Introduction

The decision to treat ectopic pregnancy by means of a radical procedure should not be taken lightly. It is not a simple matter of ectopic pregnancy plus ruptured tube equals salpingectomy. Other factors, e.g. previous ectopic pregnancy, damaged or absent contralateral tube and future fertility requirements among others, should influence the surgical decision, which in any case needs to be discussed with the couple prior to surgery. The importance of these factors is exemplified by calculating the likelihood of an ectopic pregnancy re-occurring in a tube previously treated conservatively. In this case the incidence of ectopic pregnancy increases tenfold from approximately one in 100 to 200 in the general population to one in ten in women with a previous ectopic pregnancy or damaged tubes (Schoen and Nowak, 1975) and one in five future conceptions after two previous ectopic pregnancies (DeCherney et al., 1985). It has been argued that unless the tube is irreparably damaged or bleeding is uncontrolled a conservative procedure should always be the first line treatment for ectopic pregnancy; only if this fails is a radical procedure required.

Choice of patients

There are few absolute indications for salpingectomy (Table 10.1). A desire for sterilisation is not generally accepted on its own as the primary indication for radical surgery, unless this has been documented in previous records. Relative indications are more difficult to list and the individual needs and desires of the couple should be considered.