Long term outcomes of radical and conservative surgery for late diagnosed tubal pregnancies

Abstract

Objective: To investigate long-term postoperative outcomes of conservative and radical surgery in ectopic tubal pregnancies, and evaluate the results of these techniques. Methods: A total of 145 patients that operated for tubal pregnancy between January 2006 and January 2009 were reviewed. Data on patient age, reproductive and surgical history, history of ectopic pregnancies, serum hCG levels at the time of diagnosis and intraoperative observation were retrospectively obtained from hospital records. Telephone interviews were used to obtain information about exact postoperative time interval in which the patients were trying to get pregnant, and the time when they spontaneously became pregnant. Results: There was no significant difference in cumulative spontaneous intrauterine pregnancy rate for a 2-year of conception period subsequent to conservative (64.3%) and radical (58.3%) surgery (p=0.636). During the same time interval, the rates of development of ectopic pregnancy for the conservative and radical surgery groups were 17.9% and 4.2%, respectively (p= 0.093). The patients who developed ectopic pregnancy after conservative surgery had significantly higher levels of serum hCG levels (7413+/-3155 IU/L) compared with those of patients who not-developed ectopic pregnancy (3436+/-2668 IU/L) (p=0.007). Conclusion: In late-diagnosed cases with higher serum hCG levels, conservative treatment should not be the first choice. Indeed, our results suggested that the cumulative pregnancy rates are not significantly higher, and the risk of ectopic pregnancy recurrence may be increased with conservative surgery in late tubal pregnancies.