PREGNANCY-BIRTH Messages for August, 1999: Re: No answer yet on question of etopic risk after reversal of tubal

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Re: No answer yet on question of etopic risk after reversal of tubal

From: Todd L Allen, MD (anonymous@obgyn.net)
Fri, 27 Aug 1999 13:05:05 -0500 (CDT)

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In reply to: Jodi: "No answer yet on question of etopic risk after reversal of tubal"

At Fri, 27 Aug 1999, Jodi wrote: >
>Hi, I am hoping someone will be able to answer my question. I posted
>earlier in the week but did not get a response from anyone. I had a
>reversal of my tubal ligation earlier this summer. Prior to the
>reversal my eggs were checked as well as my husbands sperm. The
>physician told us we should have no trouble getting pregnant after the
>surgery. I am 35 and my husband is 33. It is now time for us to start
>trying to conceive and I am very concerned about the risk of etopic
>pregnancy. Can anyone tell me the level of risk this is and what the
>earliest signs will be? Also, what happens if I do have an etopic
>pregnancy? Will it be another major abdominal surgery and then how long
>will I have to wait to start again, this worries me because I am already
>35? I'm trying not to worry to much about this but it's been on my mind
>and I would really appreciate some answers. Thank you.

A review of about 1800 cases of tubal reversals in 15 articles showed a pretty consistent risk of ectopic pregnancy of 4%, the overall success rate of intrauterine pregnancies was 64%. The most common signs and symptoms of ectopic pregnancy include lower abdominal pain, absent menses, or abnormal bleeding. I usually have patients follow up if irregular bleeding occurs or if pregnancy is suspected. If the pregnancy test is positive, the rate of rise in the pregnancy hormone level can be followed until the level is high enough to see a pregnancy sac in the uterus (usually about 2000). Also, early in pregnancy, the levels should double about every 48-72 hours (although some ectopics will do this also). If an ectopic pregnancy is caught early enough, surgery may not be needed; there is an alternative treatment with a single dose of a chemotherapy drug (Methotrexate) that can result in resolution of the ectopic, and rates of the tube being still open after surgery are as great as with laparoscopic removal of ther ectopic (also an alternative to major surgery). Treatment with methotrexate has a low incidence of side effects and is generally safe in patients where the ectopic gestation is not advanced, and if there is no pre-existing kidney or liver disease in the mother. The level of the pregnancy hormone has to be carefully followed after treatment until it is negative; in some patients, a second dose of medication, or surgery for failed treatment may be required. Most physicians would probably recommend a wait of 2-3 months after resolution before attempting conception again. Hope this answers your questions.

--
Todd L Allen, MD

Next message: JoAnn: "Re: Anencepahly"
Previous message: Norie: "Anencepahly"
In reply to: Jodi: "No answer yet on question of etopic risk after reversal of tubal"

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