Although condom use among all women declined markedly once they initiated long-term hormonal contraception, frequency of condom use varied by subgroup and was associated with several factors. Most importantly, women with more than one sexual partner and those who received a message during counseling on the need to continue using condoms were more likely than others to use condoms in conjunction with the implant or injectable.
Salpingostomy has gradually replaced salpingectomy as the surgical procedure of choice for unruptured tubal pregnancy in women who wish to preserve fertility. There are no prospective studies and only a few retrospective reports comparing fertility rates after salpingostomy and salpingectomy. Three major retrospective studies found no significant difference in fertility or incidence of repeat ectopic pregnancy between the two procedures, but salpingostomy carries a 5-8% risk of persistent ectopic pregnancy, contributing to increased morbidity and cost. There are approximately 109,000 ectopic pregnancies per year in the United States. If half are treated by salpingostomy, 54,500 women will need serial beta-hCG testing after surgery. Approximately 3543 will have a persistent ectopic pregnancy requiring surgical or medical treatment. The additional direct costs created by persistent ectopic pregnancy is estimated to be almost $16,000,000. Fertility after ectopic pregnancy is affected much more by the status of the contralateral tube than by the procedure performed, with fertility rates exceeding 80% after salpingectomy when the opposite tube is normal. By performing salpingectomy when the contralateral tube is normal, half the additional cost and morbidity could be avoided without jeopardizing subsequent fertility.
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