Presentation on theme: "Salpingo(s)tomy vs salpingectomy impact on future fertility"— Presentation transcript:
1 Salpingo(s)tomy vs salpingectomy impact on future fertility European Surgery in Ectopic Pregnancy (ESEP) studySalpingo(s)tomy vs salpingectomy impact on future fertility
2 ESEP: Tan Lines from Typical Summer Activities ……
3 Background RCT systemic MTX vs salpingo(s)tomy , the Netherlands5 centers, n = 100Primary outcome:elimination of tubal pregnancy (hCG < 2 IU/L) and preservation of the tube by primary treatmentSecondary outcomes:Spontaneous IUPRepeat EPQuality of LifePatients preferenceCostsInclusion:laparoscopicallyconfirmedunrupturedtubal pregnancyrandomisationMultiple doseMTX imSalpingo(s)tomyMTX - systemic methotrexate (four 1.0 mg/kg doses of intramuscular methotrexate alternated with 0.1 mg/kg oral folinic acid)
4 Conclusions MTX vs salpingo(s)tomy Both treatments were equally effectiveFertility after MTX was not improvedMTX had more negative impact on Quality of LifeMTX is only cost-effective in patients with serum hCG < 3,000 IU/l in a non invasive strategySurgery: primary interventionReference 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 1996No difference for IUPSalpingostomy: more repeat EP, more persistent trophoblastNo advantage for salpingostomyHowever? ….. did not take into account:Wish to conceiveTime to IUPSpontaneous conception vs IVF-ETReference: Clausen et al, Acta Obstet Gynecol. Scand 1996
6 Salpingo(s)tomy or salpingectomy? retrospective cohort study 1988 AZG en AMCsalpingo(s)tomy n = 56salpingectomy n = 79FRR IUP: 1.9 ( )no tubal pathology 1.4 ( )bilateral tubal pathology 3.1 ( )FRR repeat EP 2.4 ( )Persistent trophoblast 7%Reference: BW Mol et al Hum Reprod 1998
7 ESEP study salpingo(s)tomy vs salpingectomy in tubal EP with a normal contra lateral tube Pros:Shorter time to IUPMore spontaneous IUPCons:Risk repeat EPPersistent trophoblast?ESEP!
8 Salpingo(s)tomy vs salpingectomy impact on future fertility European Surgery in Ectopic Pregnancy (ESEP) studySalpingo(s)tomy vs salpingectomy impact on future fertility
9 All patients suspected for tubal EP Normal contra lateral tube? sceduled for surgeryExclusion criteriashockpregnant after IVF-ETknown bilateral tubal pathologyhistory of tubectomyInformed consentlaparoscopyTubal EP?Normal contra lateral tube?randomisationsalpingo(s)tomysalpingectomy
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