Analysis of the consecutive pregnancy outcomes in women with different times of tubal pregnancy history
Objective To analyze the consecutive pregnancy outcomes in women with different times of tubal pregnancy(TP)history.Methods The data of 415 patients with a history of TP≥1 times admitted in Gynecology Department of Obstetrics&Gynecology Hospital of Fudan University from January 2019 to April 2023 were retrospectively analyzed.They were divided into two groups:the first TP group(n=359)and the second TP group(n=56).Clinical data and consecutive pregnancy outcomes were collected and the differences of TP rate between patients treated by retaining fallopian tubes and those treated by salpingectomy were analyzed.Patients with a second TP were divided into two subgroups:ipsilateral recurrence subgroup and contralateral recurrence subgroup,and difference of TP rate between the two subgroups was assessed.Risk factors for recurrent TP were assayed by binary logistic analysis.Results Intrauterine pregnancy rate in the first TP group was higher than that in the second TP group[66.0%(237/359)vs.48.2%(27/56),P=0.008].Salpingectomy resulted in significantly lower rate of intrauterine pregnancy[35.7%(35/98)]compared with treatment with methotrexate or salpingotomy or extrusion of fallopian tubes in the first TP group,77.0%(97/126),78.2%(93/119),90.0%(9/10),respectively;all P<0.001].There was no difference of intrauterine pregnancy rate among patients treated by expectant management or methotrexate or salpingectomy or salpingotomy in the second TP group(all P>0.05).There were 24 cases in the ipsilateral recurrent subgroup and 32 cases in the contralateral recurrent subgroup.The rates of recurrent intrauterine pregnancy,ipsilateral ectopic pregnancy and contralateral ectopic pregnancy were not different between the two subgroups(all P>0.05).Logistic regression analysis suggested time interval from prior TP to next pregnancy≥36 months were positively correlated with occurrence of the second TP(OR=5.012,95%CI:2.525-9.949,P<0.001).Patients concept by in vitro fertilization and embryo transfer(IVF-ET)after the first TP had higher rate of intrauterine pregnancy compared with natural conception[91.4%(53/58)vs.61.1%(184/301),P<0.001]and IVF-ET significantly decreased the occurrence of the second TP(OR=9.666,95%CI:3.303-28.287,P<0.001).Patients concepted by IVF-ET after the second TP had higher rate of intrauterine pregnancy compared with natural conception[76.5%(13/17)vs.35.9%(14/39),P<0.001]and IVF-ET significantly decreased the occurrence of the third TP(OR=5.987,95%CI:1.529-23.447,P=0.010).Conclusion For patients who experience first-time TP,preserving the fallopian tube can help them gain the opportunity for intrauterine pregnancy.For patients with recurrent ipsilateral fallopian TP,there is currently insufficient evidence to support the benefit of removing the affected fallopian tube.Whether it is the first or the second TP,IVF-ET can help patients achieve a higher intrauterine pregnancy rate.
Pregnancy,tubalRecurrenceFertilization in vitroEmbryo transferPregnancy outcomeThird tubal pregnancy
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