Clinical Guidelines and Standards · Diagnostic Criteria and Classification
RRM Academy Synopsis
AFS classification systems for adhesions and tubal damage
In 1988, a group of doctors wrote six classification forms, several with a point score. Doctors record exam and surgery findings on these forms. They cover scar tissue, blocked tubes, reversed tube-tying, tubal pregnancies, uterus shape, and uterine scarring. The forms give surgeons a shared way to classify damage. This paper is not a study of patient outcomes.
Key Findings
- This doctors' group estimated about 60,000 ectopic pregnancies happen in the United States each year.
- Reported viable pregnancy rates after microsurgery to open a blocked tube ranged from 19% to 35%, with ectopic pregnancy rates of 5% to 18%; favorable cases reached 50% to 80%.
- More than 60% of patients who achieved an intrauterine pregnancy after this tubal surgery did so after the first postoperative year, a fairly long interval.
- In a few case series of more than 50 patients each, live birth rates after tubal ligation reversal ranged from 48% to 78%, and tubal pregnancy rates from 1.7% to 6.5%.
- An estimated 5,000 tube-tying reversal surgeries happened each year, but fewer than 1,000 were reported in published studies.
Interpretation
This is a report from a doctors' group, and it does not study patients directly. A committee of surgeons wrote six classification forms to help different surgeons describe similar findings in a similar way. The pregnancy numbers come from earlier published studies. The committee did not test the new forms themselves to produce these numbers, and it does not describe testing them on patients before publishing them. The committee calls some point values arbitrary but appropriate until prospective studies are done, and expects to modify the values afterward. The paper covers surgical classification. The forms do not evaluate how well any treatment works.
RRM Context
Restorative reproductive medicine treats a precise diagnosis as the starting point. This paper is part of that same tradition. The paper comes from the same group that wrote the Revised AFS Classification of Endometriosis. Both papers gave surgeons a shared scoring language. The shared language lets surgeons compare results of tube repair or scar tissue removal across clinics and over time.
Abstract not indexed.
Topics
Keywords
Adnexa Uteri/pathology, Adnexal Diseases/classification, Fallopian Tube Diseases/classification/etiology, Female, Fertility, Humans, Mullerian Ducts/pathology, Pregnancy, Pregnancy, Tubal/classification, Societies, Medical, Sterilization, Tubal/adverse Effects, Tissue Adhesions/classification, United States, Uterus/pathology
