appropriately managed by laparoscopic laser surgery with the advantages of minimal invasive techniques.

An Analysis Of Etiological Risk Factors And Subsequent Fertility

The incidence of ectopic pregnancies has increased significantly in the region around Oulu Finland from 10.9-20.9 between 1973-1982. Increased use of IUDs and a comparable increase in the percentage of 2-paras correlated with the increase in ectopic pregnancies in Oulu. A Finnish researcher examined retrospective and prospective age and parity matched case control studies among 552 women with ectopic pregnancy and a follow up study of infertile women to determine the risk factors for ectopic pregnancy. Previous pelvic surgery particularly tubal surgery and treatment of an earlier ectopic pregnancy; entry of the uterine cavity with medical instruments; gynecological infections; infertility; and an IUD were significant risk factors for ectopic pregnancy. For those women who had suffered an ectopic pregnancy and were infertile the risk factors included ectopic pregnancy; tubal surgery especially surgical restoration of a Fallopian tube and working in industry. The study could not determine reasons nulliparous women experienced and ectopic pregnancy. Infertile women who had pelvic infections tubal surgery and/or an earlier ectopic pregnancy had a high risk of ectopic pregnancy. 70% of the ectopic pregnancy patients underwent a salpingectomy. Of the 323 women who wished to conceive again the conception rate was 82% delivery rate 64% and recurrent ectopic pregnancy rate 11%. The operation method was not as an important predictor of subsequent fertility as were condition of the tube and parity. Research is needed to identify risk factors for ectopic pregnancy for nulliparous women. Physicians should consider any woman who is infertile and had a previous ectopic pregnancy tubal surgery and works in industry to be at high risk for ectopic pregnancy and use modern diagnostic tools to distinguish between ectopic and intrauterine pregnancy during the 5th week of amenorrhea. As for fertile and parous women with an IUD in situ they should consider an ectopic pregnancy if pain and bleeding develops.

Salpingostomy for ectopic pregnancy in the sole patent oviduct: reproductive outcome

The ultimate success of conservative surgery for tubal ectopic pregnancy is difficult to evaluate in the presence of a potentially normal contralateral fallopian tube. Fifteen cases of tubal pregnancy with only one functional fallopian tube were treated by linear salpingostomy at Yale-New Haven Hospital between 1975 and 1980. The overall term viable pregnancy rate to date is 53%; the recurrent ectopic pregnancy rate is 20%. Twenty-seven percent of those patients operated upon until now have not conceived. These statistics are based on a 100% follow-up of at least 1 year, with all patients trying actively to conceive. Review of the literature on conservative treatment of ectopic pregnancy when only one tube is present reveals an intrauterine pregnancy rate of 61% and a repeat ectopic pregnancy rate of 17%. We conclude that linear salpingostomy is an acceptable surgical technique for the treatment of tubal ectopic pregnancy, because this experiment, by its nature, eliminates the variable performance of the contralateral tube in relationship to subsequent intrauterine pregnancy and repeat ectopic pregnancy in these patients.