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Tubal ectopic pregnancy: a retrospective cohort study on clinical characteristics, treatment options and reproductive outcomes within 5 years

  • General Gynecology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate the association between different treatments of tubal ectopic pregnancy (EP) —expectant management, methotrexate (MTX), selected or recommended laparoscopic surgery—and the subsequent reproductive outcomes.

Methods

We conducted a retrospective cohort study including 228 EPs. The patients were divided into four treatment groups: 28 (12.3%) with expectant management successfully, 60 (26.3%) with MTX successfully, 140 patients with laparoscopic salpingectomy, of which 47 (20.6%) were assigned to selected surgery group because they opted for surgical treatment versus MTX, 93 (40.8%) were assigned to recommended surgery group as recommended by the attending physician.

Results

The recommended surgery group had the lowest rate of intrauterine pregnancy (IUP) (77.42%) and live birth (LB) (72.04%), while the incidence of recurrent EP (REP) (20.43%) was the highest, but the statistical differences were not significant. We did not observe significant differences of the EP-IUP time interval, rates of LB and miscarriage (MIS) between the four groups. Compared to the MTX group, recommended surgery was negatively associated with IUP (adjusted OR, 95%CI: 0.34, 0.11–1.03) and LB (0.35, 0.14–0.92), while it had higher risk for REP (3.48, 1.03–11.74) in the subsequent pregnancy. Further, compared to selective surgery group, recommended surgery was negatively associated with IUP (0.15, 0.03–0.68) and LB (0.23, 0.07–0.74), while it had higher risk for REP (6.83, 1.43–32.67) in the subsequent pregnancy. Expectant treatment was negatively associated with assisted reproductive technology (ART) (0.08, 0.02–0.40) compared with MTX. Of the185 patients who had LBs, all adverse outcomes were not statistically different between the four groups.

Conclusion

Patients with recommended laparoscopic salpingectomy had worse reproductive outcomes than the other treatment groups. The disease status of EP may play an important role in the association rather than the surgery alone.

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Funding

This work was supported by [The National Natural Science Foundation of China] (Grant numbers [81971338] and [81971338], Wen Lu).

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Author notes

  1. Yu-ting Shen and Ying-ying Yang have equally contributed to this work.

Authors and Affiliations

  1. Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China

    Yu-ting Shen, Ping-gui Zhang, La-man He, Rong-hua Che & Wen Lu

  2. Clinical Research Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China

    Ying-ying Yang & Zhen Li

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  1. Yu-ting Shen
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Contributions

YS Data collection, Data analysis, Manuscript writing and editing, Forming Table 1/2/3 and Fig. 1, Manuscript revision. YY Data analysis, Statistical analysis, Forming Fig. 2, Manuscript revision. PZ Data collection. LH Data collection. RC Data collection. ZL Statistical analysis, Manuscript revision. WL Project development, Manuscript revision.

Corresponding authors

Correspondence to Zhen Li or Wen Lu.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was approved by the Ethics Committee, Shanghai First Maternity and Infant Hospital, No. KS21336.

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Informed consent was obtained from all individual participants included in the study.

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Shen, Yt., Yang, Yy., Zhang, Pg. et al. Tubal ectopic pregnancy: a retrospective cohort study on clinical characteristics, treatment options and reproductive outcomes within 5 years. Arch Gynecol Obstet 306, 2055–2062 (2022). https://doi.org/10.1007/s00404-022-06690-2

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  • DOI: https://doi.org/10.1007/s00404-022-06690-2

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