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Evidence summaries

Conservative Versus Radical Surgery for Tubal Pregnancy

There is probably no significant difference in intrauterine pregnancy rates and repeat extrauterine pregnancy rates between conservative and radical tubal surgery. Level of evidence: "C"

A meta-analysis included 2 RCTs and 8 cohort studies with a total of 1 229 patients. The RCT (n=575) subgroup indicated that there was no statistically significant difference in intrauterine pregnancy (IUP) rates (RR 1.04, 95% CI 0.89 to 1.21, P 0.61) nor the repeat ectopic pregnancy (REP) rate (RR .30, 95% CI 0.72 to 2.38, P 0.39) between the salpingotomy and salpingectomy group. In contrast, in the cohort study subgroup (n=654) the IUP rate was higher in the salpingotomy group compared with the salpingectomy group (RR 1.24, 95% CI 1.08 to 1.42, P 0.002), and salpingotomy also increased the risk of REP rate (RR 2.27, 95% CI 1.12 to 4.58, P 0.02). The persistent ectopic pregnancy (PEP) occurred more frequently in the salpingotomy group than the salpingectomy group (RR 11.61, 95% CI 3.17 to 42.46, P 0.0002, n=932). An IUP would be more likely to occur after salpingotomy than salpingectomy when the follow-up time was more than 36 months (RR 1.16, 95% CI 1.02 to 1.32, P 0.03).

A systematic review 1 including 40 studies with a total of 4 832 subjects (15 non-comparative, retrospective studies including 1 383 patients, 15 comparative, retrospective studies including 2 965 patients, and 10 prospective, selected treatment series including 484 patients) was abstracted in DARE. No randomised controlled trials were found.

Retrospective, non-comparative studies: No statistically significant difference between intrauterine pregnancy rates was found following conservative tubal surgery (46%, 95% CI 41.7 to 51.0) or radical tubal surgery (44%, 95% CI 40.7 to 47.3). Repeat ectopic pregnancy rate was 10% (95% CI 7.8 to 13.6) following conservative surgery and 15% (95% CI 12.8 to 17.5) following radical surgery. The difference was not statistically significant.

Retrospective, comparative studies: Only 1/15 papers showed a significant difference between intrauterine pregnancy rates, and this was in favour of conservative surgery. None of the papers demonstrated a significant difference in repeat ectopic pregnancy rates.

Prospective, uncontrolled series: The average intrauterine pregnancy rate was 57% (95% CI 53.5 to 62.7) after conservative surgery. Only two studies compared conservative and radical surgery, with no difference found. The average repeat pregnancy rate was 13% (95% CI 10.4 to 16.9) after conservative tubal surgery.

    References

    • Clausen I. Conservative versus radical surgery for tubal pregnancy. A review. Acta Obstet Gynecol Scand 1996 Jan;75(1):8-12. [PubMed][DARE]
    • Cheng X, Tian X, Yan Z et al. Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis. PLoS One 2016;11(3):e0152343.[PubMed]

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