Presentation is loading. Please wait.

Presentation is loading. Please wait.

Salpingo(s)tomy vs salpingectomy impact on future fertility European Surgery in Ectopic Pregnancy (ESEP) study.

Similar presentations


Presentation on theme: "Salpingo(s)tomy vs salpingectomy impact on future fertility European Surgery in Ectopic Pregnancy (ESEP) study."— Presentation transcript:

1 Salpingo(s)tomy vs salpingectomy impact on future fertility European Surgery in Ectopic Pregnancy (ESEP) study

2 ESEP: Tan Lines from Typical Summer Activities …… ESEP

3 Background RCT systemic MTX vs salpingo(s)tomy 1993-1996, the Netherlands 5 centers, n = 100 Primary outcome: elimination of tubal pregnancy (hCG < 2 IU/L) and preservation of the tube by primary treatment Secondary outcomes: Spontaneous IUP Repeat EP Quality of Life Patients preference Costs Multiple dose MTX im Salpingo(s)tomy randomisation MTX - systemic methotrexate (four 1.0 mg/kg doses of intramuscular methotrexate alternated with 0.1 mg/kg oral folinic acid) Inclusion: laparoscopically confirmed unruptured tubal pregnancy

4 Conclusions MTX vs salpingo(s)tomy Both treatments were equally effective Fertility after MTX was not improved MTX had more negative impact on Quality of Life MTX is only cost-effective in patients with serum hCG < 3,000 IU/l in a non invasive strategy Surgery: primary intervention Reference Hajenius et al Lancet 1997, Nieuwkerk et al Fertil Steril 1998, Mol et al Am J Obstet Gynecol 1999

5 Surgery for tubal pregnancy salpingo(s)tomy or salpingectomy? Review 1996 No difference for IUP Salpingostomy: more repeat EP, more persistent trophoblast No advantage for salpingostomy However? ….. did not take into account: Wish to conceive Time to IUP Spontaneous conception vs IVF-ET Reference: Clausen et al, Acta Obstet Gynecol. Scand 1996

6 Salpingo(s)tomy or salpingectomy? retrospective cohort study 1988 AZG en AMC salpingo(s)tomy n = 56 salpingectomy n = 79 Reference: BW Mol et al Hum Reprod 1998 FRR IUP: 1.9 (0.91-3.8) no tubal pathology 1.4 (0.68-2.7) bilateral tubal pathology 3.1 (0.76-12) FRR repeat EP 2.4 (0.57-11) Persistent trophoblast 7%

7 ESEP study salpingo(s)tomy vs salpingectomy in tubal EP with a normal contra lateral tube Pros: Shorter time to IUP More spontaneous IUP Cons: Risk repeat EP Persistent trophoblast ? ESEP!

8 Salpingo(s)tomy vs salpingectomy impact on future fertility European Surgery in Ectopic Pregnancy (ESEP) study

9 salpingo(s)tomy salpingectomy randomisation laparoscopy Informed consent All patients suspected for tubal EP sceduled for surgery Exclusion criteria shock pregnant after IVF-ET known bilateral tubal pathology history of tubectomy Tubal EP? Normal contra lateral tube?

10 Inclusion and randomisation Website http://www.esepstudy.nl Inlog: ghz Wachtwoord: Hart Download patient information Online CRF Online Randomisation

11 Salpingo(s)tomy or salpingectomy Primary outcome Spontanous IUP (follow-up 3 yrs post surgery) Secondary outcomes Repeat EP Persistent trophoblast Costs Patients preference ESEP coördinators serum hCG check in both strategies

12 ESEP 33 centers The Netherlands 19 centers AMCOLVG UMCG Máxima MC UMCNBovenIJ LUMCTwee Steden AZM Reinier de Graaf UMCUAntonius Vie curiLucas Andreas EdeDeventer GelreWaterland Bronovo Groene Hart UK3 centers Kings College Hospital, Londen Birmingham (mec) Leeds (mec) Sweden 8 centers Sahlgrenska University Skövde Näl Varberg Halmstad Örebro KK Karlstad Södersjukhuset KK Norway1 center Akershus, Oslo USA1 center Wakeforest, NC

13 New….. Participating centers Wake Forest University, Winston-Salem, NC, USA Tamer Yalcinkaya Ineke Janssen Groene Hart ziekenhuis Gouda

14 Inclusion Total 115 SE 45 NL 45 UK 25

15 Demonstratie website European Surgery in Ectopic Pregnancy (ESEP) study

16

17

18 ESEP Hartelijk dank namens de studiegroep Femke Mol, Petra Hajenius, Ben Willem Mol, Pim Ankum, Fulco van der Veen en Nancy Klein Annika Strandell, Emma Sawyer en Davor Jurkovic esep@amc.uva.nl

19 New……newsletter

20 Online randomisation https://lin1.holding.gu.se/esep/ Select center Password Dessel Login

21 1. PIN 2. Initials 3. Date of Birth yyyy-mm-dd 4. History tubal pathology 5. Submit Online randomisation

22 Emergency procedure randomisation by envelopes After randomisation, please inform by Fax: +46 31 419 756 E-mail: esep@amc.uva.nl


Download ppt "Salpingo(s)tomy vs salpingectomy impact on future fertility European Surgery in Ectopic Pregnancy (ESEP) study."

Similar presentations


Ads by Google