Reproductive Outcomes After a Previous Episode of Tubal Ectopic Pregnancy in Patients Managed Expectantly and Surgically

Study Overview
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Brief Summary
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Although ectopic pregnancy was considered a leading cause of first-trimester maternal mortalities, current technological improvements allowed early diagnosis and opened a door for applying less invasive approaches. A tubal pregnancy could be managed either expectantly, medically, or surgically. The expectant management of ectopic pregnancy relies on the fact that a considerable proportion of ectopic gestations terminate by spontaneous tubal abortion. This approach is usually kept for stable cases with a small gestational sac and low beta-human chorionic gonadotropin (beta-HCG) serum levels. For hemodynamically unstable patients, higher levels of beta-HCG, and larger gestational sacs, surgery is often considered as the treatment of choice (16). Considering this background, the study aims to analyze the subsequent natural reproductive outcomes of patients that had a previous tubal ectopic pregnancy and were managed either expectantly or surgically. Moreover, it amis to determine the factors that could influence the fertility potential of these patients in each treatment group.

Official Title
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Evaluation of Reproductive Outcomes After Expectant or Surgical Management of a Previous Episode of Tubal Ectopic Pregnancy

Conditions
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Ectopic Pregnancy

Intervention / Treatment
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* Other: Expectant management
* Procedure: Salpingectomy
* Procedure: Salpingostomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women with one episode of tubal ectopic pregnancy, treated by expectant management, salpingectomy, or salpingostomy; For patients treated surgically, only patients with at least one patent Fallopian tube confirmed via postoperative hysterosalpingography were included in the analysis. Exclusion Criteria: Pregnancies of unknown location Other types of ectopic pregnancy Pelvic inflammatory disease Pelvic adhesions Intrauterine pathologies Pregnancies obtained after assisted-reproductive technologies (ART)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Ectopic pregnancy<br>Women with diagnosed tubal ectopic pregnancy | Other: Expectant management<br>* Follow-up with beta-HCG dosages and transvaginal ultrasound scans<br>Procedure: Salpingectomy<br>* Removal of the affected Fallopian tube by laparoscopy<br>Procedure: Salpingostomy<br>* Removal of the ectopic pregnancy from the Fallopian tube, without removing the whole Fallopian tube, by laparoscopy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical pregnancy rate | Presence of a gestational sac under ultrasonography | Within one year after the previous episode of tubal ectopic pregnancy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ectopic pregnancy, Expectant management, Pregnancy outcome, Salpingectomy, Salpingostomy