Preserving a fallopian tube following an ectopic
pregnancy seems like it would favor a woman’s fertility prospects, right?
A new study from Wake Forest Baptist Medical Center
looked at pregnancy outcomes in regards to the two surgical treatments for
ectopic pregnancy -- salpingectomy,
in which the affected fallopian tube is removed, or salpingotomy, in which the
tube is preserved.
aim of the study, said co-author Tamer Yalcinkaya, M.D., a reproductive
endocrinologist at Wake Forest Baptist, was to assess whether salpingotomy
would improve rates of subsequent pregnancy by natural conception compared with
women with a tubal pregnancy and a healthy opposite tube, salpingotomy does not
significantly improve fertility prospects compared with salpingectomy,”
Yalcinkaya said. “We have pondered what we should do, but it’s never been
studied. This study provides an answer -- saving the fallopian tube does not
show any improved benefit.”
research was published last month in The Lancet.
study found that ongoing pregnancy by natural conception was about 61 percent
after salpingotomy and 56 percent after salpingectomy. If the opposite tube is
normal, doctors can now just remove the tube out which is a quicker procedure,
less complex and invasive and eliminates the persistence of another occurring
ectopic pregnancy, Yalcinkaya said. Persistent growth of pregnancy tissue
occurred more frequently in the salpingotomy group than in the salpingectomy
group, the study reports.
pregnancy affects 3 percent of all pregnancies and is one of the leading causes
of maternal death, but the surgical treatment choices have never been compared
head to head, he said.
Yalcinkaya and colleagues conducted a multicenter, international, randomized
controlled trial of women aged 18 years and older with a laparoscopically
confirmed tubal pregnancy and a healthy contralateral tube. A total of 446
women were randomly assigned to receive salpingotomy (215) or salpingectomy
(231) from 2004 to 2011. Forty-three (20 percent) women in the salpingotomy
group were converted to salpingectomy during the initial surgery because of
persistent tubal bleeding, the study said.
ectopic pregnancy occurred in 18 women (8 percent) in the salpingotomy group
and 12 (5 percent) women in the salpingectomy group, the study reports.The
number of ongoing pregnancies after ovulation induction, intrauterine
insemination, or IVF did not differ significantly between the groups.
said his team’s meta-analysis, which included their own results and those of
one other study, substantiated the results of the trial.
This research was conducted by teams from Amsterdam,
The Netherlands, Sweden, London, Australia, and University of Pennsylvania.
It was supported by
Organization for Health Research and Development (ZonMW), Region Västra
Götaland Health & Medical Care Committee.