Prognostic role of laparoscopic salpingoscopy of the only remaining tube after contralateral ectopic pregnancy.

OBJECTIVE

To evaluate the prognostic value of laparoscopic salpingoscopy in detecting patients who are at increased risk for a repeat ectopic pregnancy (EP).

DESIGN

Patients with secondary infertility after a previous contralateral salpingectomy for EP were evaluated by laparoscopy with tubal perfusion and salpingoscopy of the only remaining tube. Subsequent reproductive outcome was evaluated and correlated to laparoscopic and salpingoscopic findings.

SETTING

Department of Obstetrics and Gynecology of the Catholic University, a tertiary care university center in Rome, Italy.

PATIENTS

Eighteen patients submitted to laparoscopy and salpingoscopy after a previous salpingectomy for EP.

INTERVENTION

A two- to three-puncture laparoscopy with tubal perfusion and salpingoscopy.

MAIN OUTCOME MEASURE

Reproductive outcome after a mean follow-up of 42.6 months.

RESULTS

Salpingoscopy revealed a normal tubal mucosa in 13 patients (72%) and intra-ampullary adhesions in 5 patients (28%). Eight of the 13 patients with a normal mucosa conceived an intrauterine pregnancy. In the 5 patients with intra-ampullary adhesions, there were 3 repeat EPs, with one patient having first a term pregnancy and then a repeat EP. The presence of peritubal adhesions at laparoscopy was not of prognostic significance.

CONCLUSION

Direct visualization of the ampullary mucosa by salpingoscopy can allow the detection of intraluminal adhesions that put the patient at increased risk for a repeat EP.