Impact of Salpingotomy on Intrauterine Pregnancy and Recurrent Ectopic Pregnancy Rates: A Meta-Analysis

Abstract

Ectopic pregnancy poses significant risks to future fertility and recurrence, and can be surgically resolved if the traditional approach is ineffective. Salpingotomy has emerged as a preferred surgical option to treat ectopic pregnancy, as it has been shown to preserve fertility and prevent recurrence. This meta-analysis assessed whether salpingotomy impacts the intrauterine pregnancy (IUP) and recurrent ectopic pregnancy (REP) rates. A literature search was conducted using PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online), Ovid Discovery, and ClinicalTrials.gov. The studies meeting the inclusion criteria were reviewed, and data from 2,220 patients were pooled. The statistical analysis was carried out using the Comprehensive Meta-Analysis Software version 4 (Biostat, Inc., Englewood, New Jersey, United States). The results showed that following salpingotomy, patients reported significantly higher IUP rates (95%CI: 0.487-0.724, p=0.000). The data analysis indicated significant variation in REP rates across the studies, suggesting a high probability of patients not experiencing REP (mean effect size=0.109, 95%CI: 0.074-0.157, p=0.03). A sub-analysis of factors was also conducted, including the impact of age, follow-up time, year of study publication, and geographic location on the IUP and REP rates following salpingotomy. There was a significantly higher number of IUPs in studies published before 2020 than those published after 2020 (mean effect size=0.598, 95%CI: 0.495-0.694, p=0.013). Also notable was a significantly higher IUP rate in patients under 30 (mean effect size=0.58, 95% CI: 0.442-0.706, p=0.007). There was no significant difference in IUP rates due to follow-up time or geographic location (mean effect size=0.613, 95%CI: 0.482-0.730, p=0.964; mean effect size=0.612, 95%CI: 0.541-0.681, p=0.341). Furthermore, REP rates were significantly higher in studies with a follow-up time longer than three years (mean event rate=0.127, 95%CI: 0.098-0.162, p=0.005). There was no significant difference in REP rates across geographic locations, age, or year of publication (p=0.380, p=0.257, and p=0.134, respectively). Overall, salpingotomy provides a higher likelihood of IUP in patients below the age of 30 and has a low risk of REP. The findings underscore the importance of individualized patient counseling, balancing the benefits of salpingotomy for fertility preservation against the risks of REP.

Keywords: ectopic pregnancy; fertility preservation; intrauterine pregnancy; recurrent ectopic pregnancy; salpingotomy.

Figure 1. PRISMA flowchart for literature search and study selection

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Fotor (California, United States), an online AI application, was utilized to enhance the image’s resolution

Figure 2. Forest plot illustrating the impact of salpingotomy on intrauterine pregnancy (IUP) rates

References: [20-30]

Figure 3. Sensitivity analysis of studies assessing the impact of salpingotomy on intrauterine pregnancy (IUP) rates.

References: [20-30]

Figure 4. Subgroup analysis of factors including average age (A), follow-up time (B), year of publication (C), and geographic location (D) on intrauterine pregnancy (IUP) rates following salpingotomy

References: [20-30]

Figure 5. Forest plot demonstrating the impact of salpingotomy on recurrent ectopic pregnancy (REP) rates.

References: [20-27,29]

Figure 6. Sensity analysis of studies assessing the impact of salpingotomy on recurrent ectopic pregnancy (REP) rates

References: [20-27,29]

Figure 7. Subgroup analysis of factors including average age (A), follow-up time (B), year of publication (C), and geographic location (D) on recurrent ectopic pregnancy (REP) rates following salpingotomy

References: [20-27,29]

Figure 8. Funnel plots demonstrating publication bias concerning the impact of salpingotomy on intrauterine rates (A) and recurrent pregrnancy rates (B).