PREVIOUS ECTOPIC PREGNANCY SHOULD BE CONSIDERED A CONTRAINDICATION FOR MICROSURGERY

Background To estimate the risk of subsequent ectopic pregnancy (EP) a fter tubal surgery, given that the woman becomes pregnant, by means of a logistic model, a retrospective study was initiated. Methods. Durin g the period 1986-1990, 221 women with tubal infertility underwent mic rosurgery. Subsequent fertility was evaluated in 1991. Ninety women co nceived, of whom 84 were included in the study (30 with EP and 54 with intra-uterine pregnancy as the only outcome). Clinical background fac tors of importance, surgical procedures used, scoring systems for tuba l lesions, adnexal adhesions and risk of EP were analysed for possible correlation to subsequent EP. These factors were further used in a lo gistic model to estimate the risk of subsequent EP as only outcome. Re sults. The risk of EP after microsurgery is minimum 15% without any ri sk factors. Previous EP and endometriosis could be identified as facto rs with prognostic power in the logistic model. One previous EP implie s a 60% risk, whereas two previous EPs and endometriosis increases the risk to 95%. Conclusion. Patients with previous EP should generally n ot be considered for microsurgery owing to the high risk of recurrence and to the reduced chance of intra-uterine pregnancy.