IS SALPINGOSTOMY THE SURGICAL-TREATMENT OF CHOICE FOR UNRUPTURED TUBAL PREGNANCY

Salpingostomy has gradually replaced salpingectomy as the surgical pro cedure of choice for unruptured tubal pregnancy in women who wish to p reserve fertility. There are no prospective studies and only a few ret rospective reports comparing fertility rates after salpingostomy and s alpingectomy. Three major retrospective studies found no significant d ifference in fertility or incidence of repeat ectopic pregnancy betwee n the two procedures, but salpingostomy carries a 5-8% risk of persist ent ectopic pregnancy, contributing to increased morbidity and cost. T here are approximately 109,000 ectopic pregnancies per year in the Uni ted States. If half are treated by salpingostomy, 54,500 women will ne ed serial beta-hCG testing after surgery. Approximately 3543 will have a persistent ectopic pregnancy requiring surgical or medical treatmen t. The additional direct costs created by persistent ectopic pregnancy is estimated to be almost $16,000,000. Fertility after ectopic pregna ncy is affected much more by the status of the contralateral tube than by the procedure performed, with fertility rates exceeding 80% after salpingectomy when the opposite tube is normal. By performing salpinge ctomy when the contralateral tube is normal, half the additional cost and morbidity could be avoided without jeopardizing subsequent fertili ty.