[Tubal pregnancy: recent aspects of diagnosis and treatment]

The histories of 139 patients who received treatment for tubal pregnancy between January 1975 and December 1981 in our department were reviewed. 12% of the patients had a prior contralateral tubal pregnancy. The commonest clinical finding was metrorrhagia in 84% of the cases. The HCG in the urine was positive in 68% of the cases with the clinical routine methods used up to date. The beta HCG in the blood showed an atypical trophoblastic process in all cases. The tubal pregnancy was diagnosed by ultrasonography in 19% of the cases and suspected in 54% of the cases. Aspiration of the pouch of Douglas verified the diagnosis in 79% of the cases. Laparoscopy confirmed the diagnosis in every case. Laparoscopy was especially required when the symptoms were unclear or when the aspiration of the pouch of Douglas showed negative or dubious results. 85 patients had a salpingectomy, 50 patients had a conservative operation of the tube. Laparoscopy was done in 34 patients who had a conservative tubal operation. In 79% of the patients an intact tubal wall made a conservative operation possible. 51 women desired further child-bearing by written questionnaire. After salpingectomy and normal contralateral fallopian tube at operation, 25 patients showed further desire for child-bearing. 18 cases delivered infants, three cases had abortions, and one case had a recurrent ectopic pregnancy. Following conservative operations 24 patients desired further children. 11 patients had intrauterine pregnancies, one of them an abortion. Five patients had a recurrent ectopic pregnancy.