Which clinical situation is the clearest indication for linear salpingostomy rather than salpingectomy in a woman with an unruptured ampullary ectopic pregnancy?
- A Serum beta-hCG above 5000 mIU/mL
- B Contralateral fallopian tube is absent or grossly diseased and fertility is desired ✓
- C Ectopic size greater than 4 cm with cardiac activity
- D Previous ipsilateral ectopic pregnancy treated conservatively
Correct answer: B. Contralateral fallopian tube is absent or grossly diseased and fertility is desired
Explanation
Linear salpingostomy conserves the affected tube and is chosen when the contralateral tube is absent, blocked or severely diseased and the woman desires future fertility, since it leaves her some tubal function. When the contralateral tube is healthy, randomised evidence favours salpingectomy because subsequent intrauterine pregnancy rates are similar and salpingostomy carries persistent trophoblast rates of 5 to 20 percent requiring methotrexate. Beta-hCG level, ectopic size and cardiac activity influence medical eligibility, not the choice between these two operations.
Reference: Novak's Gynecology, 16th ed.
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Written and medically reviewed by the StethoPrep medical team.