Management Of Tubal Pregnancy And Subsequent Reproductive Outcome

BACKGROUNDEctopic pregnancy is a life- and fertility-threatening condition that iscommonly seen in Chinese emergency departments. The incidence of ectopicpregnancy has increased greatly during the last two decades. Althoughspontaneous resolution of ectopic pregnancy can occur, patients are at risk oftubal rupture and catastrophic hemorrhage. Ectopic pregnancy remains animportant cause of maternal death in the first trimester. Early diagnosis ofectopic pregnancy is now possible, thanks to the development ofradioimmunoassays and antiserum that together allow sensitive and specificassays of theβ-subunit of human chorionic gonadotrophin(HCG), and highresolution ultrasonography with vaginal probes. Nowadays, improvements inthe diagnosis and management of ectopic pregnancies have shifted clinicians'concerns away from the immediate health of the woman, towards preservingher subsequent fertility.OBJECTIVEThe objective of this study was to evaluate the effectiveness of differentmanagement of ectopic pregnancy and to investigate the factors influencingthe choice of treatment, and we also compare the subsequent fertility ofectopic pregnancy at Beijing Unin Medical College Hospital.METHODSRetrospective cohort study of 648 consecutive patients who were diagnosed tubal pregnancy between January 1999 and December 2002.Statistical analysis took into consideration the basic information of the patientsand the treatment procedures used. For case follow up, the women wereinterviewed by telephone about the pregnancy outcome after the treatment.RESULTS1,The treatment of the tubal pregnancy: the first treatment given was"surgical" for 433 women(66.8%), "medical" for 169 (26.1%), and"expectant" for 46(7.1%). About 70% patients received laparoscopy, andit has been the major management of tubal pregnancy. As many as of125 out of 169(74.0%) were successfully treatment with MTX, and onlyone factor was associated with failure management: the beta-hCGconcentrations before the treatment. The success rate of expectanttherapy were 95.7%, the beta-hCG concentrations may be thedeterminant of failure of expectant management.2,Persistent ectopic pregnancy: the overall rate of persistent ectopicpregnancy after surgical treatment were 2.8%, there are significantlydifferent between the group of salpingotomy and salpingectomy(4.7%vs.1%, P=0.039).3,Fertility outcome after treatment: The mean duration of follow up was61±8 months(range 48～95months). The subsequent IUP rates aftersurgical,medical and expectant management were 65.0%,76.9%and68.8%, respectively. They were similar among the three groups(P=0.373). The recurrent EP rates of the three groups were 16.1%, 17.9% and 6.3%, respectively. We found significantly different amongthem(P=0.030).4,Several anamnestic factors had a significant and adverse effect onreproductive outcome: age(P=0.039), history of infertility (P=0.001),history of ectopic pregnancy (P=0.02) and previous pelvic surgery (P= 0.012), and condition of the controlateral tube(0.035).CONCLUSIONSEctopic pregnancy is a potentially life-threatening condition, and theincidence continues to rise steadily. Although laparoscopic surgery is themainstay of management for ectopic pregnancy, options of medical orexpectant management are available for a proportion of women. The rate ofpersistent pregnancy after salpingotomy significantly higher than that aftersalpingectomy, but the intrauterine rate may also higher. Our analysis indicatesthat subsequent fertility depends more on the patients' previous medicalhistory than on her treatment for EP.