Impact of hysterosalpingography after operative treatment for ectopic pregnancy in Taiwan

Abstract

By retrieving records from Taiwan's National Health Insurance (NHI) system's database, the current study aimed to investigate the impacts of hysterosalpingography (HSG) to patients after ectopic pregnancy (EP) operations in Taiwan.In this retrospective cohort study, insurance claims data from 1997 to 2013, derived from a cohort of 1 million people randomly sampled to represent all NHI beneficiaries, were analyzed. Patients after ectopic pregnancy (EP) operations were identified via the inclusion of the corresponding NHI procedure codes. We further divided the patients into 2 groups by whether received subsequent HSG, EP-HSG, and EP-no-HSG. Patients with history of previous pregnancies (PP) and subsequent HSG were grouped as PP-HSG. We sought to evaluate the following pregnancies (FP) rate, interval to FP in EP-HSG compared with that in EP-no-HSG, and PP-HSG.EP-HSG had significantly higher FP rate odds ratio than EP-no-HSG (OR, 1.64; 95% CI, 1.24–2.16, P < .001). EP-HSG had lower FP rate odds ratio than that in PP-HSG, but no significant difference (33.1% vs 34.6%, P = .654). The INTERVAL(HSG-FP) in EP-HSG was no significantly different from that in PP-HSG (843.34 ± 82 days vs 644.72 ± 24.30 days, P = .077). There was significant positive correlation between FP after EP and number of HSG (r = 0.070∗∗, P < .001). There were significant negative correlation between FP and EP age (r = −0.270∗∗, P < .001), FP and INTERVAL(EP-HSG) (r = −0.212∗∗, P = .001). The multivariate analysis showed that INTERVAL(EP-HSG) less than 1 year is the predictor factor of INTERVAL(EP-FP) (hazard ratio: 1.422; 95% CI: 1.130–1.788; P = .003). It was evident that the longer the INTERVAL(EP-HSG), the lower the FP rate odds ratio; and the older the EP age, the lower the FP rate odds ratio. (OR, 95% CI; >1 year: 0.59, 0.41–0.86; >2 year: 0.42, 0.32–0.55; >25 years old: 0.47, 0.38–0.57; >30 years old: 0.29, 0.24–0.35; >35 years old: 0.12, 0.08–0.18, all P < .001).Receiving HSG after EP, short INTERVAL(EP-HSG), EP age less than 30 years old, had significant positive impacts on the FP. We encourage shortening the INTERVAL(EP-HSG), and the counseling of women on the most appropriate way to conceive thereafter.

Visits to Pediatric Clinics by Adult Patients: A Nationwide Survey in Taiwan

“…In 2010, the total birth rate in Taiwan fell to 0.89, the lowest birth rate in the world [ 9 ]; since then it has remained among the lowest three. This decreasing birth rate trend has not been reversed despite policy efforts by the Taiwanese government to encourage childbearing, including a childbirth subsidy, maternity pension, children’s education subsidy, and children’s healthcare subsidy [ 15 , 16 , 17 ]. Due to depopulation, pediatricians in Taiwan are facing unprecedented levels of competition with other physicians.…”

Comparison the Results of Hysterosalpangiography in Patients with Ectopic Pregnancy Treated by Laparoscopic Salpingostomy, Laparotomy, and Treated with Methotrexate

“…It is a safe and inexpensive procedure, being the most cost-effective method in the study of the fallopian tubes. [ 16 ] HSG plays a crucial role in infertility evaluation to determine the anatomic causes of female subfertility and/or infertility, especially for uterine structure and tubal status abnormalities with high reproducibility. Hence, considering the high prevalence of EP and high mortality and morbidity and lack of adequate studies in treatment of this disease and comparison the results of different therapeutic approaches, the aim of this study was to compare the results of HSG after treatment of EP by laparoscopy, laparotomy, and MTX therapy.…”