Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Mouwasat Hospital, Saudi Arabia.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2241106. doi: 10.1080/14767058.2023.2241106.
The impact of various management plans on subsequent fertility after tubal ectopic pregnancy (EP) is not well known. The objective of the present study was an evaluation of the subsequent fertility outcome among women with EP managed either surgical or medical with systemic methotrexate or medical management followed by surgical one.
A retrospective cohort study was done by reviewing of medical records of all women diagnosed with EP at King Faisal Military Hospital, Southern Region, Saudi Arabia throughout the period from January 2015 to December 2016 provided that they were hemodynamic stable, with starting βhCG level less than 10000 IU/L, and adnexal mass less than 5 cm. These cases were followed for four years from January 2017 to December 2020.
The study included 85 women with EP. Their mean age was 31.3 ± 6.7 years. Medical management (systemic Methotrexate) was followed in 48.2% of cases whereas surgical management was applied for 43.5% of them while medical management followed by surgical one was seen in 8.2% of cases. Complete follow-up throughout 2017-2020 was available for 52 women. A history of recurrent EP was observed among 3 women (5.8%). Most of them (75%) had a viable pregnancy. There was no statistically significant association between the method of management of EP and subsequent fertility, although the rate of normal pregnancy (intrauterine viable pregnancy ≥ 24 weeks which is the age of viability at our hospital) was higher among those managed surgically or by medical followed by surgical management than those managed medical only (84.6% and 100% vs. 62.5%).
Although the normal pregnancy rate was higher among those managed surgically or by medical followed by surgical management than those managed medically only, this was not statistically significant.
各种管理方案对输卵管妊娠（EP）后后续生育能力的影响尚不清楚。本研究的目的是评估在沙特阿拉伯南部地区法伊萨尔国王军事医院接受 EP 治疗的女性中，通过手术或全身甲氨蝶呤进行药物治疗，或在药物治疗后进行手术治疗的女性的后续生育结局。
通过回顾 2015 年 1 月至 2016 年 12 月期间在沙特阿拉伯南部地区法伊萨尔国王军事医院诊断为 EP 的所有女性的病历进行回顾性队列研究，这些女性必须血流动力学稳定，β-hCG 起始水平<10000IU/L，附件包块<5cm。这些病例从 2017 年 1 月到 2020 年 12 月进行了四年的随访。
该研究纳入了 85 例 EP 患者。她们的平均年龄为 31.3±6.7 岁。48.2%的患者接受了药物治疗（全身甲氨蝶呤），43.5%的患者接受了手术治疗，8.2%的患者接受了药物治疗后手术治疗。2017-2020 年期间，52 名患者的完整随访记录可查。3 名患者（5.8%）有复发性 EP 病史。大多数患者（75%）有活产妊娠。EP 的治疗方法与后续生育能力之间无统计学显著关联，尽管与仅接受药物治疗的患者相比，接受手术或药物治疗后手术治疗的患者正常妊娠率（在我院，存活妊娠≥24 周，即胎儿存活的年龄）较高（84.6%和 100%比 62.5%）。
尽管与仅接受药物治疗的患者相比，接受手术或药物治疗后手术治疗的患者的正常妊娠率较高，但差异无统计学意义。
