eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Surgical Management of Ectopic Pregnancy: Follow-up

Author: Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM, Medical Director of Perinatal Services, Bellin Health Hospital Center
Coauthor(s): Herbert S Coussons, MD, FACOG, Private Practice in Obstetrics and Gynecology, Women's Specialty Care
Contributor Information and Disclosures

Updated: Feb 17, 2010

Outcome and Prognosis

The prognosis for patients with an ectopic pregnancy is good for those with an early diagnosis.

Fertility may be conserved in those patients diagnosed with an ectopic pregnancy. The earlier the diagnosis is made and treatment administered, the higher the likelihood of subsequent fertility.

Thirty years ago, when the diagnosis was seldom made prior to rupture, the likelihood of a subsequent healthy term pregnancy was only approximately 35%. Currently, that number is closer to 85%. The difference is in the earlier diagnosis and treatment before the ectopic pregnancy can grow large enough to severely damage the tube.

Another factor in the improved fertility rate may be related to fewer salpingectomies and more salpingostomies. In a retrospective cohort study of 651 women who underwent an operation for their first ectopic pregnancy, Bangsgaard et al reported a fertility rate of 88% after conservative surgery (salpingostomy) versus only 66% after radical surgery (salpingectomy).7 They also found no difference in recurrence rates for ectopic pregnancy in the 2 groups. However, 8% of the group that underwent conservative treatment had persistent ectopic pregnancies. These were all treated with either methotrexate or repeat surgery. This shows the need to monitor all conservatively treated patients with serial β-hCG measurements until values return to negative.

Future and Controversies

Few well-designed studies have been done for the prevention, management, and treatment of ectopic pregnancy. Randomized controlled trials to assess the benefits and harms of the 3 different management strategies (expectant management, medical management, and surgery) are a priority. All such studies should include long-term outcomes of fertility, repeat ectopic pregnancy, health-related quality of life, treatment preferences, and the cost-effectiveness of each treatment option.

Biochemical markers for diagnosis of ectopic pregnancies have been studied but none have been found to be specific enough to be used clinically. The ideal marker should be specific for tubal damage or endometrial implantation. Leukemia inhibitory factor and smooth muscle heavy chain myosin do not appear to have the specificity needed to be used clinically. Three-dimensional ultrasonography has not been found to be superior to transvaginal sonography for the diagnosis of an ectopic pregnancy.

 


More on Surgical Management of Ectopic Pregnancy

Overview: Surgical Management of Ectopic Pregnancy
Workup: Surgical Management of Ectopic Pregnancy
Treatment: Surgical Management of Ectopic Pregnancy
Follow-up: Surgical Management of Ectopic Pregnancy
Multimedia: Surgical Management of Ectopic Pregnancy
References
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References

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Further Reading

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Keywords

tubal pregnancy, ovarian pregnancy, abdominal pregnancy, heterotopic pregnancy, extrauterine pregnancy, maternal mortality, pregnancy complications, problem pregnancy, ectopic, beta hCG, beta-hCG, culdocentesis, salpingitis, failed tubal surgical sterilization, failed sterilization, tubal ligation, progestin-containing intrauterine device, progestin-containing IUD, pelvic pain, vaginal spotting, EP, tubal ring, extrauterine mass, interstitial EP, interstitial ectopic pregnancy, interstitial line sign, cervical pregnancy, hemosalpinx, salpingectomy, salpingotomy, laparoscopy, fimbrial evacuation

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Contributor Information and Disclosures

Author

Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM, Medical Director of Perinatal Services, Bellin Health Hospital Center
Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Society for Gynecologic Investigation, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Herbert S Coussons, MD, FACOG, Private Practice in Obstetrics and Gynecology, Women's Specialty Care
Herbert S Coussons, MD, FACOG is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Christian Medical & Dental Society, Idaho Medical Association, Washington State Medical Association, and Wisconsin Medical Society
Disclosure: Intuitive Surgical Consulting fee Proctor; Conceptus Consulting fee Proctor

Medical Editor

John J Kavanagh Jr, MD, Chief, Professor, Department of Internal Medicine, Section of Gynecological and Medical Therapeutics, MD Anderson Cancer Center, University of Texas College of Medicine
John J Kavanagh Jr, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association for the History of Medicine, American College of Physicians, American Federation for Medical Research, American Medical Association, Society of Gynecologist Oncologists, Southern Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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