Homm, R. J., Holtz, G., & Garvin, A. J. (1987). Isthmic ectopic pregnancy and salpingitis isthmica nodosa. Fertility and Sterility, 48(5), 756-760. https://doi.org/10.1016/s0015-0282(16)59525-9
Homm RJ, Holtz G, Garvin AJ. Isthmic ectopic pregnancy and salpingitis isthmica nodosa. Fertil Steril. 1987;48(5):756-760. doi:10.1016/s0015-0282(16)59525-9
Homm, Robert J., et al. "Isthmic ectopic pregnancy and salpingitis isthmica nodosa." Fertility and Sterility, vol. 48, no. 5, 1987, pp. 756-760.
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Salpingitis isthmica nodosa is linked to isthmic ectopic pregnancy
Salpingitis isthmica nodosa (SIN) appeared much more often in isthmic ectopic pregnancies than in ampullary ones. A 1987 chart review looked back at 255 surgically treated ectopic pregnancies in women without earlier tubal surgery. It used 39 ampullary cases for contrast.
Key Findings
Isthmic ectopic pregnancy made up 39 cases (15.3%) of the 255 ectopic pregnancies, after women with earlier tubal surgery were excluded.
Pathology showed SIN in 17 of 37 isthmic cases (45.9%), counting only cases with tissue available for review.
Among 39 matched ampullary ectopic pregnancies, 4 showed SIN (10.2%). The gap from isthmic cases was significant (P < 0.001).
Among isthmic cases, the SIN rate did not differ significantly between tubes treated by segmental resection and tubes treated by salpingectomy.
Interpretation
The authors reviewed charts from 1981 to 1986 at hospitals tied to the Medical University of South Carolina, excluding women with earlier IVF, tubal repair, or failed sterilization. One pathologist read the slides without knowing where the pregnancy was located. The authors state that the limited number of sections examined, and the use of resected segments, likely lead to an underestimate of SIN frequency. They read the finding as a sign that SIN places a woman at risk for a repeat ectopic pregnancy or infertility.
RRM Context
The authors advise segmental resection for an isthmic ectopic pregnancy. They add a careful pathology check for SIN and an X-ray of the tubes afterward when SIN is found or the other tube looks abnormal. Restorative reproductive medicine looks for the underlying cause of tubal disease. Recording what the tube shows at surgery gives later care a clear finding to work from.
Our editorial summary of this paper, not the article's abstract.
Abstract
Two hundred eighty-five charts were reviewed from patients who underwent surgery for ectopic pregnancy. Excluded were patients with previous tubal reparative surgery, linear salpingotomy, or failed sterilization. The incidence of isthmic ectopic pregnancy in the remaining 255 cases was 15.3%. The association of salpingitis isthmica nodosa (SIN) and isthmic ectopic pregnancy was determined by review of resected tubal segments. SIN was noted in 17 of 37 cases (45.9%) of isthmic ectopic pregnancy. SIN places the patient at risk for recurrent ectopic pregnancy or infertility. Recommended conservative management of isthmic ectopic pregnancy is segmental resection with postoperative emphasis on documentation of SIN when present. Postoperative hysterosalpingography is recommended with an abnormal contralateral tube or when SIN is noted in the resected tubal segment. Management options after an isthmic ectopic pregnancy when future fertility is desired are presented.
How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.
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