Fertility after ectopic pregnancy

Article Abstract:

Ectopic pregnancies are pregnancies where the fertilized egg is implanted outside of the uterus and must be surgically removed. Ectopic pregnancies often occur in the fallopian tubes leading from the ovaries, which can greatly compromise the chances of becoming pregnant again. To determine the factors influencing subsequent fertility after surgical elimination of an ectopic pregnancy, 264 women were evaluated. A hysterosalpingogram, an X-ray of the uterus and tubes, can detect any blockage preventing an egg from passing through. This procedure was performed after an ectopic surgical procedure on 76 women. A pregnancy resulted in 30 of the 55 patients who were followed-up, of whom six had repeat ectopic pregnancies and 24 had normal, uterine pregnancies. Of the 39 patients who underwent salpingectomy, the removal of a fallopian tube, 60.8 percent had pregnancies inside the uterus. Of the 12 patients having had a salpingostomy, the creation of a new opening in the tube, all three who desired another pregnancy were able to achieve it. The salpingostomy group had more repeat ectopic pregnancies than the salpingectomy group. Patients whose tubes remained open, as determined by hysterosalpingogram, had the best fertility results. It was found that 80 percent of the women having an open tube detected, compared with 50 percent having a closed tube, achieved a pregnancy inside of the uterus. This discrepancy may be the result of tube spasm or testing technique.

Research, Complications and side effects, Pregnancy, Ectopic, Ectopic pregnancy, Fertility, Human, Human fertility, Hysterosalpingography

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Metanalysis for the obstetrician-gynecologist

Article Abstract:

Combining the results of related scientific studies into metaanalyses may yield improvements in obstetric and gynecologic patient care. A metaanalysis of existing medical literature allows a researcher to combine statistics from various studies and see if an even stronger conclusion can be drawn. Readers can evaluate a metaanalysis using 15 questions. Questions deal with whether the purpose of the study was clear, what previous studies did the metaanalysis cover, and were the subject groups comparable from study to study. Studies included in a metaanalysis should all be well done. Conclusions of metaanalyses which do not adequately answer all 15 questions may not be valid for translation into changes in patient care. Metaanalytic methods should be used more frequently in obstetrics and gynecology.

Practice, Clinical medicine, Meta-analysis

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The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization

Article Abstract:

The risk of pregnancy after tubal sterilization may be higher than previously reported. Researchers conducted a prospective study of 10,685 American women who underwent tubal sterilization and followed them up for eight to 14 years. A total of 143 women became pregnant after tubal sterilization. The 10-year failure rate for all methods of tubal sterilization was 1.85%. The sterilization method with the highest failure rate was the spring clip application (3.6%). Women who were younger than 28 years when sterilized were more likely to become pregnant than women sterilized after age 33, as younger women have more fertile years left than older women. Forty-seven of the 143 pregnancies (32.9%) were ectopic pregnancies. Pregnancy may occur more than two years after sterilization.

Evaluation, Risk factors, Pregnancy, Tubal sterilization

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