The value of medical history taking as risk indicator for tuboperitoneal pathology: a systematic review

Abstract

Background Guidelines recommend diagnostic laparoscopy in subfertile women with known co-morbidities in their medical history. Aggregated evidence underpinning these recommendations is, however, currently lacking.Objective The objective of this study was to perform a systematic review and meta-analysis of the available evidence on the association between items reported during medical history taking and tuboperitoneal pathology. Selection criteria All relevant studies that compared medical history with the presence or absence of tubal pathology.Data collection and analysis Studies comparing medical history with the presence or absence of tubal pathology were included. A diagnosis of tubal pathology had to be made by hysterosalpingography, laparoscopy or a combination of both. In the absence of invasive tubal testing, tuboperitoneal pathology was considered to be absent in case of intrauterine pregnancy. Homogeneity between studies was assessed, and the association between medical history and tubal pathology was expressed as a common odds ratio with a 95% CI. No language restriction was applied. Main resultsWe included 32 studies. In cohort studies, strong associations were found for a history of complicated appendicitis (OR 7.2, 95% CI 2.2-22.8), pelvic surgery (OR 3.6, 95% CI 1.4-9.0) and pelvic inflammatory disease (PID) (OR 3.2, 95% CI 1.6-6.6), and in case-control studies, for a history of complicated appendicitis (OR 3.3, 95% CI 1.8-6.3), PID (OR 5.5, 95% CI 2.7-11.0), ectopic pregnancy (OR 16.0,, endometriosis (OR 5.9, 95% CI 3.2-10.8) and sexually transmitted disease (OR 11.9,3).Author's conclusions Subfertile women reporting a history of PID, complicated appendicitis, pelvic surgery, ectopic pregnancy and endometriosis are at increased risk of having tuboperitoneal pathology. In these women, diagnostic laparoscopy should be offered early in the fertility work-up.

The Diagnostic Properties of Medical History in the Diagnosis of Tubal Pathology among Subfertile Patients

“…There were 10 cases of the history of chlamydial infection and 2 cases of syphilis in our study, but the cases with gonococcal infection were lacking. However, chlamydial and gonococcal infection in particular is strongly associated with tubal damage [32], and this issue was supported by the data of meta-analysis [26]. The clinical manifestation of STDs has transformed during the several last decades.…”

“…This relationship was proved in the systematic review [26]. Nevertheless, the data on the diagnostic properties of the history of ectopic pregnancy in the prediction of tubal damage were lacking.…”

“…The increased risk for tubal factor infertility for the patients with the history of PID was evaluated by numerous researches [20, 22–25] and summarized in systematic review [26]. Nevertheless, the studies on the diagnostic value of the history of PID as a screening test for prediction of tubal lesions are limited [22].…”

“…Reports by Forman et al and Cramer et al supported the issue about elevated risk of tubal damage in IUCD user's [17, 33], and other studies denied this relationship [29, 34]. However, the recently published meta-analysis still showed a mild association between IUCD use and tubal pathology [26]. …”

Peut-on réellement se passer de la cœlioscopie en cas d’infertilité a trompes normales en hystérosalpingographie ?

“…Cet auteur ne retrouve aucune corré lation entre les é lé ments issus du questionnaire et les constatations de la coelioscopie : les valeurs pré dictives de salpingite, des leucorrhé es et des anté cé dents d'infection gé nitale basse sont basses, respectivement 56, 59 et 35 %. À l'inverse, dans une mé ta-analyse de 32 é tudes, Luttjeboer et al [12] retrouvent des é lé ments pré dictifs d'adhé rences à l'interrogatoire : les anté cé dents d'appendicite compliqué e, de chirurgie pelvienne, de syndrome inflammatoire pelvien, de grossesse extra-uté rine (GEU) et de maladies sexuellement transmissibles. Portuondo et al [13] confirment la valeur de l'interrogatoire dans la sé lection des patientes devant avoir une coelioscopie, et reconnaît que la pratique de celle-ci ne modifie que trè s peu la conduite thé rapeutique.…”