Comparison the results of hysterosalpangiography in patients with ectopic pregnancy treated by laparoscopic salpingostomy, laparotomy, and treated with methotrexate

Document Type : Original Article

Authors

Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Ectopic pregnancy (EP) occurs in 1% of pregnancies, and may seriously effects on women's health and future fertility so this study aimed to compare the results of hysterosalpingography (HSG) after treatment of EP by laparoscopy, laparotomy, and methotrexate (MTX) therapy. Materials and Methods: This was a clinical trial study was done on 112 EP women with treatment indication referred to Isfahan Al-Zahran and Shahid Beheshti Hospitals from 2017 to 2018. They were divided into 33 populated groups of laparoscopic salpingostomy, laparotomy and MTX. Then patients of three groups underwent HSG 3 months after intervention. The factors such beta human chorionic gonadotropin (β–hCG) (mIU/mL), size of EP (mm), infection, hospital length of stay (LOS), and tubal patency were recorded and compared between the groups. Results: There were no significant differences between groups for age, body mass index, β–hCG, Size of EP, and hospital LOS (P > 0.05). The infection was more frequent in laparotomy group with no significant difference among three groups. The infection rates were 9%, 12%, and 6% for MTX, laparotomy, and laparoscopy arms, respectively. Between the three groups tubal patency as primary outcome had higher frequency than laparoscopy group, although, the difference was not statistically significant (P = 0.595). Conclusion: Although infection was more in laparotomy and that tubal patency was more within 3 months in laparoscopy and MTX, there were no statistically significant differences in the results of laparoscopy, laparotomy, and MTX in HSG results.

Keywords

1.
Chaudhary P, Manchanda R, Patil VN. Retrospective study on laparoscopic management of ectopic pregnancy. J Obstet Gynaecol India 2013;63:173-6.  Back to cited text no. 1
    
2.
Kamwendo F, Forslin L, Bodin L, Danielsson D. Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Sex Transm Infect 2000;76:28-32.  Back to cited text no. 2
    
3.
Soliman HH. Single dose Methotrexate injection, could be a safe and effective treatment for early cases of tubal ectopic pregnancy, with minimal maternal health hazards. Evid Based Womens Health J 2019;9:501-6.  Back to cited text no. 3
    
4.
Alkhafajy WR, Alyaseen FF. Tubal patency and pregnancy rate following surgical and medical treatments of ectopic pregnancy. Indian J Public Health Res Dev 2018;9:1906-10.  Back to cited text no. 4
    
5.
Mol F, Mol BW, Ankum WM, van der Veen F, Hajenius PJ. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: A systematic review and meta-analysis. Hum Reprod Update 2008;14:309-19.  Back to cited text no. 5
    
6.
Ye XP, Yang YZ, Sun X×. A retrospective analysis of the effect of salpingectomy on serum anti Mu¨llerian hormone level and ovarian reserve. Am J Obstet Gynecol 2015;212:53.e1-10.  Back to cited text no. 6
    
7.
Uyar I, Yucel OU, Gezer C, Gulhan I, Karis B, Hanhan HM, et al. Effect of single-dose methotrexate on ovarian reserve in women with ectopic pregnancy. Fertil Steril 2013;100:1310-3.  Back to cited text no. 7
    
8.
Boots CE, Gustofson RL, Feinberg EC. Does methotrexate administration for ectopic pregnancy after in vitro fertilization impact ovarian reserve or ovarian responsiveness? Fertil Steril 2013;100:1590-3.  Back to cited text no. 8
    
9.
Hill MJ, Cooper JC, Levy G, Alford C, Richter KS, DeCherney AH, et al. Ovarian reserve and subsequent assisted reproduction outcomes after methotrexate therapy for ectopic pregnancy or pregnancy of unknown location. Fertil Steril 2014;101:413-9.  Back to cited text no. 9
    
10.
Ulug P, Oner G. Evaluation of the effects of single or multiple dose methotrexate administration, salpingectomy on ovarian reserve of rat with the measurement of anti-Müllerian hormone (AMH) levels and histological analysis. Eur J Obstet Gynecol Reprod Biol 2014;181:205-9.  Back to cited text no. 10
    
11.
Lin YJ, Ou YC, Huang FJ, Lin PY, Kung FT, Lan KC, et al. Ovarian response to gonadotropins in patients with tubal factor infertility: Salpingectomy versus nonsalpingectomy. J Minim Invasive Gynecol 2013;20:637-41.  Back to cited text no. 11
    
12.
Lund Kårhus L, Egerup P, Wessel Skovlund C, Lidegaard Ø. Long-term reproductive outcomes in women whose first pregnancy is ectopic: A national controlled follow-up study. Hum Reprod 2013;28:241-6.  Back to cited text no. 12
    
13.
Sahin C, Taylan E, Akdemir A, Ozgurel B, Taskıran D, Ergenoglu AM, et al. The impact of salpingectomy and single-dose systemic methotrexate treatments on ovarian reserve in ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 2016;205:150-2.  Back to cited text no. 13
    
14.
Fakheri T, Farshchian N, Rezaie M, Seyedzadeh SM. Comparison of the effect of single and multiple-dose methotrexate therapy on tubal patency in women with ectopic pregnancy. Sci J Kurdistan Univ Med Sci 2016;20:26-33.  Back to cited text no. 14
    
15.
Garcia Grau E, Checa Vizcaíno MÁ, Oliveira M, Lleberia Juanós J, Carreras Collado R, Canet Estevez Y, et al. The value of hysterosalpingography following medical treatment with methotrexate for ectopic pregnancy. Obstet Gynecol Int 2011;2011:547946.  Back to cited text no. 15
    
16.
Chiu NC, Ho CH, Shen SH, Tsuei YC, Lee KL, Huang CY, et al. Impact of hysterosalpingography after operative treatment for ectopic pregnancy in Taiwan: A 16-year nationwide population-based analysis. Medicine (Baltimore) 2017;96:e7263.  Back to cited text no. 16
    
17.
Vermesh M, Silva PD, Rosen GF, Stein AL, Fossum GT, Sauer MV, et al. Management of unruptured ectopic gestation by linear salpingostomy: A prospective, randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecol 1989;73:400-4.  Back to cited text no. 17
    
18.
Ozcan MC, Wilson JR, Frishman GN. A systematic review and meta-analysis of surgical treatment of ectopic pregnancy with salpingectomy versus salpingostomy. J Minim Invasive Gynecol 2020; 28: 656-667.  Back to cited text no. 18
    
19.
Shalev E, Peleg D, Tsabari A, Romano S, Bustan M. Spontaneous resolution of ectopic tubal pregnancy: Natural history. Fertil Steril 1995;63:15-9.  Back to cited text no. 19
    
20.
Rantala M, Mäkinen J. Tubal patency and fertility outcome after expectant management of ectopic pregnancy. Fertil Steril 1997;68:1043-6.  Back to cited text no. 20
    
21.
Mol BW, Swart P, Bossuyt PM, Van der Veen F. Is hysterosalpingography an important tool in predicting fertility outcome? Fertil Steril 1997;67:663-9.  Back to cited text no. 21