284 Obstetrics and Gynecology Board Review •••
❍ What is the surgical treatment of choice for a patient with a nonruptured ectopic pregnancy who is desirous
of future fertility?
A laparoscopic linear salpingostomy is the most recommended surgical procedure. When performed correctly and
compared with salpingectomy, the incidence of repeat ectopic pregnancy is no different, while the subsequent live
birth rate is increased.
❍ What are the indications of conservative surgical therapy (conservation of the fallopian tube)?
The tube can be conserved if the tube has minimal damage and the woman desires further fertility.
❍ List the possible techniques for conservative tubal surgery.
Possible conservative techniques include salpingostomy, salpingostomy, fimbrial evacuation, and segmental
resection (with future anastomosis of the tube).
❍ Which of the techniques listed in the previous question increase the risk of a future ectopic pregnancy?
Fimbrial evacuation, with milking of the ectopic from the distal end of the tube, increases the risk of another
ectopic pregnancy.
❍ When should salpingectomy be performed?
With a severely damaged tube, recurrent ectopic in that tube, uncontrolled hemorrhage, or a desire for sterility
especially after previous tubal ligation.
❍ If a salpingectomy is performed, what is the best predictor of future fertility?
The best predictor is the degree of adhesive disease and the quality of the contralateral tube as well as a history of
past fertility.
❍ What is the advantage of closing the salpingostomy site on the fallopian tube?
There is no advantage to suturing the salpingostomy site. In fact, this may slow the return to normal function as
subsequent pregnancy rates are decreased at 1 year when compared with salpingostomy.
❍ What follow-up is required for women undergoing linear salpingostomy?
Serial hCG levels are necessary to rule out persistent trophoblastic tissue.
❍ What is the risk of persistent ectopic pregnancy with linear salpingostomy?
About 5% to 10% of ectopic pregnancies treated by linear salpingostomy will have retained trophoblastic tissue
and require further therapy.
❍ How is a persistent ectopic pregnancy treated?
This can be treated with medical therapy or removal of the affected tube. Expectant management can be
considered if the hCG levels are falling.
❍ When observing the tube at surgery, what is the most likely site of the ectopic pregnancy?
The most likely site of implantation is proximal to the most dilated portion of the tube.