Reproductive Outcomes after Surgery for Ectopic pregnancy

Abstract

Objective: To evaluate the reproductive outcomes after radical salpingectomy or conservative surgery for ectopic pregnancy (EP), with attention to tubal patency and peritubal adhesions.Design: Retrospective study.Setting: Department of Obstetrics and Gynecology, Tottori Prefectural Central Hospital.Patients: Among 94 patients who underwent surgery for EP between 2000 and 2010, 51 patients who desired subsequent pregnancy were followed.Interventions: Of the 51 patients, 40 had undergone salpingectomy and 11 had received conservative surgery. Main outcome measures:The pregnancy rate and the time to conception after surgery were examined. The intrauterine pregnancy (IUP) and repeat EP (REP) rates were compared between the salpingectomy and conservative surgery groups. The revised American Fertility Society (re-AFS) adnexal adhesion scores were compared between the IUP and REP groups.Results: A total of 35 of the 51 (68.6%) patients had pregnancies during the follow-up interval. Twenty (57.1%) patients conceived within 1 year, and 30 (85.7%) conceived within 1.5 years after surgery. Postoperative hysterosalpingography confirmed patency of the contralateral tube in 22/25 of the salpingectomy cases and in 8/9 of the conservative surgery cases.The variation in IUP rates for salpingectomy (47.1%) and conservative surgery (77.8%) was not statistically significant.No significant difference was found in the REP rate between the salpingectomy (8.8%) and conservative surgery (11.1%) groups. However, the re-AFS adhesion score was significantly lower in the IUP group compared with the REP group (1.2±0.4 vs. 5.8±2.3, respectively).Conclusions: Women without contralateral tubal damage can be expected to conceive within 1.5 years after surgery for EP, regardless of surgical procedure. REP is related to adnexal adhesions.