Surgical management of tubal pregnancy

The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and meta-analysis was performed to evaluate the effectiveness of surgery, medical treatment and expectant management in terms of treatment success (i.e. complete elimination of trophoblastic tissue), financial costs and future fertility. This systematic review confirmed the lack of knowledge on the impact on future fertility of the two surgical approaches, salpingotomy and salpingectomy. Therefore, we started an international multicentre randomised controlled trial comparing salpingotomy with salpingectomy, with future pregnancy being the outcome of interest. Finally, we investigated the impact on financial costs (cost-effectiveness analysis) and women’s preference towards salpingotomy and salpingectomy.