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At least 19 recordsLinked to original sources

PubMed1993

Comparison of persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for ectopic pregnancy.

OBJECTIVE: To compare persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for the treatment of intact ampullary ectopic pregnancy. METHODS: We reviewed the medical records of 157 patients who had undergone salpingostomy for intact ampullary ectopic pregnancy at Yale-New Haven Hospital between September 1, 1986 and August 31, 1991. One hundred three women had laparoscopic salpingostomy and 54 had salpingostomy at laparotomy. RESULTS: Sixteen of 103 women (15.5%) undergoing laparoscopic salpingostomy were treated for persistent ectopic pregnancy, in contrast to one of 54 women (1.8%) who had salpingostomy by laparotomy. The adjusted odds ratio for persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for an intact ampullary ectopic pregnancy was 8.4, with 95% confidence interval 1.1-62 (P < .02). Stepwise logistic regression demonstrated that a laparoscopic approach to salpingostomy (P < .05), smaller ectopic size (P < .01), and fewer days of amenorrhea (P < .05) predicted persistent ectopic pregnancy. CONCLUSION: Persistent ectopic pregnancy is more likely after laparoscopic salpingostomy than after salpingostomy at laparotomy for intact ampullary ectopic pregnancy.

Cohort Studies↗

PubMed1980

Surgery-pregnancy time intervals after salpingolysis, unilateral salpingostomy, and bilateral salpingostomy.

Pregnancy rates and time intervals to achieve pregnancy were determined in 144 patients treated for infertility by lysis of bilateral tubal or peritubal adhesions. The pregnancy rate after bilateral salpingostomy for hydrosalpinges was low (18.7%; n = 91). The eventual pregnancy rate after unilateral salpingostomy with bilateral division of adhesions (43.8%; n = 16), however, was comparable to that after bilateral salpingolysis for purely peritubal adhesions (54.1% n = 37). In contrast, the mean surgery-pregnancy time interval was substantially longer after unilateral salpingostomy (104 weeks) than after bilateral salpingolysis (45 weeks) (P < 0.01). These findings indicate that salpingo-oophorectomy may be preferable to salpingostomy for unilateral hydrosalpinx.

Adnexal Diseases↗

PubMed1998

Preoperative serum hCG level and intraoperative failure of laparoscopic linear salpingostomy for ectopic pregnancy.

OBJECTIVE: To identify factors that predict failure of linear salpingostomy requiring salpingectomy for ectopic pregnancy. METHODS: Using a retrospective cohort, we examined the various risk factors of women with ectopic pregnancies presenting for conservative laparoscopic management. Success or failure of laparoscopic linear salpingostomy was the primary end point. RESULTS: One hundred fifty-seven women underwent laparoscopic linear salpingostomy for ectopic pregnancy, of whom 120 had successful procedures and 36 had unsuccessful operations because of bleeding and needed subsequent salpingectomy either by laparoscopy or laparotomy. The likelihood of success of laparoscopic linear salpingostomy was unrelated to gestational age, size of the ectopic pregnancy, surgical technique, or experience of the surgeon or resident. However, median (quartiles) serum beta hCG levels were significantly higher in patients who underwent failed salpingostomy (10,103 [3549-19,962] IU/L) compared with those who underwent successful salpingostomy (1692 [565-3971] IU/L, P < .01). Median blood loss (225 [181-562] mL versus 100 [50-200] mL, respectively, P < .01) and mean (+/- standard error of the mean [SEM]) operating times (111.1+/-6.1 minutes versus 76.8+/-2.3 minutes, P < .01) were significantly greater with failed salpingostomy followed by salpingectomy, compared with successful salpingostomy. CONCLUSION: Preoperative serum beta hCG level was the only significant determinant of failure of laparoscopic linear salpingostomy for ectopic pregnancy. Morbidity due to intraoperative blood loss and operating time was significantly increased as a result of attempting and failing to complete laparoscopic linear salpingostomy.

Adult↗

PubMed1997

Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy.

BACKGROUND: Laparoscopic salpingostomy is a well-established treatment for patients with tubal pregnancy who desire to retain fertility. Another approach that preserves the fallopian tube is medical treatment. We compared systemic methotrexate and laparoscopic salpingostomy in the treatment of tubal pregnancy. Outcome measures were treatment success, tubal preservation, and homolateral tubal patency. METHODS: Between January, 1994, and September, 1996, haemodynamically stable patients with laparoscopically confirmed unruptured tubal pregnancy and no signs of active bleeding were randomly assigned systemic methotrexate (four 1.0 mg/kg doses of intramuscular methotrexate alternated with 0.1 mg/kg oral folinic acid) or laparoscopic salpingostomy. Treatment success was defined as complete elimination of the tubal pregnancy (serum human chorionic gonadotropin < 2 IU/L) and preservation of the tube. Homolateral tubal patency was assessed by hysterosalpingography. Analysis was by intention to treat. FINDINGS: 100 patients were included in the trial. Of 51 patients allocated systemic methotrexate, 42 (82%) were successfully treated with one course; two (4%) patients needed a second course for persistent trophoblast. Surgical intervention was needed in seven (14%) patients; salpingectomy was necessary in five of these patients for tubal rupture. Of the 49 patients allocated laparoscopic salpingostomy, 35 (72%) were successfully treated by laparoscopic salpingostomy alone; salpingectomy was needed in four (8%) patients, and ten (20%) needed methotrexate for persistent trophoblast. The tube was preserved in 46 (90%) patients in the methotrexate group versus 45 (92%) in the salpingostomy group (rate ratio 0.98 [95% CI 0.87-1.1]). Homolateral tubal patency could be assessed in 81 patients: the tube was patent in 23 (55%) of 42 patients in the methotrexate group and in 23 (59%) of 39 patients in the salpingostomy group (rate ratio 0.93 [0.64-1.4]). INTERPRETATION: In haemodynamically stable patients with unruptured tubal pregnancy, systemic methotrexate and laparoscopic salpingostomy were successful in treating the majority of cases. We found no significant difference between the treatments in the homolateral patency rate. Subsequent fertility outcome has to be awaited to show which treatment yields better fertility prospects.

Adult↗

PubMed1991

Microsurgical salpingostomy is not an obsolete procedure.

OBJECTIVE: A review of the results of microsurgery for bilateral distal tubal blockage. DESIGN: A retrospective review. SETTING: Hammersmith Hospital London and local private hospitals. SUBJECTS: 388 patients with bilateral ampullary occlusion treated between 1971 and 1988 by microsurgery. INTERVENTIONS: Full investigation for other causes of infertility followed by abdominal microsurgical salpingostomy. Repeated meticulous follow-up was essential with check laparoscopy one year after surgery. MAIN OUTCOME MEASURE: Successful pregnancy in relation to tubal damage. RESULTS: In 65 women microsurgery followed tubal reocclusion after failed conventionally performed salpingostomy. 74 women (23%) had one term pregnancy after primary salpingostomy and 12 women (18%) after repeat salpingostomy. Over half the women having a term pregnancy subsequently had a second infant. The tubal damage was classified in four stages according to the degree of mucosal damage and tubal fibrosis, the presence of isthmic disease and the quality of tubal and ovarian adhesions. Approximately one quarter of patients had stage I disease and amongst these 39% had babies after primary salpingostomy and 25% after repeat salpingostomy. CONCLUSION: Microsurgical salpingostomy is a specialized procedure. Proper selection of patients, competent microsurgical technique and adequate follow-up appear crucial to success. In selected patients treatment by salpingostomy gives better results than multiple cycles of in vitro fertilization.

Adult↗

PubMed1993

Comparison of a local injection of hyperosmolar glucose solution with salpingostomy for the conservative treatment of tubal pregnancy.

OBJECTIVE: To compare a local injection of hyperosmolar glucose and salpingostomy for the laparoscopic treatment of tubal pregnancy in terms of immediate success and postoperative tubal patency. DESIGN: Prospective. PATIENTS, SETTING: Forty women with an unruptured tubal pregnancy were enrolled from among 117 women with ectopic pregnancies (EPs) admitted consecutively to the university clinic. The inclusion criteria were as follows: [1] concentration of beta-hCG in the serum < or = 5,000 IU/L; [2] no living fetus in the EP; and [3] unruptured tubal pregnancy at laparoscopy. INTERVENTIONS: After randomization, 20 of these patients were treated with a local injection of hyperosmolar (50%) glucose solution and 20 women by salpingostomy. Tubal patency was evaluated at relaparoscopy or by hysterosalpingography 6 to 13 months after the primary treatment. RESULTS: The mean decrease in beta-hCG concentration from the preoperative value to the first postoperative day was 37% and 52% in the glucose and salpingostomy groups, respectively, and the mean resolution time was 13 and 12 days, respectively. Human chorionic gonadotropin showed a persistent EP in 4 women (20%) in the glucose group and 2 (10%) in the salpingostomy group. A patent treated tube was found in 9 of 13 women in the glucose group and 9 of 10 in the salpingostomy group at re-examination. During a follow-up of 6 to 20 months 4 women in the glucose group and 4 women in the salpingostomy group had an intrauterine pregnancy. CONCLUSION: A local injection of hyperosmolar glucose is a reasonable method treating tubal pregnancy in selected cases but does not seem to offer any advantage over salpingostomy concerning persistent trophoblastic disease rate.

Adult↗

PubMed1998

Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular methotrexate with salpingostomy.

OBJECTIVE: To evaluate resolution of serum hCG and progesterone in patients with ectopic pregnancy receiving single-dose intramuscular (IM) methotrexate as compared with those undergoing laparoscopic salpingostomy. METHODS: In this prospective randomized clinical trial, 75 hemodynamically stable women with a diagnosis of ectopic pregnancy were randomized to treatment with single-dose IM methotrexate (1 mg/kg) or laparoscopic salpingostomy. All women had initial, day 4, and weekly serum hCG and progesterone measurements taken until hCG levels were less than 15 mIU/mL. Methotrexate therapy was repeated if posttreatment day 7 hCG levels did not decrease by 15%, as compared with day 4 levels. Success rate was defined as ectopic resolution without the need for the alternate mode of therapy. RESULTS: Thirty-eight women were randomized to treatment with methotrexate and 37 to laparoscopic salpingostomy. The mean (+/-standard deviation) time required for serum progesterone concentrations to decrease to less than 1.5 ng/mL was significantly less for laparoscopic salpingostomy than for treatment with methotrexate: 7.8+/-1.7 and 17.6+/-2.2 days, respectively (P < .01). Within each treatment group, serum progesterone levels resolved (less than 1.5 ng/mL) more rapidly than did hCG levels (less than 15 mIU/mL) (P < .01). No further treatment was required once serum progesterone levels had decreased to less than 1.5 ng/mL. Success rates were similar in both groups: 94.7% (36 of 38) for methotrexate and 91.4% (33 of 36) for laparoscopic salpingostomy. Mean time required for hCG concentrations to decrease to less than 15 mIU/mL was significantly less for laparoscopic salpingostomy than for methotrexate therapy: 20.2+/-2.7 and 27.2+/-2.3 days, respectively (P < .05). Additional methotrexate injections were required in 15.8% (6 of 38) of women randomized to methotrexate therapy. Initial serum hCG levels for patients receiving additional methotrexate doses were 4830+/-1588 mIU/mL as compared with 2133+/-393 mIU/mL for women receiving only one dose (P = .07). CONCLUSION: Serum progesterone levels of less than 1.5 ng/mL are a good predictor of ectopic pregnancy resolution regardless of treatment, and because its return to normal values occurs more rapidly than that of hCG levels, serum progesterone may be a better marker for predicting successful treatment. Although laparoscopic salpingostomy leads to faster resolution of hormonal markers of ectopic gestation, methotrexate is equally successful for treating small unruptured ectopic pregnancies. Initial hCG levels may be a marker for women requiring additional doses of methotrexate.

Abortifacient Agents, Nonsteroidal↗

PubMed1978

Factors influencing the success of salpingostomy techniques for distal fimbrial obstruction.

The present study reviews the pregnancy outcome of 99 patients treated with salpingostomy techniques for distal fimbrial obstruction. Eighty-seven patients were treated with terminal salpingostomy, 10 with medioampullary salpingostomy, and 2 with isthmic salpingostomy. The pregnancy rates were 28%, 20%, and 0%, respectively. Within the terminal salpingostomy group, 5 of 18 patients treated with a prosthesis conceived, for a pregnancy rate of 28%. Nineteen of the 69 patients treated with an eversion technique conceived, for a pregnancy rate of 28%. No advantage with the use of a terminal prosthesis could be demonstrated. Tubal disease treated with techniques of salpingostomy was categorized according to a classification incorporating the several prognostic factors thought to influence subsequent conception. The pregnancy rate was found to be in direct relationship to the extent of tubal disease and pelvic adhesion formation. The tubal patency rate decreased in direct relationship to the extent of disease. The use of postoperative hydrotubation did not appear to improve the conception rate after salpingostomy for distal fimbrial obstruction.

Actuarial Analysis↗

PubMed1996

Comparison of local injection of methotrexate and linear salpingostomy in the conservative laparoscopic treatment of ectopic pregnancy.

STUDY OBJECTIVE: To compare local injection of metothrexate (MTX) and linear salpingostomy in the conservative laparoscopic treatment of ectopic pregnancy. DESIGN: Prospective, nonrandomized study, July 1991 to May 1994. SETTING: Department of obstetrics and gynecology in a university hospital. PATIENTS: Fourteen women with unruptured ectopic pregnancies without documented fetal heart motion and size below 50 mm as measured by ultrasound. INTERVENTIONS: All 14 women underwent the laparoscopic treatment by either local injection of MTX or linear salpingostomy (7 patients each). MEASUREMENTS AND MAIN RESULTS: Both treatments were successful in all patients. Mean length of operation was 32 +/- 5 minutes (range 25-35 min) in the MTX group versus 67 +/- 15 minutes (range 50-90 min) in the salpingostomy group. Mean length of hospital stay was 2.7 days (range 1-5 days) and 1.7 days (range 1-3 days), respectively. No intraoperative complications occurred, and the postoperative course was uneventful in all women. Mean disappearance time of serum beta-human chorionic gonadotropin (hCG) levels was similar in both groups, although in the linear salpingostomy group the decrease was immediate. No difference in tubal patency on follow-up hysterosalpingography was observed between the two groups. CONCLUSIONS: Although this is a preliminary report with a small number of patients, both types of treatment were safe and effective. An advantage of linear salpingostomy was the predictable and consistent decline of circulating beta-hCG, and consequently a reduced need for a close follow-up. Local MTX injection was safe, economic, effective, and easy to perform, and in our experience the surgical time was statistically shorter than that for linear salpingostomy. Therefore, in selected patients, local injection of MTX could be the treatment of choice for unruptured ectopic pregnancy, avoiding a longer and potentially more dangerous procedure. Long-term outcomes do not seem to differ between the two types of treatment.

Adult↗

PubMed2001

Prophylactic methotrexate after linear salpingostomy: a decision analysis.

OBJECTIVE: To compare two strategies for managing women after linear salpingostomy for treatment of tubal pregnancy: observation and prophylactic methotrexate. DESIGN: Decision analysis. SETTING: Outpatient tertiary-care center. PATIENT(S): One thousand hypothetical women treated with a linear salpingostomy for ectopic pregnancy. INTERVENTION(S): Observation after salpingostomy and treatment of persistent ectopic pregnancy with a single dose of methotrexate (current standard of care) versus treatment with prophylactic methotrexate at the time of salpingostomy. MAIN OUTCOME MEASURE(S): Number of ruptured ectopic pregnancies, surgical procedures, complications, and cost for each group (observation vs. prophylaxis). RESULT(S): Prophylactic methotrexate results in fewer cases of tubal rupture (0.4% vs. 3.7%) and fewer procedures (1.9% vs. 4.7%) at a lower cost ($67.55 less/patient) compared with observation alone. Methotrexate-associated complications occur more frequently with prophylaxis (5.5% vs. 0.8%). Certain conditions change which strategy is preferable. Observation is the best strategy when the persistent ectopic pregnancy rate is <9%, the success of prophylaxis is <95%, the complication rate associated with methotrexate is >18%, or the rupture rate of persistent ectopic pregnancies is <7.3%. CONCLUSION(S): Prophylactic methotrexate at the time of linear salpingostomy for the treatment of ectopic pregnancy is preferable to observation as long as certain conditions exist.

Abortifacient Agents, Nonsteroidal↗

PubMed2002

The potential of preoperative beta-hCG and progesterone levels to predict failure of laparoscopic linear salpingostomy in ectopic pregnancies.

STUDY OBJECTIVE: To estimate the association between preoperative beta-human chorionic gonadotropin (hCG) and progesterone levels, and success of linear salpingostomy in treatment of tubal pregnancy. DESIGN: Retrospective case control study (Canadian Task Force classification II-1). SETTING: Women's general hospital. PATIENTS: Three hundred five women undergoing laparoscopic linear salpingostomy for ectopic pregnancy. INTERVENTION: Examination of risk factors for surgical failure of salpingostomy by analyzing corresponding receiver operating curves. MEASUREMENTS AND MAIN RESULTS: In 305 women, intervention was successful in 272 and failed in 33, as assessed by either postoperative hemorrhage (16) or rising beta-hCG values (14); 3 women had both. Of 295 patients in whom beta-hCG was evaluated preoperatively, 149 (50.5%) had values of 1000 mU/ml. or less; 75% had progesterone levels of 10 ng/ml or below. No association was found between preoperative beta-hCG and progesterone levels and the success of linear salpingostomy. CONCLUSION: Preoperative beta-hCG and progesterone levels are of no significance with regard to success of linear salpingostomy for treatment of tubal pregnancy.

Adult↗

PubMed2005

External application of chinese drugs on acupoint Shenque combined with salpingostomy for treatment of sterility caused by obstruction of the fallopian tube--a clinical report of 45 cases.

OBJECTIVE: To observe the therapeutic effect of external application of Chinese drugs on acupoint Shenque (CV 8) combined with salpingostomy for treatment of sterility caused by obstruction of the fallopian tube. METHOD: 75 cases were randomly divided into the following 2 groups. Forty-five patients in the treatment group were treated with external application of Chinese drugs on acupoint Shenque (CV 8) combined with salpingostomy, while 30 patients in the control group were treated with salpingostomy only. RESULTS: The results showed that in the treatment group, 26 cases were cured, 11 cases improved, and 8 cases failed, with a total effective rate of 82.22%; while in the control group, 14 cases were cured, 7 cases improved, and 9 cases failed, with a total effective rate of 70.00%. There is a significant difference in the total effective rate between the two groups (P<0.05). CONCLUSION: The therapeutic effect of external application of Chinese drugs on acupoint Shenque combined with salpingostomy is better than that of salpingostomy only.

Acupuncture Points↗

PubMedDate not supplied

Fertility after salpingostomy following mechanically produced hydrosalpinx in rabbits.

Microsurgical salpingostomy results in 90% of tubes remaining patent following surgery. Although pregnancy rates have improved to a slight extent, the percentage of patients having live babies after salpingostomy is still disappointing. The discrepancy between patency rates and pregnancy rates seems to be due mainly to long standing tubal damage after the original infection. Possibly, raised intraluminal pressure from accumulated fluid may be a factor. Mechanically produced hydrosalpinges in rabbits show similar morphological characteristics to human hydrosalpinges (Vasquez et al., 1981, Otubu et al., 1984). This rabbit model was used in this study to examine the relationship between the severity of these changes and fertility after salpingostomy. Mechanical hydrosalpinges were produced in thirty mature New Zealand white rabbits by double clip application. After a period varying from 8 to 52 weeks of clip application, cuff salpingostomy and ampullary-isthmic anastomosis was done. One week after surgery, the animals were mated with bucks of proven fertility. There were pregnancies in all the uterine horns on the unoperated side (control) in all animals. There were pregnancies on the operated side in only two animals giving a pregnancy rate of 6.7%. A total of sixteen tubes were patent out of thirty operated, giving a patency rate of 53.3%. Adhesion was a major problem. We conclude that fertility is reduced after salpingostomy in mechanically produced hydrosalpinges in rabbits. The significance of this finding is discussed.

Animals↗

PubMed1995

Is salpingostomy the surgical treatment of choice for unruptured tubal pregnancy?

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.

Costs and Cost Analysis↗

PubMed1999

Treatment of tubal pregnancy in the netherlands: an economic comparison of systemic methotrexate administration and laparoscopic salpingostomy.

OBJECTIVE: This study was undertaken to compare from a societal perspective the costs of systemic methotrexate administration with those of laparoscopic salpingostomy for the treatment of patients with tubal pregnancy. STUDY DESIGN: An economic evaluation was set up in tandem with a multicenter randomized clinical trial that compared systemic methotrexate administration and laparoscopic salpingostomy for the treatment of 100 hemodynamically stable patients with laparoscopically confirmed unruptured tubal pregnancy. Data on resources used for treatment and lost production time were prospectively collected and costs of both treatments were calculated by multiplying actual expenses for resource units at a single center and resource unit use measured in all centers. Costs were originally calculated in Dutch guilders and converted to US dollars at a rate of 1.67 guilders/$1. RESULTS: Because clinical outcomes of the trial were equivalent for the 2 strategies a cost-minimization analysis was done. Mean total costs per patient were $5721 for systemic methotrexate administration and $4066 for laparoscopic salpingostomy, with a mean difference of $1655 (95% confidence interval, $906-$2414). Costs of systemic methotrexate administration were similar to those of salpingostomy for patients in whom the initial serum human chorionic gonadotropin concentration was <1500 IU/L, a cutoff value that had not been previously hypothesized. In a scenario without a confirmatory laparoscopy, in which transvaginal ultrasonography and serial repeated serum human chorionic gonadotropin measurements were assumed to be as accurate as laparoscopy, systemic methotrexate therapy would have reduced total cost by $1500 for a patient with an initial serum human chorionic gonadotropin concentration of <1500 IU/L. In such a scenario total costs would have been similar for a patient with an initial serum human chorionic gonadotropin concentration in the range of 1500 to 3000 IU/L, whereas systemic methotrexate administration would be more costly for a patient with an initial serum human chorionic gonadotropin concentration of >3000 IU/L. CONCLUSIONS: Although systemic methotrexate administration is safe and effective for the treatment of tubal pregnancy, it does not necessarily reduce costs. Systemic methotrexate therapy could reduce costs if administered to patients with low initial serum human chorionic gonadotropin concentrations without confirmatory laparoscopy.

Chorionic Gonadotropin↗

PubMed1998

Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients' health-related quality of life.

OBJECTIVE: To compare patients' health-related quality of life after systemic methotrexate therapy versus laparoscopic salpingostomy for tubal pregnancy. DESIGN: Multicenter randomized clinical trial. SETTING: Departments of obstetrics and gynecology of six Dutch hospitals. PATIENT(S): Hemodynamically stable patients with a laparoscopically confirmed unruptured tubal pregnancy without signs of active bleeding, who were randomly assigned to undergo either systemic methotrexate therapy or laparoscopic salpingostomy. INTERVENTION(S): Standard health-related quality of life questionnaires administered before and 2 days, 2 weeks, 4 weeks. and 16 weeks after confirmative laparoscopy. MAIN OUTCOME MEASURE(S): Health-related quality of life. RESULT(S): Health-related quality of life was impaired most severely 2 days after confirmative laparoscopy in both treatment groups and improved during follow-up. Health-related quality of life was impaired more severely after systemic methotrexate therapy than after laparoscopic salpingostomy. Medically treated patients had more limitations in physical functioning, role functioning, and social functioning; had worse health perceptions, less energy, more pain, more physical symptoms, and a worse overall quality of life; and were more depressed than surgically treated patients. CONCLUSION(S): Systemic methotrexate therapy had a more negative impact on patients' health-related quality of life than did laparoscopic salpingostomy. This negative impact on patients' health-related quality of life of systemic methotrexate therapy should be taken into account when deciding on the appropriate therapy for tubal pregnancy.

Adaptation, Psychological↗

PubMed1996

Laparoscopic salpingostomy versus laparoscopic local methotrexate injection in the management of unruptured ectopic gestation.

OBJECTIVE: Our goal was to determine whether laparoscopic salpingostomy is preferable to laparoscopic methotrexate injection in the management of unruptured tubal gestation. STUDY DESIGN: Forty-eight patients with unruptured tubal pregnancy were prospectively randomized to either laparoscopic salpingostomy or laparoscopic local methotrexate injection in a university medical center. Operation time, duration of hospital stay, decrease in levels of beta-human chorionic gonadotropin, and fertility outcome were compared between the two groups. RESULTS: The salpingostomy group had a longer operative time (p < 0.0001) but a shorter hospital stay (p < 0.01) and a lower incidence of persistent trophoblastic activity (5% vs 14%), although this difference did not reach statistical significance. The time interval until beta-human chorionic gonadotropin disappearance was similar (13.9 and 13.7 days), and the subsequent intrauterine pregnancy rate was similar in the two groups (83.5% and 81%). One repeat tubal pregnancy occurred in the salpingostomy group. CONCLUSIONS: Both these methods of conservative management are equally effective and each one has its merits.

Chorionic Gonadotropin, beta Subunit, Human↗

PubMed2002

Serum beta-hCG regression after laparoscopic salpingostomy in the treatment of ectopic pregnancy in Thai women.

This is a descriptive study which reviewed the regression pattern of serum beta hCG in Thai women with ectopic pregnancy after laparoscopic salpingostomy. The study group included the medical records of 21 patients who underwent laparoscopic salpingostomy between January 1991 and August 2001. The results revealed that the regression of serum beta hCG in patients with ectopic pregnancy after laparoscopic salpingostomy was about 10, 100, 1,000 times at day 6, 20 and 35 after operation. The correlation between days after operation and serum beta hCG was in the equation of log (beta hCG difference) = -0.0671 (days after operation) - 0.6187. This estimation curve can probably be used to predict the normal serum beta-hCG regression after laparoscopic salpingostomy.

Adolescent↗