Treatment Of Tubal Pregnancy Research Articles

Off-label letrozole for tubal pregnancy monotherapy is not an alternative to methotrexate: a prospective cohort study.

Inhibition of estradiol production by letrozole may interfere with physiological effects of progesterone necessary to maintain the pregnancy. Treatment of tubal pregnancy (TP) with letrozole would allow to avoid the disadvantages of methotrexate (MTX). The aim was to compare the effectiveness of letrozole with MTX in the management of TP. A prospective open-label cohort study was conducted among women with TP and increasing B-human chorionic gonadotropin (B-hCG) concentrations. MTX was administered in a single dose of 100 mg intravenously, while letrozole in a dose of 5 mg orally for 10 days. Blood parameters (B-hCG, hemoglobin, creatinine, urea, transaminases, bilirubin) were tested on days 0, 4 and 7. Out of 22 eligible women, 14 received MTX and received 8 letrozole. Mean age, lesion diameter, gestation age in the MTX vs letrozole arm were: 31 vs 32 years (p = 0.3), 13.2 vs 16.3 mm (p = 0.1), 7 + 1 vs 7 + 0 weeks (p = 0.6), respectively. In case of 4 women treated with letrozole and in 2 treated with MTX (4/8, 50% vs 2/14, 14.3%, p = 0.07) the treatment was unsuccessful. There were no significant differences in blood parameters on days 0, 4 and 7 between both arms, except for the increasing urea concentration in the letrozole arm (p = 0.01). Even though the results did not reach statistical significance, it is likely that a larger study sample would confirm the trend of letrozole being less effective. The results did not support the use of letrozole in the studied regimen as an alternative to MTX.

Ectopic pregnancy in China during 2011-2020: a single-centre retrospective study of 9499 cases.

Previous studies have shown that the incidence of ectopic pregnancy (EP) is increasing in China. It is unclear, however, whether the incidence of EP has changed after the implementation of the universal two-child policy in the context of China's aging population and declining fertility rate. Data concerning EP from January 2011 to December 2020 were collected from the hospital's electronic medical records, which included the annual number of delivery, caesarean section rate, ectopic pregnancies, treatment of tubal pregnancy, and average costs and length of hospitalization. Trends of the EP incidence were analysed and annual percentage change (APC) was calculated using connected point regression analyses. A total of 9499 cases of EP were collected, among which caesarean scar pregnancy (CSP) accounts for the second highest (6.73%). The EP per 100 deliveries revealed a downward trend, from 7.60% in 2011 to 4.28% in 2020 with an APC of -1.87 (P < 0.05). The maternal age was increased, especially after the implementation of the universal two-child policy. The constituent ratio for the advanced maternal age (≥ 35) and the caesarean section rate, but not the CSP, were also increased. Laparoscopic salpingectomy was the main surgical method, whereas the adoption of laparotomy and laparoscopic salpingostomy was decreasing year by year. Although no obvious effect of the two-child policy on EP has been observed under the conditions of this study, the change in EP especially in advanced-age women after the policy implementation needs further evaluation. A decreased caesarean section rate, in primipara is beneficial to reducing the CSP.

Diagnosis and treatment of tubal pregnancy by endoscopic method

As many as 242 women with extrauterine pregnancy were operated using the endoscopic method. The removal of uterine tube was carried out in 157 women with pronounced changes of uterine tube, the reconstructive operation with preserving of the tube was carried out in 87 women. The removal of fetal ovum was carried out by squeezing or vacuumaspiration with the following retrograde hydrotubation. The tube part was removed with application of tubotubar anastomosis in 32 women. Hysterosalpin- gography and kymotubal insufflation showed the efficiency of organ saving operations. The use of endosurgical treatment methods of extrauterine pregnancy made it possible to avoid laparatomy in tubal pregnancy excluding hemorrhagic shock caseg.

Evaluation of tubal patency using hysterosalpingo-contrast sonography (HyCoSy) following salpingostomy and medical treatment of tubal pregnancy

Objective. Ectopic pregnancy adversely affects the patency of the fallopian tube and consequently the future pregnancy. There are different options of conservative treatment of tubal pregnancy such as methotrexate and salpingostomy [1]. There is little information on the success rate of maintaining tubal patency after methotrexate and salpingostomy [2]. Therefore, the aim of this study is to evaluate the ipsilateral tubal patency using HyCoSy after treatment of tubal pregnancy with methotrexate therapy versus salpingostomy. Patients and methods. This was a case-series study conducted in Ain Shams and Al-Azhar University Maternity Hospitals to evaluate the ipsilateral tubal patency using hysterosalpingo-contrast sonography (HyC0Sy) following salpingostomy and medical treatment of tubal pregnancy. This study included patients who were admitted to Ain Shams and Al-Azhar University Maternity Hospitals for having tubal pregnancy and were treated either with methotrexate or salpingostomy over a 4-year period between January 2017 and December 2020. The patients seeking fertility were re-evaluated for fallopian tubes patency by hysterosalpingogram 3 months after discharge. The study included 2 groups of women: group I (n = 200): women who were treated with methotrexate, and group II (n = 140): women who underwent salpingostomy. Results. HSG was performed in 200 cases of patients with tubal pregnancy who were treated with methotrexate and 140 cases of patients who underwent salpingostomy. The patency of the ipsilateral tube was 85% after methotrexate treatment and 84.2% after salpingostomy. There was no statistically significant difference between the two groups. Conclusion. The findings suggest similar success rate in maintaining the patency of the fallopian tube with either methotrexate or salpingostomy. Key words: ectopic pregnancy, hysterosalpingography, methotrexate, infertility, salpingostomy

Evaluation of Tubal Pregnancy After Treatment With Methotrexate by Ultrasound Elastography.

The purpose of this study was to evaluate the application of ultrasound elastography in the assessment of methotrexate (MTX) treatment for tubal pregnancy and the association with the elasticity score and human chorionic gonadotropin (hCG) concentration. A total of 73 cases of unruptured tubal pregnancy were diagnosed and treated systemically with MTX. The sonographic characters of conventional transvaginal sonography and elastography and serum hCG concentrations before and after MTX therapy were retrospectively reviewed and analyzed. The mean elasticity score was statistically significantly lower for the ectopic tubal masses of the success group (mean ± SD, 2.58 ± 0.68) than for the failure group (3.33 ± 0.47) on day 7 (P < .001) and similar on day 0. The median elasticity score for the success group on day 7 was 3, and for the failure group, it was 4. When elasticity scores of 3 and 2 were used for the criterion of successful MTX treatment, the elastography had 94.5% sensitivity, 61.1% specificity, 88.1% positive predictive value, and 78.6% negative predictive value. Elastography of the ectopic masses and subsequent hCG concentration at 1 week after the MTX injection in the success group had a strong relationship. Our results suggest that transvaginal elastography was a useful tool in the evaluation of tubal pregnancy after pharmacologic management.

Predictors of Success with Single-dose Methotrexate Regimen for the Treatment of Ectopic Pregnancy in Chonburi Hospital

Objective : To determine the factors that effect the success in management of tubal pregnancy with single–dose methotrexate regimen in Chonburi hospital. Research design : Retrospective descriptive study Material and method : Out-Patient Department (OPD) and In-Patient Department (IPD) charts of the patients who were diagnosed ectopic pregnancy and treated with methotrexate from January 2010 to December 2014 were reviewed from Chonburi hospital database. The successful treatment was defined in case of disease resolution without surgery. Result : For all 70 patients were enrolled in this study. The overall success rate was 88.57% (62/70). The baseline characteristics of patients were not different between success and failure group and included age, BMI, parity gestational age, pretreatment serum β-hCG and average sized of adnexal mass. The absent fetal heart activity (OR 23.12, 95%CI 1.46-366.12, p 0.02) and size of adnexal mass less than 3.5 cms (OR 37.56, 95%CI 2.49-567.62, p 0.01) were independent predictors for successful treatment of ectopic pregnancy after analyzed with logistic regression model. Conclusion: The independent predictors of success in treatment of tubal pregnancy with single dose methotrexate regimen were absence of fetal heart activity and adnexal mass less than 3.5 cms.

Возможности сохранения и восстановления фертильности после хирургического лечения трубной беременности

The efficacy of measures that improved postoperative rehabilitation of natural fertility in women after conservative surgical treatment of progressive tubal pregnancy (TP) was assessed. A randomized, controlled, open examination of 102 those who planned pregnancy, have undergone treatment endovideosurgical progressive TP was held. The improved complex of rehabilitation: 1) used anti-adhesive barrier; 2) bacteriological and virological examination of discharge from the fallopian tubes, followed by determination of sensitivity to antibiotics; 3) for the rehabilitation of the reproductive system, improve the regenerative processes in the fallopian tubes, and effective contraception for women of the main group in the postoperative period were appointed individually combined oral contraceptives (drospirenone 3 mg/ethinylestradiol 30 mcg) the duration of 9-12 months; 4) anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs in the form of rectal suppositories, enzyme) was determined. The effectiveness of the improved complex to recovery of fertility in women after conservative surgical treatment of progressive TP was 80%.

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

The clinical observation of methotrexate under hysteroscopy by tubal cavity injection with Huayu shapei prescription in the treatment of tubal pregnancy

Objective To explore the clinical effects of injecting methotrexate with hysteroscopic tubal cannulation combined with Huayu shapei prescription in the treatment of salpingocyesis. Methods 82 unruptured salpingocyesis patients were randomly divided into the two groups.41 patients in the observation group were treated by hysteroscopic tubal cannulation injection of methotrexate combined with Huayu shapei prescription,41 patients in the control group were treated by methotrexate intramuscular injection with oral mifepristone.The clinical efficacy of the two groups were observed, the level of serum β HCG required for tubal pregnancy, the mass absorption and after treatment of tubal patency. Results Compared with the control group, the difference was significant of the decline of serum β HCG in the treatment group(t= 2.67,P< 0.05). Compared with the control group, the treatment effectiveness and the absorption of the mass in fallopian tube in the treatment group, the difference was significant(t= 3.57,P< 0.05). Tubal patency detected treated group was superior compared with the control group, the difference was significant(χ2= 100.23,P<0.05). Conclusion Compared with traditional treatments, injecting methotrexate with hysteroscopic tubal cannulation combined with Huayu shapei prescription in the treatment of salpingocyesis can effectively reduce the HCG levels, promote the absorption and softening of the ectopic pregnancy mass, to achieve the purpose of killing embryos eliminate micro, it will help to improve patients with clinical symptoms and signs, to maximize the recovery of the patient's reproductive function and physical health. Key words: Uteroscop; Prescription salpingocyesis; Methotrexate; Huayu shapei

Treatment of tubal pregnancy using comprehensive interventional methods

Objective: To investigate the efficacy of combined interventional methods in treatment of tubal pregnancy. Materials and Methods: One hundred sixty-two patients with tubal pregnancy were enrolled in this study. In all patients, the feeding uterine artery at affected side was perfused with methotrexate (MTX), followed by occlusion using gelatin sponge. Nineteen patients were also treated by perfusion of MTX in ovarian artery at affected side which partially participated in blood supply. Seven patients received direct puncture perfusion of MTX under B ultrasound guidance. Four cases received perfusion of MTX through fallopian tube. After surgery, the serum beta-human chorionic gonadotropin (%-HCG) level was regularly detected, and B ultrasound was used to monitor the pelvic mass change. For 33 patients with fertility requirement, hysterosalpingography (HSG) was conducted after menstruation restoration. Results: Tubal pregnancy was terminated in 160 patients (98.76%), with inefficacy in two patients (1.23%) who were treated by surgery. HSG showed tubal patency in 27 patients. Tubal obstruction was found in the other six patients. After recanalization, three cases were unobstructed, with obstruction in other three cases. Fifteen patients achieved intrauterine pregnancy after six to 17 months from surgery. Conclusions: Comprehensive interventional treatment can prevent internal bleeding caused by failure of many conservative treatments, improve the indication and success rate of treatment, and preserve the complete fallopian tube.

Surgery for Ectopic Pregnancy: Sparing the Tube Might Not Always Be Best

For surgical treatment of tubal pregnancy, salpingostomy (preferred term for salpingotomy in the U.S.; removal of the pregnancy with preservation of

Evaluation of Postsurgical Pain in Single- Port versus Three-Port Laparoscopic Surgery for Ectopic Pregnancy: A Preliminary Study

Objective: To retrospectively compare the postsurgical pain after single-port laparoscopic surgery and conventional laparoscopic salpingectomy for the surgical treatment of tubal pregnancy. Methods: The cases of two groups of patients with ectopic pregnancies were reviewed: those who had undergone a single-port laparoscopic surgery (n=6) and those who had undergone a conventional multi-port laparoscopic surgery (n=20). We compared these groups’ surgical outcomes, including operative time, blood loss, use of analgesics, and complications. Results: There was no significant difference between the two groups regarding the surgical time, blood loss during surgery, or analgesics use after laparoscopic surgery. There were no serious complications and no need for conversion to conventional laparoscopy or laparotomy in both groups. Conclusion: Our present findings suggest that single-port laparoscopic surgery is feasible and practical for the surgical treatment of ectopic pregnancies. However, the results also indicate that the reduction of the number of laparoscopy ports did not offer further pain relief in these patients.

Clinical observation of tubal pregnancy treated by suspended laparoscope

Objective To compare the efficacy of suspended laparoscope and traditional laparotomy in the treatment of tubal pregnancy.Methods 160 cases of tubal pregnancy were treated by traditional laparotomy (A group,n =100) and suspended laparoscope(B group,n =60).The curative effect was compared between the two groups.Results In group B,the operation time was (45.70 ± 3.76) min,the volume of bleeding during the operation was (29.10 + 6.17) ml,anal exhaust time after operation was (17.70 + 7.75) h,post-operative off-bed time was (23.13 ± 7.55) h,postoperative hospitalization time was (4.52 ± 1.10) d,postoperative pain observed in 12 cases,10 cases had postoperative fever,postoperative poor wound healing in 0 case.Those in group A were (47.01 ± 3.83)min,(40.07 ±6.02)m1,(23.90 ±7.86)h,(27.87 +9.06)h,(6.26 ± 1.14) d,38 cases,35 cases,9 cases,the differences between the two groups were statistically significant(t =2.1101,11.0477,4.8568,3.4022,9.4835,x2 =5.6199、6.1961、4.1521,P ＜0.01).The decline of blood human chorionic gonadotropin had no significant difference between the two groups after operation.Conclusion Suspended laparoscope in treatment of tubal pregnancy is better than traditional laparotomy,it is effective,minimally invasive and safe. Key words: Pregnancy, tubal; Laparoscopy

Salpingoscopy after a single dose of methotrexate for treatment of tubal pregnancy

Salpingoscopy after a single dose of methotrexate for treatment of tubal pregnancy

Outcome analysis on conservative treatment for tubal pregnancy after pregnancy

Objective To explore the different conservative manners or methods of treatment for unruptured tubal pregnancy 2 years after pregnancy,seeking better treatment for tubal pregnancy and on subsequent pregnancy affected treatment method.Methods We summarized and analyzed the clinical data of 123 cases of unruptured ectopic pregnancy patients treated by different methods from January 2005 to December 2009 in our hospital.According to different methods of conservative treatment they were divided into laparoscopic group (group A),using Laparoscopic salpingostomy in 69 cases.Drug group (group B) with 54 cases was given mifepristone or mifepristone combined with methotrexate.Comparison of two groups were followed up for 2 years after menstrual recovery,Re-pregnancy,intrauterine pregnancy,ectopic pregnancy and infertility again occurrence.Results Within 2 years the intrauterine pregnancy rate was 50.72％ (35/69) in group A,higher than that in the group B [35.19％(19/54)].Average pregnancy time in group A was (10.53 ± 2.05) months,shorter than that of the group B [(14.12 ± 3.15) months].Secondary infertility in group A was 27.54％(19/69),lower than that of the group B,38.89％(21/54).Repeated ectopic pregnancy in group A was 21.74％ (15/69),while the group B was 25.92％ (14/54).The pregnancy time,intrauterine pregnancy and secondary infertility in comparison in two groups,the difference was statistically significant (P＜0.05),the difference between the repeated ectopic pregnancy in two groups was not statistically significant (P＞0.05).Conclusions The operation of laparoscopic conservative treatment for tubal pregnancy patients is better than conservative treatment. Key words: Ectopic pregnancy; Tubal pregnancy; Pregnancy; Laparoscope

Assessment of β-human chorionic gonadotropin level as a reliable predictor of tubal patency confirmed with transvaginal ultrasound-guided selective salpingography (TVSSG) following conservative treatment of tubal pregnancy

To try putting the β-hCG level as a reliable predictor for tubal patency for women, who had previously undergone expectant treatment or who had received systemic methotrexate injection because of tubal pregnancy, and to simply check their tubal patency using a newly proposed procedure, a transvaginal ultrasound guided selective salpingography (TVSSG). One hundred and sixty patients were submitted to TVSSG after tubal pregnancy treatment. TVSSG was subsequently performed in the follicular phase of the menstrual cycle after the clinical treatment of tubal pregnancy. One hundred patients received expectant management and 60 were treated with single-dose methotrexate (50 mg/m(2) intramuscularly). Of 160 patients (235 fallopian tubes examined), the affected tube was observed to be patent by TVSSG in 84 and 78%, respectively (P > 0.05). The contralateral tube was patent in 93%. Forty patients became pregnant and were thus not subsequently assessed with laparoscopy. Ten of these pregnancies ended in a miscarriage and five in a recurrent tubal pregnancy. The concordance of 86% for Fallopian tubes was achieved between the TVSSG and laparoscopy by the gold standard method. After the logistic regression was performed, it was observed that the levels of β-hCG > 5,000 mUI/ml were directly related to the tubal obstruction risk, odds ratio = 11.7 (95% CI = 2.27-61.32). In the current study, the probability of ipsilateral tubal obstruction depends on the β-hCG levels. The increase in β-hCG levels is followed by an enhancement in tubal obstruction risk. Therefore, assessment of the β-hCG may be an effective tool for the prognosis of the reproductive future of these patients.

Interventional Therapy By Trans Uterine Artery for Treatment of 42 Patients With Tubal Pregnancy

Objective To analyze the effect and safety of interventional therapy by trans uterine artery for treatment of tubal pregnancy. Methods Forty-two patients with tubal pregnancy were performed two side uterine arteries. MTX perfusion and embolization with gelfoam particles guided by DSA fluoroscopy. Results Forty patients obtained the decline of serum β-HCG value and 39 patients' ectopic mass absorption after treatment. Two patients occurred ectopic mass bleeding after interventional therapy and emergency surgical operation were done, but the amount of bleeding was low than 400ml. Conclusion Interventional therapy by trans uterine artery for treatment of tubal pregnancy could preserve the function of fallopian tubal, it was more benefit for patients who want normal pregnancy. Key words: Pregnancy,tubal; Interventional therapy; Uterine artery; Methotrexate

To Evaluate the Efficacy of Laparoscopic versus Open Surgical Management of the Tubal Pregnancy and its Effects on Future Pregnancy

Ectopic pregnancy is the most common cause of maternal death in early pregnancy and its incidence is rising. Most of the ectopicpregnancies occur in the young age group and subsequent fertility is an important issue. There is no consensus in the literatureregarding conservative laparoscopic versus radical treatment of tubal pregnancy in terms of future reproductive performance. Thereare no randomized controlled trials of sufficient power, and meta-analysis of studies has shown different results with different investigators.But in certain studies laparoscopic surgery has advantages over open surgery and results in higher rates of subsequent intrauterinepregnancies and a lower rate of ectopic pregnancy.Background: In the treatment of tubal ectopic pregnancy (EP), laparoscopic surgery remains the cornerstone of treatment (CochraneDatabase 2007). In the absence of randomized data, the question as to whether surgical treatment should be performed eitherconservatively (salpingostomy) or radically (salpingectomy) in women with desire for future pregnancy is subject to ongoing debate (Molet al 2008).Since the first study demonstrated the potential effectiveness of salpingostomy, this treatment has been compared with salpingectomyin numerous nonrandomized studies (Stromme et al 1962, Mol et al 2008). Pooled data showed no beneficial effect of salpingostomy onintrauterine pregnancy (IUP) whereas there is an increased risk of repeat EP (Clausen 1996, Yao et al 1997, Mol et al 2008). Based onthese findings, the Royal College of Obstetricians and Gynecologists guideline advises salpingectomy as the preferred standardsurgical approach for tubal EP (RCOG 2004). However, there are good reasons to question this advice. Interpretation of the pooled datais troublesome, since many of the original studies failed to report essential details, e.g. time to pregnancy, presence of the desire forfuture pregnancy, and whether subsequent pregnancies occurred either spontaneously or after fertility treatment, such as in vitrofertilization (IVF). Only a few nonrandomized studies have taken these matters into account and came to different conclusions (Silva etal 1993, Job spira et al 1996, Mol et al 1998, Bouyer et al 2000, Bangsgaard et al 2003, Tahseen et al 2003, Mol et al 2008). The IUP rateswere higher and the time to an IUP was shorter after salpingostomy compared to salpingectomy. Especially in women with history ofbilateral tubal pathology, salpingostomy offered better IUP rates than salpingectomy, albeit at the cost of an increased risk for repeat EP(Silva et al 1993, Job spira et al 1996, Mol et al 1998, Bangsgaard et al 2003, Mol et al 2008). In women without history of tubal pathology,this benefit was less clear and also in these women there was an increased risk of repeat EP (Mol et al 1998, Mol et al 2008). In view ofthese data, it has been felt that the most effective type of surgery for women with a tubal EP in the presence of contralateral tubalpathology with desire for future pregnancy is salpingostomy. In women without contralateral tubal pathology, the most optimal surgicaltreatment is currently unknown.

Outcome and relevant factors of tubal pregnancy treated with laparoscopic conservative surgery

To investigate the therapeutic outcome and its influencing factors after laparoscopic conservative surgery in treatment of tubal pregnancy. From January 2003 to December 2008, 226 cases with tubal pregnancy were treated by laparoscopic conservative surgery. The tubal patency was evaluated in 152 cases given by hysterosalpingography (HSG) and 6 cases given by second laparoscopic exploration at 3 - 6 months after surgery. In their first laparoscopic surgeries, 209 got successful treatment and 19 underwent fail treatment. At 3 - 6 months after surgery, 89 cases with tubal patency among 207 cases with successful treatment were enrolled in group A. Nineteen cases who were failed in their first laparoscopic conservative surgery and treated by salpingectomy and 63 cases with tubal obstruction were enrolled in group B. The rate of tubal patency was calculated on patients with characteristics of gestational sac less or more than 5 cm, the level serum human chorionic gonadotropin (hCG) less than 2000 IU/L, 2000 IU/L to 5000 IU/L, and more than 5000 IU/L. There was no significant difference in age, parity, amenorrhea, location of tubal pregnancy, rupture, pelvic adhesion between group A and group B. Two hundred and seven cases (91.6%, 207/226) were successfully treated at initial laparoscopy. One hundred and fifty-two cases got follow up and 55 cases lost follow up at 3 to 6 months after surgery. There was statistical difference in preoperative hCG value which median were 980 (55 - 12 000) IU/L in group A, 3150 (570 - 40 000) IU/L in group B (P < 0.01); the diameter of tubal gestational sac were (3.4 +/- 1.3) cm in group A and (5.0 +/- 1.7) cm in group B (P < 0.01); respectively, the volume of peritoneal bleeding were 200 (0 - 1500) ml and 300 (0 - 1600) ml, the rate of live tubal embryo was 2% (2/89) in group A and 11% (9/82) in group B, which all reached statistical difference (P < 0.05). Among 171 cases in both group A and B, the rate of tubal patency were 65% (67/103) in 103 cases with maximal diameter of tubal gestational sac less than 5 cm and 32% (22/68) in 68 cases with maximal diameter of tubal gestational sac more than 5 cm, which reached statistical difference (P < 0.01). The rate were 72% (73/102) in patients with serum level of hCG less than 2000 IU/L, 29% (12/42) in patients with 2000 IU/L to 5000 IU/L and 15% (4/27) in patients with more than 5000 IU/L, which also showed statistical difference (P < 0.05). It was observed that preoperative serum hCG level (OR = 0.277, P < 0.01), the maximal diameter of gestational sac (OR = 0.577, P < 0.01) and the volume of peritoneal bleeding (OR = 0.999, P < 0.05) were significant factors influencing successful laparoscopy treatment by logistical regression analysis. In order to preserve fertility, laparoscopic conservative surgery was a safe and feasible approach in treatment of tubal pregnancy. Preoperative serum hCG levels, size of tube gestational sac were significant factors influencing successful laparoscopic surgery.

O305 Methotrexate (MTX) injection by hysteroscopic tubal catheterization combined with Mifepristone in the treatment of tubal pregnancy

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S180-S180 Free communication (oral) presentations O305 Methotrexate (MTX) injection by hysteroscopic tubal catheterization combined with Mifepristone in the treatment of tubal pregnancy L. Feng, L. FengSearch for more papers by this authorH. Zhao, H. ZhaoSearch for more papers by this authorB. Yang, B. YangSearch for more papers by this author L. Feng, L. FengSearch for more papers by this authorH. Zhao, H. ZhaoSearch for more papers by this authorB. Yang, B. YangSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)60677-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S180-S180 RelatedInformation