Factors influencing reproductive performance following previous ectopic pregnancy

OBJECTIVE: To assess the factors that influence the reproductive performance in patients who had previous salpingectomy by laparotomy for ectopic pregnancy in the South-west Region of Saudi Arabia.

METHODS: Fifty four patients who had pregnancies following salpingectomy for previous ectopic pregnancy were studied retrospectively at Abha Maternity Hospital in the Southern Region of Saudi Arabia.

RESULTS: There were 130 ectopic pregnancies during the study period out of which 54 patients became pregnant subsequently. Of the subsequent pregnancies, there were 41 (80%) intrauterine pregnancies and 13 (20%) extrauterine recorded pregnancies. Out of the intrauterine pregnancies, 36 (88%) resulted in full term live births while abortion occurred in 5 (12%) of the cases. The risk of a 2nd ectopic pregnancy seemed to be positively related to the age of the patient and also the interval between the previous ectopic and new pregnancy, while it was negatively related to the parity of the patient. The mean age of the patients was 27.89 years and the mean parity 2.74. Of the 13 patients who had extrauterine pregnancies, 4 (30%) were nulliparous while 9 (70%) had had between 1-5 children. In those patients who had a repeat ectopic pregnancy, the mean gestation of the ectopic pregnancy was 6.78 weeks while the interval between admission to hospital and surgery ranged between 1 to 48 hours with a mean of 21.85 hours. At the time of surgery, the fallopian tube was ruptured in 6 (46%) of the cases and these included patients who were nulliparous. They all had repeat salpingectomy. Conservative surgery was performed only in 2 (28%) of those whose fallopian tubes were not ruptured at the time of surgery.

CONCLUSION: It seemed as if the probability of repeat ectopic pregnancy increased as the age of the patient increased and the interval between the previous ectopic gestation and new pregnancy is prolonged. At the same time the probability of another ectopic pregnancy decreased as the parity increased. The obstetric outlook following laparotomy for ectopic pregnancy seemed not to be very encouraging as the fertility rate was about 48% and therefore, efforts should be geared at managing patients with ectopic pregnancy laparoscopically. A larger multicenter study is needed to validate these findings.