Retrospective analysis of laparoscopic salpingostomy and conservative expectant management of tubal ectopic pregnancy
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ORIGINAL ARTICLE
Retrospective analysis of laparoscopic salpingostomy and conservative expectant management of tubal ectopic pregnancy Kunitomo Takashima Æ Hiroshi Yoshida Æ Mariko Murase Æ Aya Sato Æ Hideya Sakakibara Æ Fumiki Hirahara Æ Masahiko Ishikawa
Received: 22 December 2008 / Accepted: 1 June 2009 / Published online: 1 July 2009 Ó Japan Society for Reproductive Medicine 2009
Abstract Purpose To identify predictive factors for successful expectant management of ectopic pregnancy and to evaluate the prognosis for fertility after expectant management and laparoscopic salpingostomy. Methods Forty-six cases of expectant management and eighty cases of laparoscopic salpingostomy for tubal ectopic pregnancy were retrospectively analyzed. Subjects were classified in three groups: those who underwent laparoscopic salpingostomy, those treated by expectant management only, and those treated by expectant management but requiring additional treatment. Results The rates of tubal patency, intrauterine pregnancy and repeated ectopic pregnancy in the laparoscopic salpingostomy group were 75, 40, and 16%. The rates in the expectant management group were not significantly different: 72, 42 and 15%. Finally, the rates in the extra treatment group were 75, 39 and 15%. Success rate of expectant management was 54%. In 93% of cases expectant management was successfully completed when the initial levels of urinal hCG were less than 3000 mIU/ml
K. Takashima H. Yoshida (&) M. Murase A. Sato M. Ishikawa Department of Gynecology, Yokohama City University, Medical Center Hospital, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, Japan e-mail: [email protected] H. Sakakibara F. Hirahara Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
and the levels of hCG 48 h later were less than 80% of the initial levels. However, expectant management alone was insufficient and required extra treatment in 90% of cases when the initial levels of hCG were 3000 mIU/ml and above or when the levels of hCG level 48 h later was 80% of initial levels and above. Conclusions Expectant management in combination with salpingostomy is not only minimally invasive but also a useful way to preserve fertility. Initial urine hCG levels and their variation over time can help predict whether expectant management will succeed. Keywords Ectopic pregnancy Expectant management Fertility hCG Laparoscopic liner salpingostomy
Introduction Laparoscopic treatment and methotrexate administration are often introduced for ectopic tubal pregnancy because earlier diagnosis is now possible using highly sensitive hCG assays and transvaginal sonographs. When circulating hCG levels are stable, even conservative management can be chosen under certain conditions. So far, many cases have been reported in which conservative expectant therapy has succeeded. Thus, some of our cases with minor symptoms opted for expectant management. However, some cases enrolled in expectant managemen
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