Conservative versus radical surgery for tubal pregnancy. A review.

OBJECTIVE: The aim of this work was to analyse the fertility prognosis after conservative or radical surgery for tubal pregnancy. DATA SOURCES: Index Medicus was searched for all attainable literature on the subject. METHODS OF STUDY SELECTION: A total of 40 scientific publications through the latest 40 years were selected. For fulfilling the selection criterias the study design should appear clearly. Furthermore the rate of women obtaining intrauterine pregnancy and the rate of repeat ectopic pregnancy following radical or conservative tubal surgery was to be compared using 95% confidence limits. The results from each report were compared in four groups according to study design i.e. retrospective non-comparing materials, retrospective comparing studies, prospective selected treatment series or prospective randomized comparing investigations. DATA EXTRACTION AND SYNTHESIS: Pooling the results from the retrospective noncomparing materials revealed that there was no significant difference in intrauterine pregnancy rates, i.e. 46% following conservative tubal surgery and 44% after radical surgery. The repeat ectopic pregnancy rate was 10% following conservative surgery and 15% after radical surgery. In the group of restrospective comparing studies only one of 15 materials could document a significant better intrauterine pregnancy rate after conservative tubal surgery than following radical treatment for tubal pregnancy. There were no differences either in this group in repeat ectopic pregnancy rates. Prospective investigations were almost exclusively represented by selected conservative treatment series. In these series the average intrauterine pregnancy rate was 57% and the repeat ectopic pregnancy rate was 13%.
CONCLUSIONS: In studies on fertility after radical or conservative surgical treatment for tubal pregnancy no significant difference in intrauterine pregnancy rates or repeat ectopic pregnancy rates were found. Prospective selected treatment series demonstrated higher intrauterine pregnancy rates than retrospective studies. The repeat ectopic pregnancy rate was not raised in prospective series. No prospective randomised trial was found.