Tubal patency assessment using sequential transvaginal ultrasound and hysterosalpingo-foam sonography after methotrexate treatment for tubal pregnancy: a new approach to an old challenge

CONTEXT AND OBJECTIVE: As there is little information about fertility outcomes among women following clinical treatment (methotrexate and expectant management) and surgery (salpingectomy) consequent to ectopic pregnancy, we evaluate the results from hysterosalpingography subsequent to treatment. The objective was to evaluate contralateral tubal patency using hysterosalpingography following surgery and clinical treatment of tubal pregnancy. DESIGN AND SETTING: This was a prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. METHOD: Among 115 patients who underwent hysterosalpingography following surgery and clinical treatment of tubal pregnancy between April 1994 and February 2002, 30 were treated with a single intramuscular dose of methotrexate (50 mg/m²), 50 were followed up expectantly and 35 underwent salpingectomy. RESULTS: The patency of the ipsilateral tube was 84% after methotrexate treatment and 78% after expectant management. In addition, contralateral tubal patency was 97% after methotrexate treatment, 92% after expectant management and 83% after salpingectomy. There were no statistically significant differences between the clinical treatment and surgery groups. CONCLUSIONS: The findings from this study suggest similar contralateral tubal patency rates following salpingectomy, methotrexate treatment and expectant management.

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Evaluation of tubal patency using hysterosalpingo-contrast sonography (HyCoSy) following salpingostomy and medical treatment of tubal pregnancy

Voprosy ginekologii akušerstva i perinatologii ◽

10.20953/1726-1678-2021-4-12-16 ◽

2021 ◽

Vol 20 (4) ◽

pp. 12-16

Author(s):

Aml El-Shabrawy ◽

◽

Ahmed Elsheikh ◽

Samy Gebreel ◽

Mohammed Elsokkary ◽

...

Keyword(s):

Medical Treatment ◽

Ectopic Pregnancy ◽

Success Rate ◽

Fallopian Tube ◽

Tubal Pregnancy ◽

Tubal Patency ◽

Group I ◽

Case Series Study ◽

Maternity Hospitals ◽

Significant Difference

Objective. Ectopic pregnancy adversely affects the patency of the fallopian tube and consequently the future pregnancy. There are different options of conservative treatment of tubal pregnancy such as methotrexate and salpingostomy [1]. There is little information on the success rate of maintaining tubal patency after methotrexate and salpingostomy [2]. Therefore, the aim of this study is to evaluate the ipsilateral tubal patency using HyCoSy after treatment of tubal pregnancy with methotrexate therapy versus salpingostomy. Patients and methods. This was a case-series study conducted in Ain Shams and Al-Azhar University Maternity Hospitals to evaluate the ipsilateral tubal patency using hysterosalpingo-contrast sonography (HyC0Sy) following salpingostomy and medical treatment of tubal pregnancy. This study included patients who were admitted to Ain Shams and Al-Azhar University Maternity Hospitals for having tubal pregnancy and were treated either with methotrexate or salpingostomy over a 4-year period between January 2017 and December 2020. The patients seeking fertility were re-evaluated for fallopian tubes patency by hysterosalpingogram 3 months after discharge. The study included 2 groups of women: group I (n = 200): women who were treated with methotrexate, and group II (n = 140): women who underwent salpingostomy. Results. HSG was performed in 200 cases of patients with tubal pregnancy who were treated with methotrexate and 140 cases of patients who underwent salpingostomy. The patency of the ipsilateral tube was 85% after methotrexate treatment and 84.2% after salpingostomy. There was no statistically significant difference between the two groups. Conclusion. The findings suggest similar success rate in maintaining the patency of the fallopian tube with either methotrexate or salpingostomy. Key words: ectopic pregnancy, hysterosalpingography, methotrexate, infertility, salpingostomy

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Unsuccessful methotrexate treatment of a tubal pregnancy with a live embryo

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/0028-2243(92)90262-w ◽

1992 ◽

Vol 46 (2-3) ◽

pp. 154-157

Author(s):

David Bider ◽

Gabriel Oelsner ◽

Dahlia Admon ◽

David Levran ◽

Mordechai Goldenberg ◽

...

Keyword(s):

Tubal Pregnancy ◽

Live Embryo ◽

Methotrexate Treatment

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Methotrexate treatment of tubal pregnancy

Fertility and Sterility ◽

10.1016/s0015-0282(16)54347-7 ◽

1991 ◽

Vol 55 (6) ◽

pp. 1033-1038 ◽

Cited By ~ 13

Author(s):

Lisa Cannon ◽

Hanna Jesionowska

Keyword(s):

Tubal Pregnancy ◽

Methotrexate Treatment

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Luteal blood flow as a predictive factor for methotrexate treatment outcomes in women with unruptured tubal pregnancy

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-02882-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Li Wang ◽

Meili Pei ◽

Ting Yang ◽

Juan Zhao ◽

Xiaofeng Yang

Keyword(s):

Blood Flow ◽

Treatment Outcomes ◽

Predictive Factor ◽

Tubal Pregnancy ◽

Methotrexate Treatment

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Methotrexate treatment of tubal pregnancy

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(91)90657-d ◽

1991 ◽

Vol 164 (1) ◽

pp. 231

Author(s):

Bruce G. Bateman

Keyword(s):

Tubal Pregnancy ◽

Methotrexate Treatment

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Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/906825 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Mara Clapp ◽

Jaou-Chen Huang

Keyword(s):

Ectopic Pregnancy ◽

Surgical Management ◽

Thermal Injury ◽

Tubal Pregnancy ◽

Effective Alternative ◽

Intrauterine Pregnancy ◽

Tubal Ectopic Pregnancy ◽

Tubal Patency ◽

Ectopic Pregnancies

Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue.Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG) confirmed tubal patency. The patient subsequently had an intrauterine pregnancy.Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.

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