The Prognostic Value of Tubal Patency Test After Medical Treatment of an Ectopic Pregnancy

Abstract

Background: Ectopic pregnancy (EP) is defined as the abnormal implantation of the blastocyst outside the uterine endometrium. The most common site of implantation is the Fallopian tube. The effect of different management strategies on subsequent fertility following tubal ectopic pregnancy is unknown. Some women who have had ectopic pregnancies will have difficulty becoming pregnant again. The aim of this study is to evaluate the tubal patency after successful medical treatment of an un-ruptured tubal ectopic pregnancy with systemic methotrexate (MTX).

Methods: This is an observational retrospective study carried out on 72 women diagnosed as un-ruptured tubal ectopic pregnancy. Systemic treatment with a single dose methotrexate (50 mg/m² intramuscularly) was used for 32 women and 40 cases underwent surgery. Hysterosalpingography (HSG) was performed on 30 patients (successfully managed with methotrexate) and 40 cases that underwent unilateral salpingectomy (as initial treatment).

Results: The medical treatment with single dose MTX for EP was effective (93.8%) as a primary treatment. In the MTX group, the HSG findings from the ipsilateral tube showed that 83.3% the diseased tubes were open and 16.7% were obstructed. The contralateral tube was patent in 93.3% and obstructed in 6.7%. In salpingectomy group the contralateral tube was patent in 82.5% and obstructed in 17.5%.

Conclusion: For an un-ruptured tubal EP, the medical treatment with MTX is effective. Routine HSG following medical treatment does not seem necessary but might be considered in selected risk cases.




doi: http://dx.doi.org/10.4021/jcgo48w