A woman is diagnosed with a 3.5 cm ampullary ectopic pregnancy (β-hCG 4,200 mIU/mL, hemodynamically stable, no free fluid on ultrasound). She wants future fertility. After counseling, she agrees to salpingostomy. Which statement is TRUE regarding subsequent reproductive outcomes?

• A Intrauterine pregnancy rates are significantly higher after salpingostomy than salpingectomy
• B Salpingostomy requires methotrexate prophylaxis in all cases to prevent persistent trophoblast
• C Salpingostomy is the preferred approach over salpingectomy for all ectopic pregnancies regardless of tubal status
• D Recurrent ectopic rates are similar after salpingostomy and salpingectomy if the contralateral tube is normal ✓

Explanation

The ESEP study (multicenter RCT) found no significant difference in 24-month cumulative ongoing intrauterine pregnancy rates between salpingostomy and salpingectomy when the contralateral tube is healthy (57% vs 61%). Salpingostomy carries a ~10% risk of persistent trophoblastic disease requiring methotrexate in some cases, but prophylactic methotrexate is not routine. When the contralateral tube is damaged, salpingostomy may be preferred to preserve tubal function, but this is individualized.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.