Reproductive outcome after laparoscopic salpingectomy for tubal pregnancy

Dubuisson, JB; Aubriot, FX; Foulot, H; Bruel, D; Joliniere, J. Bouquet De; Mandelbrot, L

doi:10.1016/0020-7292(91)90640-q

Cited by 5 publications

(6 citation statements)

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“…Published comparisons of intrauterine pregnancy rates for conservative‐surgical and radical treatments have produced conflicting results. Some studies found little or no difference 8–11 , whereas others found that the rate was higher with conservative‐surgical than with radical treatment 12–18 . None of these studies adjusted for confounders, so they may differ due to differences in the characteristics of the women.…”

Section: Discussionmentioning

confidence: 99%

Fertility following radical, conservative‐surgical or medical treatment for tubal pregnancy: a population‐based study

Bouyer

Job‐Spira

Pouly³

et al. 2000

BJOG

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Objective To investigate the factors influencing the choice of treatment for ectopic pregnancy and to Design Population-based study of 835 ectopic pregnancies registered between 1992 and 1996. Setting Auvergne Ectopic Pregnancy Register (France).Sample Four hundred and seventy-six women with tubal ectopic pregnancy who were not using contraception at the time of conception. Subsequent fertility was studied for the 291 women who attempted to conceive again. MethodsComparison of reproductive outcomes according to ectopic pregnancy treatment. Cumulative fertility curves were calculated by the Kaplan-Meier estimator and compared by log rank test for univariate analysis and by Cox regression to take into account confounding variables.compare the subsequent fertility rates of radical, conservative-surgical or medical treatments.Main outcome measure Recurrence and fertility rates after ectopic pregnancy. ResultsThe fist treatment given was 'radical' for 178 women (37%), 'conservative-surgical' for 262 (55%), and 'medical' for 35 (8%). The treatment failed in 1% for radical treatment, 5% for conservative-surgical treatment, and 36% for medical treatment. The two-year cumulative rate of recurrence was 27% with no significant difference between treatments. For women with previous infertility factors (in particular diseased contralateral tube), the treatments differed significantly, with the rate of intrauterine pregnancy lower for radical treatment and higher for medical treatment than for conservative-surgical treatment. For women with no infertility factor, there was no significant difference between treatments.Conclusions These results should be confirmed in a controlled trial. The results of this study provide the elements necessary to plan such a trial.

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Section: Discussionmentioning

confidence: 99%

Fertility following radical, conservative‐surgical or medical treatment for tubal pregnancy: a population‐based study

Bouyer

Job‐Spira

Pouly³

et al. 2000

BJOG

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“…1) All randomized controlled trials (RCTs) and cohort studies (prospective or retrospective) comparing the fertility outcomes of conservative surgery and salpingectomy to treat women with tubal pregnancy were included. 2) Because Dubuisson et al [ 11 ] reported that approximately 93% of all spontaneous pregnancies after ectopic pregnancy surgery occur in the 18 months following the procedure, and Bouyer et al [ 12 ] reported that spontaneous pregnancies following ectopic pregnancy often occurred 18–24 months after treatment, we therefore defined the follow-up time of the current review as 2 years or longer. 3) All included studies had their diagnoses confirmed via laparoscopy or pathology.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis

et al. 2016

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ObjectiveTo compare the natural fertility outcomes of salpingotomy and salpingectomy among women treated for tubal pregnancy.MethodsAn online database search including PubMed, Embase, CENTRAL and Web of Science was performed to identify studies comparing salpingotomy and salpingectomy to treat women with tubal pregnancy. The search included papers published after the databases were established until May 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria and then extracted data and assessed the methodological quality of all of the included studies. The meta-analysis was conducted using RevMan 5.3 software. The registration number is CRD42015017545 in PROSPERO.ResultsTwo randomized controlled trials (RCTs) and eight cohort studies, including a total of 1,229 patients, were znalyzed. The meta-analysis of the RCT subgroup indicated that there was no statistically significant difference in IUP rates (RR = 1.04, 95% CI = 0.89–1.21, P = 0.61) nor the repeat ectopic pregnancy (REP) rate (RR = 1.30, 95% CI = 0.72–2.38, P = 0.39) between the salpingotomy and salpingectomy group. In contrast, the cohort study subgroup analysis revealed that the IUP rate was higher in the salpingotomy group compared with the salpingectomy group (RR = 1.24, 95% CI = 1.08–1.42, P = 0.002); Salpingotomy also increased the risk of REP rate (RR = 2.27, 95% CI = 1.12–4.58, P = 0.02). The persistent ectopic pregnancy (PEP) occurred more frequently in the salpingotomy group than the salpingectomy group (RR = 11.61, 95% CI = 3.17–42.46, P = 0.0002). An IUP would be more likely to occur after salpingotomy than salpingectomy when the follow-up time was more than 36 months (RR = 1.16, 95% CI = 1.02–1.32, P = 0.03). The IUP rate (RR = 1.13, 95% CI = 1.01–1.26, P = 0.03), and the REP rate (RR = 1.62, 95% CI = 1.02–2.56, P = 0.04) was higher after salpingotomy than salpingectomy among patients from Europe compared with those from America.ConclusionsBased on the available evidence, we believe that for patients with a healthy contralateral tube operated for tubal pregnancy, the subsequent fertility after salpingectomy and salpingotomy are similar in the long term. The fertility prospects will not be improved via salpingotomy compared with salpingectomy.

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“…58 Support for this time interval is based on the knowledge that 93% of all spontaneous pregnancies after surgical treatment of ectopic pregnancy occur within the ®rst 18 months.…”

Section: Persistent Trophoblast Following Salpingotomymentioning

confidence: 99%

Evidence-based management of ectopic pregnancy

Varma

Mascarenhas

2001

Reprod. Med. Rev.

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Ectopic pregnancy occurs when the conceptus implants outside the normal site within the uterine cavity. The most common site is within the Fallopian tube (98.3%), followed by abdominal (1.4%), ovarian (0.15%) and cervical (0.15%) implantation. Considering tubal ectopic pregnancies, 80% occur at the ampulla and 12% at the isthmus; 6% are fimbrial and 2% are interstitial. Approximately 5% to 5.7% of all clinical pregnancies from assisted reproductive technology (ART) in 1988–92 were ectopic; however, in 1995 the incidence was less at 2.8%. A meta-analysis of risk factors that predispose to ectopic pregnancy is depicted in Table 1. However, this meta-analysis does not control for the interplay of risk factors (multivariate analysis), including the impact of control group data and consequent problems of data collection (e.g. the incidence of pelvic inflammatory disease (PID) in the ectopic group is laparoscopically derived whereas it is derived from the history in the control group).

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Reproductive outcome after laparoscopic salpingectomy for tubal pregnancy

Cited by 5 publications

References 0 publications

Fertility following radical, conservative‐surgical or medical treatment for tubal pregnancy: a population‐based study

Fertility following radical, conservative‐surgical or medical treatment for tubal pregnancy: a population‐based study

Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis

Evidence-based management of ectopic pregnancy

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