Treatment of tubal heterotopic pregnancy with viable intrauterine pregnancy: a retrospective study

Abstract

Objective The aim of our study was to analyze surgical treatment and expectant treatment of tubal heterotopic pregnancy (HP) with viable intrauterine pregnancy (IUP). Study Design This was a retrospective analysis of 65 tubal HP with viable IUP patients. Patients were divided into surgical treatment group or expectant treatment group. Main outcome measures were abortion rate, rescue treatment rate, complication rate and ectopic pregnancy (EP) rupture rate. Results The abortion rate, rescue treatment rate and complication rate in the expectant treatment group were 8.69% (2/23), 30.43% (7/23) and 0.00%, compared to 16.67% (7/42), 0.00% and 2.38% (1/42), respectively, in the surgical treatment group. Five patients in the expectant treatment group suffered tubal EP rupture. Subgroup analysis of the expectant treatment group revealed that the rescue treatment rate in patients with an EP mass enlargement ≥50% was 80% (4/5), which was significantly higher than that in patients with an EP mass enlargement <50% (6.25%, 1/16, P =0.028). In the surgical treatment group, lower abortion rates were demonstrated in the laparotomy subgroup, salpingectomy subgroup and ≥49 days gestational age subgroup, with abortion rates of 0.00%, 12.12% (4/33) and 6.25% (1/16), respectively. Conclusions Both surgical and expectant treatments are optional treatment modalities for tubal HP with viable IUP. The abortion rate was low in the expectant treatment patients. EP mass enlargement ≥50% can be a predictor of rescue treatment in expectant treatment patients. Laparotomy surgery and salpingectomy would be more preferable in surgical treatment patients.