National rates, trends and determinants of inpatient surgical management of tubal ectopic pregnancy in the United States, 1998-2011

Spontaneous ectopic pregnancy occurring in the distal fallopian tube cut off from the uterus after an incomplete prior operation to remove only the middle of the fallopian tube: A case report

After salpingectomy, recurrent ectopic pregnancies occur in the contralateral fallopian tube. Here, we present a case of ipsilateral remnant fallopian tube pregnancy in a 30-year-old woman with a history of incomplete prior operation to remove the middle region of the left fallopian tube following fallopian tube isthmus pregnancy 6 years earlier. During the previous salpingectomy, the left fallopian tube was not completely observed because of adhesions to the pelvic peritoneum and sigmoid colon; a partial remnant may have been present. The patient presented with lower abdominal pain 6 weeks after the most recent menstrual cycle, and transvaginal ultrasonography revealed a remnant left fallopian tube ectopic pregnancy. A 4 cm-sized mass identified at the distal end of the remnant left fallopian tube and the proximal remnant tube were laparoscopically removed. The possibility of an ipsilateral remnant tubal pregnancy should be carefully considered in spontaneous pregnancy after partial fallopian tube resection.

Socioeconomic Analysis of the Surgical Management of Ectopic Pregnancies: An Analysis of the National Inpatient Sample

STUDY OBJECTIVE

To identify racial and socioeconomic disparities in the surgical management of ectopic pregnancy DESIGN: The National Inpatient Sample (NIS) was sampled from 2015 to 2017 for inpatient hospitalizations for ectopic pregnancy. Cohorts were identified by surgical treatment type - open procedure versus laparoscopic procedure. Race/ethnicity, primary payer status, and median household income were primary variables of interest. Univariate and multivariable analysis was conducted.

DESIGN CLASSIFICATION

Retrospective SETTING: Nationwide inpatient analysis PATIENTS: Women presenting for ectopic pregnancy treatment INTERVENTIONS: Type of surgery MAIN OUTCOME MEASURES: Laparotomy versus laparoscopy for treatment MAIN RESULTS: A total of 18,725 cases were identified, 8,325 open and 10,400 laparoscopic. Hispanic women were more likely to receive open procedures as treatment for ectopic pregnancy compared to white women (OR 1.226, p<0.001). Women with private insurance were more likely to receive open procedures than women who were self-pay for treatment (OR 0.809, p<0.001). Women of lower median income status, <$60,000, were more likely to receive open procedures than women of fourth quartile income group. Black women predominantly made up the first quartile income group. When controlling for covariates, Black women were not more likely to receive one method of surgical procedure over another.

CONCLUSION

Income appears to be related to surgical management of ectopic pregnancy with women of lower median incomes receiving laparotomies over laparoscopic procedures. Equal access to healthcare remains a prudent need in communities of color. Further studies are needed to elucidate surgical decision-making in management of ectopic pregnancy.

Evaluation of the recurrence and fertility rate following salpingostomy in patients with tubal ectopic pregnancy

Background

Ectopic pregnancy is one of the leading causes of pregnancy-related mortality; the treatment strategies associated with this condition entail complications, such as recurrence of ectopic pregnancy or infertility. The objective of this study was to evaluate the recurrence and fertility rate after salpingostomy in patients with tubal ectopic pregnancy.

Methods

This cross-sectional retrospective study was conducted at four referral centers of Obstetrics and Gynecology, under the supervision of Shiraz University of Medical Sciences (Iran). The medical records of 125 patients with tubal pregnancy were reviewed. These patients underwent laparoscopic salpingostomy from April 2009 to March 2016.Data on maternal age, BMI, history of previous EP, genital tract infection, IUD insertion, history of previous surgery, and infertility were further obtained. The patients were followed up for approximately 1 to 7 years. The recurrence of EP and subsequent pregnancy rate were assessed during the follow-up period.

Results

There was no statistically significant relationship between post-salpingostomy recurrence and maternal age, previous abdominopelvic surgery, and history of infertility(P = .425); however, the post-salpingostomy recurrence of EP was correlated with BMI (P = 0.001), previous history of EP (P = 0.001), genital tract infection (P = 0.001), and IUD insertion (P = 003). Among 95 women who had no contraception, pregnancy occurred in 51 cases (53.6%) and recurrence of EP was observed in 16 patients (12.8%).

Conclusions

Our results suggest that salpingostomy is a safe method with a low risk of recurrence and good fertility outcomes for women who consider future pregnancy.

Benzodiazepine use before conception and risk of ectopic pregnancy

STUDY QUESTION

Are women who fill a benzodiazepine prescription before conception at increased risk of ectopic pregnancy?

SUMMARY ANSWER

Risk of ectopic pregnancy is 50% higher among women who fill a benzodiazepine prescription before conception.

WHAT IS KNOWN ALREADY

Benzodiazepine use in pregnancy increases the risk of miscarriage, adverse birth outcomes and adverse child development outcomes.

STUDY DESIGN, SIZE, DURATION

Using data from US commercial insurance claims, we performed a cohort study of 1 691 366 pregnancies between 1 November 2008 and 30 September 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We identified ectopic pregnancies using diagnosis and procedure codes and used unadjusted and inverse probability of treatment (IPT)-weighted log-binomial models to calculate relative risks (RR) of ectopic pregnancy for pregnant women who did and did not fill any prescriptions for benzodiazepines in the 90 days before conception. Two sub-groups of women with specific indications for benzodiazepine use were also examined-women who had a least one diagnosis for anxiety disorder and women who had at least one diagnosis of insomnia in the year before conception.

MAIN RESULTS AND THE ROLE OF CHANCE

Of the 1 691 366 pregnancies, 1.06% filled at least two benzodiazepine prescriptions totaling at least 10 days supply in the 90 days before conception. Among women with a benzodiazepine prescription, there was an excess of 80 ectopic pregnancies per 10 000 pregnancies, and their IPT-weighted risk of ectopic pregnancies was 1.47 (95% CI 1.32 to 1.63) times greater relative to women without benzodiazepine prescriptions before conception. The IPT-weighted RR between ectopic pregnancy and benzodiazepine use was 1.34 (95% CI 1.18 to 1.53) among women with anxiety disorder diagnoses and 1.28 (95% CI 0.99 to 1.68) among women with an insomnia diagnosis.

LIMITATIONS, REASONS FOR CAUTION

We relied on outpatient prescription data to identify benzodiazepine use before conception, which could result in over- or under-estimation of actual benzodiazepine consumption. We relied on medical claim codes to identify pregnancies and conception date, which may result in misclassification of pregnancy outcomes and gestational length.

WIDER IMPLICATIONS OF THE FINDINGS

This study found that women who have a benzodiazepine prescription before conception are at an increased risk of ectopic pregnancy. This information can help women, and their healthcare providers make more fully informed decisions about benzodiazepine use in their reproductive years.

STUDY FUNDING/COMPETING INTEREST(S)

Funding for this project was provided by a Banting Postdoctoral Fellowship and a Stanford Maternal and Child Health Research Institute Postdoctoral Award. Data access for this project was provided by the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and internal Stanford funding. The authors have no competing interest.

TRIAL REGISTRATION NUMBER

N/A.

Antidepressant Use around Conception, Prepregnancy Depression, and Risk of Ectopic Pregnancy

OBJECTIVE

To compare the risk of ectopic pregnancy among women with and women without antidepressant prescriptions around conception and examine whether this risk differs by prepregnancy depression status.

METHODS

We conducted a cohort study of all pregnancies between November 1, 2008, and September 30, 2015, identified in the nationwide (American) IBM® MarketScan® Databases. At least one day's supply of antidepressants in the 3 weeks after a woman's last menstrual period defined active antidepressant use around conception. At least one depression diagnosis in the year before the last menstrual period defined prepregnancy depression. Relative risk (RR) of ectopic pregnancy was estimated using unadjusted and inverse probability of treatment (IPT)-weighted log-binomial models.

RESULTS

Of the 1,703,245 pregnancies, 106,788 (6.3%) women had a prepregnancy depression diagnosis. Among women with a depression diagnosis, 40,287 (37.7%) had an active antidepressant prescription around conception; the IPT-weighted risk of ectopic pregnancy was similar among women who did and did not fill an antidepressant prescription around conception (IPT-weighted RR = 1.01; 95% CI, 0.93 to 1.10). Overall, the risk of ectopic pregnancy was higher among women who had a prepregnancy depression diagnosis than women who did not have a prepregnancy depression diagnosis (IPT-weighted RR = 1.09; 95% CI, 1.04 to 1.15).

CONCLUSIONS

This study's findings suggest that women who have a prepregnancy depression diagnosis are at a slightly increased risk of ectopic pregnancy, and among women who have a prepregnancy depression diagnosis, the use of antidepressants around conception does not increase the risk of ectopic pregnancy.

Anesthetic efficacy of propofol combined butorphanol in laparoscopic surgery for ectopic pregnancy: A protocol of systematic review and meta-analysis

BACKGROUND

Recent studies have suggested that propofol combined butorphanol (PB) has anesthetic effect in laparoscopic surgery (LS) for ectopic pregnancy (EP). But investigations of its potential effects are inconsistent. We will explore the current literature examining PB in LS for EP.

METHODS

We will perform a comprehensive search from MEDLINE, Embase, Cochrane Library, PsycINFO, Global Health, Web of Science, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from inception to the present. Other literatures, such as conference abstracts, references to the relevant reviews will also be checked. Two authors will check the titles, abstracts, and full texts independently. They will also independently carry out data collection and study quality assessment. We will conduct statistical analysis using RevMan 5.3 software.

RESULTS

This study will provide accurate results on the anesthetic effect and safety of PB in LS for EP.

CONCLUSION

This study will establish high-quality evidence of the anesthetic effect and safety of PB in LS for EP to facilitate the clinical practice and guideline development.

STUDY REGISTRATION NUMBER

INPLASY202040044.

The effect of salpingectomy on the ovarian reserve and ovarian response in ectopic pregnancy: A systematic review and meta-analysis

BACKGROUND

Salpingectomy is routinely performed in ectopic pregnancy (EP). However, the effect of the surgery on the ovarian reserve and ovarian response in EP patients is still uncertain and has not been systematically evaluated. Therefore, we conducted this meta-analysis to provide a comparison of the ovarian reserve and ovarian response between the pre-salpingectomy and post-salpingectomy in EP patients.

METHODS

Pubmed, Embase, and Cochrane Library were searched for all relevant articles published up to December 2018. We retrieved the basic information and data of the included studies. The data was analyzed by Review Manager 5.3 software (Cochrane Collaboration, Oxford, UK).

RESULTS

A total of 243 articles were extracted from the databases, and 7 studies were included in the meta-analysis. The ovarian reserve including anti-Mullerian hormone (inverse variance [IV] -0.7 [95% confidence interval [CI] -0.63, 0.49]), antral follicle count (IV 1.7 [95% CI -2.02, 5.42]) and basal follicle stimulating hormone (IV 0.02 [95% CI -0.63, 0.68]) was comparable between the pre-salpingectomy group and the post-salpingectomy group. The amount of gonadotropin was significantly higher in the post-salpingectomy group when compared with that in the pre-salpingectomy group (IV -212.65 [95% CI -383.59, -41.71]). There was no significant difference in the left parameters of the ovarian response including the duration of gonadotropin stimulation (IV -0.32 [95% CI -0.76, 0.12]), the estrogen level on the human chorionic gonadotropin triggering day (IV -4.12 [95% CI -236.27, -228.04]) and the number of retrieved oocytes (IV 0.35 [95% CI -0.76, 1.46]) between 2 groups.

CONCLUSIONS

The current results suggest that salpingectomy has no negative effect on the ovarian reserve and ovarian response.