SELECTIVE SALPINGOGRAPHY FOR THE DIAGNOSIS AND TREATMENT OF EARLY TUBAL PREGNANCY

Objective: To determine whether selective salpingography can accuratel y diagnose and treat patients with early ectopic pregnancies (EPs). De sign: Prospective clinical case study. Setting: Selective salpingograp hy was performed in an outpatient setting under IV sedation. Patients: Selective salpingography was performed in 10 women who had clinical p resentation suggestive of EP, two consecutive abnormal hCG measurement s < 2,000 mIU/mL, and inconclusive vaginal probe sonogram. Interventio n: Selective salpingography was performed under fluoroscopy. A cervica l cannula was placed, and the tubal ostium was cannulated with a curve d selective salpingography catheter (Bard Gynecology and Radiology, Co vington, GA). Methotrexate (MTX) (25 or 50 mg) was injected into the a ffected tube through the selective salpingography catheter. Main Outco me Measure: The accuracy of selective salpingography in the diagnosis of early EP was determined by the rate of fluoroscopic imaging of an a mpullary radiolucency upon injection of contrast material through the selective salpingography catheter. Resolution of the EP after injectio n of MTX into the tube was detected by serial declining hCG measuremen ts. Results: Selective injection of contrast material into the fallopi an tubes detected seven ampullary pregnancies in 10 patients. Two pati ents demonstrated neither tubal pregnancy nor intrauterine pregnancy. One patient with apparent bilateral proximal cornual occlusions on sel ective salpingography underwent laparoscopy, followed by salpingostomy of an ampullary pregnancy. All 7 patients who received MTX through th e selective salpingography catheter completely resolved the EP. Four p atients demonstrated patent fallopian tubes on hysterosalpingograms pe rformed 3 to 6 months later. Conclusion: Selective salpingography may diagnose early tubal pregnancies of some patients with equivocal clini cal, laboratory, and sonographic findings. These patients can be succe ssfully treated at the same time with a single dose of MTX delivered i nto the affected tube. Selective salpingography reduced the need for l aparoscopy and operative intervention. Selective salpingography is a s imple and relatively inexpensive diagnostic and therapeutic alternativ e in patients with suspected early tubal pregnancy.