Isthmic ectopic pregnancy: segmental resection as the treatment of choice

We reviewed the records of 12 patients who were admitted to Yale-New Haven Hospital between February 1979 and January 1983 with the diagnosis of isthmic ectopic pregnancy. All pregnancies were unruptured. Two patients were managed by salpingectomy. Ten patients were treated conservatively. Of the women managed by conservative surgery, four had a linear salpingostomy and none of the four conceived. Three of these four patients demonstrated occlusion of the operated tube by hysterosalpingogram (HSG). The other six patients were managed by segmental resection and delayed microsurgical anastomosis. Four of the six patients conceived. Three pregnancies were intrauterine and one was an ectopic pregnancy in the conserved tube. Three patients conceived before an HSG could be done. The remaining three patients had HSGs 3 to 4 months after anastomosis, and the operated tube was patent in all three. From these data and a review of the literature, we conclude that segmental resection with either immediate or delayed anastomosis appears preferable to linear salpingostomy for the conservative management of unruptured isthmic ectopic pregnancy.