Recurrent Ectopic Pregnancy Research Articles

Psychological Distress in Patients With Recurrent Ectopic Pregnancies: A Cross-Sectional Study.

Most patients with ectopic pregnancies experience a high level of psychological distress for various reasons. The psychological state and needs of patients with recurrent ectopic pregnancies need to be seriously addressed. However, psychological distress in patients with recurrent ectopic pregnancy has not been widely studied. The purpose of this study is to investigate and understand the prevalence and factors influencing psychological distress in patients with recurrent ectopic pregnancies. A cross-sectional study. This study follows the STROBE guidelines. The Kessler Psychological Distress Scale (K10) was utilised to assess the level of psychological stress in patients. The Kruskal-Wallis test or Mann-Whitney U test was used to compare the factors influencing psychological stress in patients with different conditions. A total of 134 patients with recurrent ectopic pregnancies completed the survey, and most patients experienced moderate-to-severe psychological distress. The psychological distress experienced by patients with recurrent ectopic pregnancies is complex and dynamic, influenced by various factors. Among them, the main factors affecting the psychological distress of patients were age, education level, number of children, number of abortions, medical insurance and economic pressure (p < 0.05). This study suggests that the psychological distress experienced by patients with recurrent ectopic pregnancies is universal and cannot be ignored. It is necessary to pay attention to the psychological needs of patients with recurrent ectopic pregnancies and carry out scientific and effective psychological care management.

Early diagnosis, effective treatment: modern approaches to the management of ectopic pregnancies

Purpose of research: The aim of this article is to provide an overview of the diagnosis and management of atypical ectopic pregnancy, with particular reference to pregnancy in the cesarean scar. The importance of early detection and medical intervention will be described, as well as the impact of advanced diagnostic techniques and modern treatments on the curability of patients.This article aims to provide valuable insights into the development of effective strategies for the diagnosis, treatment and prognosis of ectopic pregnancy. State of knowledge: Ectopic pregnancies account for 1-2% of all pregnancies, with the majority (90%) occurring in the fallopian tube. Less commonly, they present as ovarian, cervical or abdominal pregnancies. Advances in diagnosis and treatment have made it possible to identify rare forms such as cesarean scar pregnancy (0.15% of all pregnancies), interstitial pregnancy and recurrent ectopic pregnancy on tubal remnants. Techniques such as transvaginal ultrasound (TVS), MRI and laparoscopy have the potential to improve diagnostic accuracy and treatment outcomes. Modern interventions such as transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and methotrexate have shown promise in terms of safety and efficacy. Conclusions: Ectopic pregnancy and its complications have a significant impact on the psycho-physical health of patients, requiring ongoing research to improve diagnostic and therapeutic methods. Future studies should focus on long-term outcomes and the coordination of multidisciplinary medical care to further improve diagnosis and treatment.

Laparoscopic surgery for ectopic pregnancy: A comparative study on the clinical benefits and impact on tubal patency and reproductive outcomes.

Ectopic pregnancy is a major contributor to maternal morbidity and mortality across the globe. This study aims to investigate the clinical benefits of laparoscopic surgery in treating ectopic pregnancy, and its impact on tubal patency and reproductive outcomes. A clinical study was conducted to compare laparoscopic and medical conservative treatment for ectopic pregnancy. A total of 206 patients were treated for ectopic pregnancy at our hospital from January 2018 to June 2020. Among them, 46 underwent laparoscopic ipsilateral salpingectomy, 54 underwent laparoscopic ipsilateral salpingostomy with lesion removal, and 106 were treated conservatively with medication. The age range and average age of each group are provided, with no significant differences in these general demographic characteristics (p> 0.05). Both the salpingostomy and medication groups had higher rates of ectopic pregnancy compared to the salpingectomy group, with statistically significant differences (p< 0.05). The comparison of ectopic pregnancy rates between the salpingostomy and medication groups showed no significant difference. Within three years, the salpingostomy group had 10 cases of recurrent ectopic pregnancy, with 2 cases on the same side, while the medication group had 18 cases, with 8 cases on the same side. At 3 months after the normalization of blood β-HCG, the salpingostomy group showed 43 cases of tubal patency (patency rate: 79.63%), while the medication group showed 57 cases (patency rate: 53.77%), with a statistically significant difference between the two groups (p= 0.01). Laparoscopic surgery for ectopic pregnancy offers significant clinical benefits over conservative medical treatment, including higher rates of tubal patency and improved reproductive outcomes. These findings support laparoscopic surgery as an effective approach for the management of ectopic pregnancy.

Ruptured Recurrent Interstitial Ectopic Pregnancy Successfully Managed by Laparoscopy.

Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection.

Tubal Stump Ectopic Pregnancy with Acute Abdomen: A Rare Case Report

Ectopic pregnancy, characterized by the implantation of the gestational sac outside the uterine cavity, is a grave condition. The objective of this study is to report a case of recurrent ectopic pregnancy in the residual site of the same fallopian tube, which had undergone unilateral salpingectomy due to ectopic pregnancy five years prior. Despite its rarity in the literature, tubal stump ectopic pregnancy poses higher risks of maternal mortality and morbidity compared to other types of tubal ectopic pregnancies. It is important to note that a history of salpingectomy does not exclude the possibility of ipsilateral recurrent ectopic pregnancy. Furthermore, this is the first documented case of stump tubal ectopic pregnancy from Turkey.

Recurrent ipsilateral interstitial ectopic pregnancy after salpingectomy

Introduction: This case highlights the long-term obstetric risks following salpingectomy. These include recurrent ipsilateral interstitial ectopic pregnancy and uterine rupture. Case Report: A 29-year-old lady presented with acute abdominal pain as well as signs and symptoms of hemorrhagic shock at 14 weeks of gestation. She was subsequently diagnosed with a ruptured right-sided interstitial ectopic pregnancy, which was managed surgically. The patient had a past history of open salpingo-oophorectomy for a complicated right-sided ectopic pregnancy involving the ovary at 12 weeks of gestation in her previous pregnancy. A subsequent pregnancy a year later was complicated by impending uterine rupture at 30 weeks of gestation. A healthy baby was delivered by Cesarean section. Conclusion: A meticulous surgical technique is of the essence when performing a salpingectomy for whatever pathology. The risk of a recurrent ipsilateral interstitial ectopic pregnancy must always be considered. Also, the risk of antenatal and intrapartum uterine rupture must be addressed in future pregnancies following interstitial pregnancies.

Early pregnancy complications including recurrent pregnancy loss and obesity.

This review on early pregnancy complications and obesity will focus on the known pregnancy complications such as miscarriage (whether spontaneous or after fertility treatment), polycystic ovaries and risk of miscarriage, recurrent pregnancy loss, ectopic pregnancy, hyperemesis gravidarum and birth defects. Evidence will be assessed and mechanistic pathways for the outcomes will be described. We know that obesity is now a pandemic and has an impact on early pregnancy complications. The evidence has been summarised to provide the reader with a comprehensive overview and advice for pregnant women with obesity in early pregnancy.

The impact of systemic methotrexate and surgical management on fertility preservation in tubal ectopic pregnancy among Saudi women

Background The impact of various management plans on subsequent fertility after tubal ectopic pregnancy (EP) is not well known. The objective of the present study was an evaluation of the subsequent fertility outcome among women with EP managed either surgical or medical with systemic methotrexate or medical management followed by surgical one. Patients and methods A retrospective cohort study was done by reviewing of medical records of all women diagnosed with EP at King Faisal Military Hospital, Southern Region, Saudi Arabia throughout the period from January 2015 to December 2016 provided that they were hemodynamic stable, with starting βhCG level less than 10000 IU/L, and adnexal mass less than 5 cm. These cases were followed for four years from January 2017 to December 2020. Results The study included 85 women with EP. Their mean age was 31.3 ± 6.7 years. Medical management (systemic Methotrexate) was followed in 48.2% of cases whereas surgical management was applied for 43.5% of them while medical management followed by surgical one was seen in 8.2% of cases. Complete follow-up throughout 2017–2020 was available for 52 women. A history of recurrent EP was observed among 3 women (5.8%). Most of them (75%) had a viable pregnancy. There was no statistically significant association between the method of management of EP and subsequent fertility, although the rate of normal pregnancy (intrauterine viable pregnancy ≥ 24 weeks which is the age of viability at our hospital) was higher among those managed surgically or by medical followed by surgical management than those managed medical only (84.6% and 100% vs. 62.5%). Conclusion Although the normal pregnancy rate was higher among those managed surgically or by medical followed by surgical management than those managed medically only, this was not statistically significant.

P-524 Fertility and subsequent pregnancy outcomes among women with tubal ectopic pregnancy treated with methotrexate

Abstract Study question What are the future fertility prospects and subsequent pregnancy outcomes among women with tubal ectopic pregnancy treated with methotrexate? Summary answer Pregnancy post-ectopic pregnancy occurred in 53% of women within 12 months following methotrexate treatment. Among those who became pregnant, ectopic pregnancy recurrence occurred in 16.8%. What is known already Concerns regarding ectopic pregnancy recurrence and future fertility predominate when counselling women about management options for tubal ectopic pregnancy treatment. Current UK National Institute for Health and Care Excellence guidance is based on low quality evidence and estimate long-term ectopic pregnancy recurrence rate of ∼18.5%. Further, they state that there are no differences in rates of subsequent pregnancy or ectopic pregnancy recurrence between ectopic pregnancy management methods. However, 30% of women managed with methotrexate experience treatment failure and require rescue surgery and subsequent pregnancy outcomes in this group are poorly understood. Study design, size, duration The data for this study were derived from a UK multicentre RCT of methotrexate and gefitinib versus methotrexate and placebo for treatment of ultrasound diagnosed definite or probable tubal ectopic pregnancy with pre-treatment hCG ≥1000 IU/L and ≤5000 IU/L (GEM3). The trial found adding gefitinib to methotrexate was not superior to placebo. This analysis reports trial participant follow-up data at 12-months examining post-treatment fertility, subsequent pregnancy outcomes and participant characteristics associated with ectopic pregnancy recurrence. Participants/materials, setting, methods Trial participants of GEM3 (as described above). Participants were contacted to provide follow-up data 12 months after randomisation to treatment. Where telephone contact was unsuccessful, electronic health records were reviewed to collect pregnancy outcome data. Post-treatment fertility and pregnancy outcomes were summarised using descriptive statistics and compared between groups using a chi-squared test, p&amp;lt;.05 signified statistical significance. Main results and the role of chance Pregnancy follow-up data was obtained for 283/327 trial participants. (167 participants were successfully contacted by telephone; the electronic health records were reviewed for 116 participants). 52.7% (149/283) of the trial participants became pregnant in the 12-month follow-up period. There was no difference in subsequent pregnancy rates between ‘methotrexate only’ and ‘methotrexate and rescue surgery’ groups. The surgical approach (salpingectomy vs salpingotomy) did not affect subsequent pregnancy rates. Among women who had a pregnancy in the follow-up period, a live birth was recorded in 65% of women (n = 93/142, n = 7 missing), any pregnancy loss (miscarriage, ectopic pregnancy, stillbirth, termination of pregnancy or molar pregnancy) was recorded in 43% of women (n = 59/137, n = 12 missing). Recurrent ectopic pregnancy was reported in 16.8% of women (n = 22/131, n = 18 missing). There was no difference in rates of live birth, pregnancy loss or recurrent ectopic pregnancy between methotrexate only and methotrexate and surgery groups or between type of surgical management groups (salpingectomy vs salpingotomy). Limitations, reasons for caution This study only reports on a 12-month follow-up period and this should be considered when interpreting comparatively low post-treatment pregnancy rates. We did not record which couples were trying-to-conceive post treatment and were therefore unable to stratify results by this variable or report subfertility rates. Wider implications of the findings This prospective dataset strengthens current understanding of the likelihood of ectopic pregnancy recurrence. Furthermore, it provides reassurance that women with tubal ectopic pregnancy managed with methotrexate requiring rescue surgery have similar post-treatment fertility and pregnancy outcomes to those successfully treated with methotrexate. Trial registration number ISRCTN67795930

Tubal ectopic pregnancy: a retrospective cohort study on clinical characteristics, treatment options and reproductive outcomes within 5years.

To investigate the association between different treatments of tubal ectopic pregnancy (EP) -expectant management, methotrexate (MTX), selected or recommended laparoscopic surgery-and the subsequent reproductive outcomes. We conducted a retrospective cohort study including 228 EPs. The patients were divided into four treatment groups: 28 (12.3%) with expectant management successfully, 60 (26.3%) with MTX successfully, 140 patients with laparoscopic salpingectomy, of which 47 (20.6%) were assigned to selected surgery group because they opted for surgical treatment versus MTX, 93 (40.8%) were assigned to recommended surgery group as recommended by the attending physician. The recommended surgery group had the lowest rate of intrauterine pregnancy (IUP) (77.42%) and live birth (LB) (72.04%), while the incidence of recurrent EP (REP) (20.43%) was the highest, but the statistical differences were not significant. We did not observe significant differences of the EP-IUP time interval, rates of LB and miscarriage (MIS) between the four groups. Compared to the MTX group, recommended surgery was negatively associated with IUP (adjusted OR, 95%CI: 0.34, 0.11-1.03) and LB (0.35, 0.14-0.92), while it had higher risk for REP (3.48, 1.03-11.74) in the subsequent pregnancy. Further, compared to selective surgery group, recommended surgery was negatively associated with IUP (0.15, 0.03-0.68) and LB (0.23, 0.07-0.74), while it had higher risk for REP (6.83, 1.43-32.67) in the subsequent pregnancy. Expectant treatment was negatively associated with assisted reproductive technology (ART) (0.08, 0.02-0.40) compared with MTX. Of the185 patients who had LBs, all adverse outcomes were not statistically different between the four groups. Patients with recommended laparoscopic salpingectomy had worse reproductive outcomes than the other treatment groups. The disease status of EP may play an important role in the association rather than the surgery alone.

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.

Adaptation of Nursing Care for Depression and Anxiety Experienced in the Case of Recurrent Ectopic Pregnancy to the Stetler Model

Gebelik kaybı hem kadınlar hem de aileleri için psikolojik ve duygusal bozukluklara neden olabilen önemli bir durumdur. Yaşanılan bu durum her kadının farklı duygular hissetmesine ve farklı tepkiler vermesine neden olabilmektedir. Kadınların bu kayba vermiş olduğu tepki kişiden kişiye farklılık gösterse de, yapılan çalışmalarda daha önce gebelik kaybı yaşayan kadınların daha fazla stres, depresyon ve anksiyete yaşadığı görülmüştür. Yaşanan bu psikolojik bozukluklar çoğu zaman göz ardı edilmektedir. Bu dönemde verilen bakım ve danışmanlık hizmetlerinin kadının psikolojisi üzerinde önemli bir etkisi vardır. Hemşireler anksiyete ve depresif belirtileri azaltmak için kadınları anlamaya ve yaşadığı sıkıntıları çözmeye yönelik girişimler yapmalı, sosyal desteklerini artırıp, eşleri de sürecin içine dahil ederek duygularını ifade etmelerini sağlamalıdırlar. Kayıp sonrası dönemde de kadınların psikolojik durumları değerlendirilmeli, bunlara yönelik girişimler yapılmalı, gerekirse psikolojik destek almaları sağlanmalıdır. Stetler Modeli, kanıta dayalı bakımın geliştirilmesinde kullanılan bir modeldir. Modelin kullanım amacı, kanıta dayalı uygulamalar doğrultusunda hastaya uygun olan en iyi bakımı sağlamaktır. Bu olgu sunumu ile tekrarlayan ektopik gebelik olgusunun kayıp sonrası yaşadığı depresyon ve anksiyeteye yönelik verilen hemşirelik bakımının, Stetler Modeli’ne uyarlanması amaçlanmıştır.

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.

Short-term Reproductive Outcomes of Nulliparous Women with Previous Ectopic Pregnancy.

To determine the characteristics and subsequent pregnancy outcomes in patients with a previous ectopic pregnancy (EP). Descriptive-cross sectional study. Department of Obstetrics-Gynaecology, Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey, between January 2014 and December December 2018. The data of nulliparous patients diagnosed with tubal ectopic pregnancy (EP) was analysed retrospectively. Reproductive outcomes within the first two years after ectopic pregnancy diagnosis were used as "short-term" reproductive outcomes. Their EP treatment and pregnancy outcome were determined. Expectant management was chosen in 5.8% of the patients, while the surgical intervention was 32.3%. Medical therapy involving methotrexate (MTX) was given to the remaining patients (61.9%). The tubal rupture was confirmed in 12% of the cases that received MTX. In the 2-year follow-up period after the ectopic event, the most common outcome of the subsequent pregnancies was a live birth (47.7%). Recurrent EP occurred in 4.6%. The subsequent short-term pregnancy outcomes in this study were not related to the chosen treatment modality. Ectopic pregnancy, Nulliparity, Reproductive outcomes, Treatment modalities, Expectant management.

40 Multidose methotrexate treatment of tubal ectopic pregnancies with high initial β-human chorionic gonadotropin over 5,000 mIU/mL

Introduction and aims of the study: To investigate the success, fertilization and side effect rates of individualized multidose methotrexate (MTX) regimen in patients with high initial serum hCG (>5000mIU/mL). Methods: 90 patients with tubal pregnancies were included to this prospective case-control study that consists of three groups: Single-dose (n=40), double-dose (n=10) and multi-dose (n=40) regimens. Patients were followed between 2014-2020 in a dedicated referral center for management ectopic pregnancies. Patients with serum βhCG>5,000 mIU/mL received individualized multiple doses of Mtx (1mg/kg) with tailored folinic acid rescue taking the patient's clinical course into consideration. Results: The success rate of single-, double- and multi-dose MTX regimens were 90%, 80% and 82.5%, respectively. Mean BhCG level was found as 11631.3±7577.3 mIU/mL (range:5042-31114). The changes in before and after MTX injections can be seen in Figure-1. Twelve patients were conceived after the multidose regimen; 10 of those have delivered healthy babies and remaining 2 have ongoing pregnancy. There was no recurrent ectopic pregnancy observed. In multidose protocol,10 patients (25%) had ectopic mass size larger than 30mm with mean size of 35.1±2.77mm and success rate of 80% (n=8/10; failures had 35 and 40 mm). Fetal pole was seen in 13 patients (32.5%) and success rate was 69.2% in patients with visible fetal pole. Free intraperitoneal fluid was observed in 17 patients (42.5%, mean: 28.59±14.45mm). Among those, the success rate was 82.35% (n=3). Side effects in multidose protocol were observed in 23 of 40 (57.5%); 20(50%) of them exhibited mild symptoms and all resolved spontaneously, whereas 3 patients (7.5%) had a severe symptom, where all were resolved under appropriate medical treatment. A second dose of MTX was needed in 12.5% of patients who underwent to single-dose protocol. Conclusions: Multiple-dose Mtx treatment for ectopic pregnancies with high initial hCG is safe and effective alternative to elective surgery.

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.

Evaluation of the recurrence and fertility rate following salpingostomy in patients with tubal ectopic pregnancy

BackgroundEctopic pregnancy is one of the leading causes of pregnancy-related mortality; the treatment strategies associated with this condition entail complications, such as recurrence of ectopic pregnancy or infertility. The objective of this study was to evaluate the recurrence and fertility rate after salpingostomy in patients with tubal ectopic pregnancy.MethodsThis cross-sectional retrospective study was conducted at four referral centers of Obstetrics and Gynecology, under the supervision of Shiraz University of Medical Sciences (Iran). The medical records of 125 patients with tubal pregnancy were reviewed. These patients underwent laparoscopic salpingostomy from April 2009 to March 2016.Data on maternal age, BMI, history of previous EP, genital tract infection, IUD insertion, history of previous surgery, and infertility were further obtained. The patients were followed up for approximately 1 to 7 years. The recurrence of EP and subsequent pregnancy rate were assessed during the follow-up period.ResultsThere was no statistically significant relationship between post-salpingostomy recurrence and maternal age, previous abdominopelvic surgery, and history of infertility(P = .425); however, the post-salpingostomy recurrence of EP was correlated with BMI (P = 0.001), previous history of EP (P = 0.001), genital tract infection (P = 0.001), and IUD insertion (P = 003). Among 95 women who had no contraception, pregnancy occurred in 51 cases (53.6%) and recurrence of EP was observed in 16 patients (12.8%).ConclusionsOur results suggest that salpingostomy is a safe method with a low risk of recurrence and good fertility outcomes for women who consider future pregnancy.

A Case Report on Management of Recurrent Ectopic PregnancyA Medical Success

Recurrent ectopic cases have been on the rise as there is increase in Artificial Reproductive Techniques (ART) recently. Earlier patient presentation and more precise diagnosis by proper clinical examination and with proper interpretation of serial β-human Chorionic Gonadotropin (β-hCG) allows identification of an ectopic pregnancy before ruptures and differentiates from other common conditions like infection, miscarriage, degenerating leiomyomas or pain around ligament. Various studies have been conducted over time to set a discriminatory zone for β-hCG. Initially, the cut-off for β-hCG was taken to be 1000-2000 mIU/mL. But now the cut-off has been increased to 3510 mIU/mL. Methotrexate has been used as first line drug in medical management of ectopic pregnancy for a long time. But methotrexate has been used with caution when laboratory values show a high β-hCG. Here, authors report a case of a 29- year-old female with recurrent ectopic pregnancy which was successfully managed with methotrexate therapy despite the initial high β-hCG values thus avoiding a surgical intervention.

A recurrent tubal ectopic pregnancy after ipsilateral salpingectomy

A recurrent tubal ectopic pregnancy after ipsilateral salpingectomy

Fertility outcomes subsequent to medical and surgical treatment for ectopic pregnancy: A retrospective cohort study in Iran.

BackgroundEctopic pregnancy (EP) and its treatment methods may affect subsequent fertility outcomes.ObjectiveTo compare methotrexate (MTX), laparoscopic salpingostomy, and salpingectomy methods of EP treatment and their effects on fertility outcomes.Materials and MethodsThis retrospective cohort study was performed on women receiving a definitive diagnosis of tubular EP from 2014 to 2017 at Arash Medical Center, Tehran, Iran. In total, 194 women were studied, of which 64 were treated with MTX, 52 underwent salpingostomy, and 78 underwent salpingectomy, depending on their clinical status. Basic information, obstetrics history, and major outcomes of the treatment after an 18-month follow-up, including recurrence of EP, miscarriage, and successful intrauterine pregnancy (IUP), were recorded and variables were compared among the three groups.ResultsThere was no significant difference in fertility outcomes among the three groups. Among the studied variables, predictors of successful IUP after EP treatment were multiparity (Hazard Ratio (HR): 1.37; 95%CI: 1.06-1.77), no history of miscarriage (HR: 2.37; 95%CI: 1.01-5.56), and a higher number of live births (HR: 1.54; 95%CI: 1.01-2.37). On the other hand, predictors of EP recurrence included nulliparity (HR: 1.61; 95%CI: 1.02-2.53) and a lower number of live births (HR: 3.84; 95%CI: 1.43-10.98). The effect of other factors, including the utilized therapeutic modalities, was not statistically significant.ConclusionThe current study results demonstrated that after an 18-month follow-up, fertility outcomes, including recurrence of EP and successful IUP, were not significantly different among the subjects with EP treated with MTX, salpingostomy, or salpingectomy. Further studies with long-term follow-ups are recommended.