A haemodynamically stable woman with a 3 cm ampullary tubal ectopic and a completely normal contralateral fallopian tube undergoes laparoscopy. According to current evidence-based practice, which procedure is generally preferred?
- A Segmental resection and reanastomosis of the tube
- B Linear salpingostomy, because it doubles future intrauterine pregnancy rates
- C Salpingectomy, because subsequent intrauterine pregnancy rates are comparable to salpingostomy with lower rates of persistent trophoblast ✓
- D Fimbrial expression of the gestational products
Correct answer: C. Salpingectomy, because subsequent intrauterine pregnancy rates are comparable to salpingostomy with lower rates of persistent trophoblast
Explanation
Randomised evidence shows that salpingostomy offers no significant advantage in subsequent intrauterine pregnancy over salpingectomy when the contralateral tube is healthy, while carrying a 5 to 20 percent risk of persistent trophoblast requiring methotrexate and demanding weekly hCG follow-up until negative. Salpingostomy is therefore reserved for women with only one tube or a diseased contralateral tube. Milking out fimbrial pregnancies causes recurrent ectopic rates too high to recommend.
Reference: Williams Gynecology, 4th ed.
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