Rune Svenningsen1, Anne Cathrine Staff2, Anton Langebrekke3, Erik Qvigstad2. 1. Department of Gynecology, Oslo University Hospital, Oslo, Norway (all authors). Electronic address: RUNSVE@ous-hf.no. 2. Department of Gynecology, Oslo University Hospital, Oslo, Norway (all authors); Faculty of Medicine, University of Oslo, Oslo, Norway (Drs. Staff and Qvigstad). 3. Department of Gynecology, Oslo University Hospital, Oslo, Norway (all authors).
Abstract
STUDY OBJECTIVE: To evaluate future pregnancy rates beyond gestational week 24 after cornual resections for interstitial pregnancies, subsequent modes of delivery, and the rate of later uterine ruptures. DESIGN: A single-center historic cohort with follow-up registry data (Canadian Task Force classification II-2). SETTING: Department of Gynecology, Oslo University Hospital, Oslo, Norway. PATIENTS: Forty consecutive women with interstitial ectopic pregnancies were treated in the study period from 2005 to 2016, 33 of whom were treated with laparoscopic cornual resection (3 converted to laparotomy). Twenty-six of the 33 women were presumed still fertile after treatment (cases) and thereby age and parity matched with a reference group of 52 women with an equal follow-up time having undergone salpingectomy for tubal (noninterstitial) ectopic pregnancies (controls) (ratio 1:2). Subsequent fertility data for both groups were retrieved from medical records and the national Medical Birth Registry of Norway. INTERVENTIONS: None, data extracted from the patients' medical records and the Medical Birth Registry of Norway. MEASUREMENTS AND MAIN RESULTS: The incidence of interstitial pregnancies among the ectopic pregnancies was 3%. The median time to follow-up for cases and controls was 76 and 71 months, respectively. Subsequent pregnancy rates beyond gestational week 24 were equal in both groups (46% [cases] and 54% [controls]). Cesarean delivery in subsequent pregnancies was more common among women having undergone cornual resections (60% vs 18%, p = .006). Only 2 subsequent uterine ruptures were encountered. CONCLUSION: Cornual resection as treatment for interstitial pregnancies seems to have no added detrimental effect on subsequent pregnancy rates compared with salpingectomy for noninterstitial tubal ectopic pregnancies. However, they more often lead to elective cesarean deliveries in subsequent pregnancies.
STUDY OBJECTIVE: To evaluate future pregnancy rates beyond gestational week 24 after cornual resections for interstitial pregnancies, subsequent modes of delivery, and the rate of later uterine ruptures. DESIGN: A single-center historic cohort with follow-up registry data (Canadian Task Force classification II-2). SETTING: Department of Gynecology, Oslo University Hospital, Oslo, Norway. PATIENTS: Forty consecutive women with interstitial ectopic pregnancies were treated in the study period from 2005 to 2016, 33 of whom were treated with laparoscopic cornual resection (3 converted to laparotomy). Twenty-six of the 33 women were presumed still fertile after treatment (cases) and thereby age and parity matched with a reference group of 52 women with an equal follow-up time having undergone salpingectomy for tubal (noninterstitial) ectopic pregnancies (controls) (ratio 1:2). Subsequent fertility data for both groups were retrieved from medical records and the national Medical Birth Registry of Norway. INTERVENTIONS: None, data extracted from the patients' medical records and the Medical Birth Registry of Norway. MEASUREMENTS AND MAIN RESULTS: The incidence of interstitial pregnancies among the ectopic pregnancies was 3%. The median time to follow-up for cases and controls was 76 and 71 months, respectively. Subsequent pregnancy rates beyond gestational week 24 were equal in both groups (46% [cases] and 54% [controls]). Cesarean delivery in subsequent pregnancies was more common among women having undergone cornual resections (60% vs 18%, p = .006). Only 2 subsequent uterine ruptures were encountered. CONCLUSION: Cornual resection as treatment for interstitial pregnancies seems to have no added detrimental effect on subsequent pregnancy rates compared with salpingectomy for noninterstitial tubal ectopic pregnancies. However, they more often lead to elective cesarean deliveries in subsequent pregnancies.