SECONDARY SURGICAL MEASURES IN UNSUCCESSF UL PROSTAGLANDIN TREATMENT OF A TUBAL PREGNANCY

As local drug treatment grew more common, the risk of persisting troph oblast remnants increased in tubal pregnancies treated in this way. We studied the secondary surgical measures in 52 patients, who had to un dergo surgery for a second time after tubal pregnancy treated with pro staglandins. The indication for revision was arrived at 30 times on th e basis of laboratory parameters (increasing or constant beta-HCG) (Gr oup I). Reoperation had to be performed 22 times because of acute clin ical symptoms (Group II). Laparotomy was performed 40 times, repelvisc opy 12 times. In patients of Group I, the rate of rupture, that, had a lready occurred at the time of secondary surgery, was significantly sm aller (p<0.0001); in that case secondary surgery was significantly mor e often successful (p < 0.06) in preserving the tubes. In case of cons tant beta-HCG values 11 patients (50% of Group II) developed acute sym ptoms; another 7 patients (31.8%) also had to be reoperated on due to acute complaints, although the values were already clearly reduced. Th e study proves, that tubal pregnancies can be reoperated with preserva tion of the tubes even after unsuccessful prostaglandin therapy. The s tarting position for secondary surgery with preservation of the tubes is much better before acute clinical symptoms occur.