Salpingectomy May Often Have Edge in Ectopic Pregnancy

By David Douglas

February 27, 2014

NEW YORK (Reuters Health) - In women with ectopic pregnancy, salpingotomy can increase the risk of persistent trophoblast with no corresponding fertility advantage, European researchers say.

Instead, salpingectomy should generally be preferred, Dr. Femke Mol told Reuters Health by email. "It appears that salpingotomy does not significantly improve fertility prospects compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube," said Dr. Mol.

In a February 3rd online paper in The Lancet, Dr. Mol of the University of Amsterdam and colleagues note that tubal ectopic pregnancy can be surgically treated by salpingectomy, in which the affected Fallopian tube is removed, or by salpingotomy in which the tube is preserved. The assumption is that two tubes may provide better pregnancy prospects, but the subject has not been well examined.

To do so, the researchers randomly assigned 446 women with a laparoscopically confirmed tubal pregnancy and a healthy contralateral tube to undergo salpingotomy or salpingectomy.

They were enrolled between 2004 and 2011 and follow-up was discontinued early in 2013. During this period the ongoing pregnancy rate was 60.7% after salpingotomy and 56.2% after salpingectomy (p=ns). But persistent trophoblast was seen in 14 of the salpingotomy group compared to only one of the salpingectomy group.

Repeat ectopic pregnancy was seen in 8% of the salpingotomy group and 5% of the salpingectomy group.

However, the researchers say, "Since our results cannot exclude the possibility of a very small benefit from salpingotomy, women with a strong preference for maximizing their future pregnancy prospects might still opt for salpingotomy."

In comments emailed to Reuters Health, Dr. Thomas M. D'Hooghe, co-author of an accompanying editorial, advised that "in women with normal contralateral tubes, younger than 35 years old, and without history of infertility or tubal disease, shared decision making between patient and doctor should be based on surgical experience, benefits, risks of both techniques, and patient preferences, taking into account that the risk for repeat ectopic pregnancy is not increased after salpingotomy when compared to salpingectomy."

Dr. D'Hooghe of Leuven University Fertility Center, Belgium added that "salpingostomy is the method of choice if the contralateral tube is abnormal because the cumulative intrauterine pregnancy rate (IUPR) is higher than after salpingectomy. Salpingostomy should also be offered to women with normal contralateral tubes, especially if they are older than 35 years old or have a history of infertility, since benefits (increased cumulative IUPR) also from a patient's perspective outweigh risks (increased trophoblast persistence rate)."

SOURCE: http://bit.ly/1hzEY2t

Lancet 2014.

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