Salpingostomy





Definition

A salpingostomy is a surgical incision into a fallopian tube. This procedure may be done to repair a damaged tube or to remove an ectopic pregnancy (one that occurs outside of the uterus).


Purpose

The fallopian tubes are the structures that carry a mature egg from the ovaries to the uterus. These tubes, which are about 4 in (10 cm) long and 0.2 in (0.5 cm) in diameter, are found on the upper outer sides of the uterus, and open into the uterus through small channels. It is within the fallopian tubes that fertilization, the joining of an egg and a sperm, takes place.

During a normal pregnancy, the fertilized egg passes from the fallopian tubes into the uterus and then implants into the lining of the uterus. If the fertilized egg implants anywhere outside of the uterus, it is called an ectopic (or tubal) pregnancy. The majority of ectopic pregnancies occur in the fallopian tubes (95%); they may also occur in the uterine muscle (1–2%), the abdomen (1–2%), the ovaries (less than 1%), and the cervix (less than 1%).

As an ectopic pregnancy progresses, the fallopian tubes are unable to contain the growing embryo and may rupture. A ruptured ectopic pregnancy is considered a medical emergency as it can cause significant hemorrhaging (excessive bleeding). If an ectopic pregnancy is diagnosed early (i.e., before rupture has occurred), it may be possible to manage medically; the drug methotrexate targets rapidly dividing fetal cells, preventing the fetus from developing further. If medical management is not possible or has failed, surgical intervention may be necessary. A salpingostomy may then be performed to remove the pregnancy.

Salpingostomy may also be performed in an effort to restore fertility to a woman whose fallopian tubes have been damaged, such as by adhesions (bands of scar tissue that may form after surgery or trauma). In the case of hydrosalpinx, a condition in which a tube becomes blocked and filled with fluid, a salpingostomy may be performed to create a new tubal ostium (opening).


Demographics

Ectopic pregnancy occurs in approximately 2% of all pregnancies. Once a woman has an ectopic pregnancy, she has an increased chance (10–25%) of having another. Women between the ages of 25 and 34 have a higher incidence of ectopic pregnancy, although the mortality rate among women over the age of 35 is 2.5–5.9 times higher. Minority women are also at an increased risk of ectopic pregnancy-related death.


Description

Salpingostomy may be performed via laparotomy or laparoscopy , under general or regional anesthesia. A laparotomy is an incision made in the abdominal wall through which the fallopian tubes are visualized. If the tube has already ruptured as a result of an ectopic pregnancy, a salpingectomy will be performed to remove the damaged fallopian tube. If rupture has not occurred, a drug called vasopressin is injected into the fallopian tube to minimize the amount of bleeding. An incision (called a linear salpingostomy) is made through the wall of the tube in the area of the ectopic pregnancy. The products of conception are then flushed out of the tube with an instrument called a suction-irrigator. Any bleeding sites are treated by suturing or by applying pressure with forceps. The incision is not sutured but instead left to heal on its own (called closure by secondary intent). The abdominal wall is then closed.

A neosalpingostomy is similar to a linear salpingostomy but is performed to treat a tubal blockage (e.g., hydrosalpinx). An incision is made to create a new opening in the fallopian tube; the tissue is folded over and stitched into place. The new hole, or ostium, replaces the normal opening of the fallopian tube through which the egg released by an ovary each menstrual cycle is collected.

Salpingostomy may also be performed laparoscopically. With this surgery, a tube (called a laparoscope) containing a tiny lens and light source is inserted through a small incision in the navel. A camera can be attached that allows the surgeon to see the abdominal cavity on a video monitor. The salpingostomy is then performed with instruments inserted through trocars, small incisions of 0.2–0.8 in (0.5–2 cm) made through the abdominal wall.

A tubal or ectopic pregnancy can be removed in several ways. If the fallopian tube is ruptured (A), the tube is tied off on both sides, and the embryo removed. If the tube is intact, the embryo can be pulled out the end of the tube (C), or tube can be cut open and the contents removed (D). (Illustration by GGS Inc.)
A tubal or ectopic pregnancy can be removed in several ways. If the fallopian tube is ruptured (A), the tube is tied off on both sides, and the embryo removed. If the tube is intact, the embryo can be pulled out the end of the tube (C), or tube can be cut open and the contents removed (D). (
Illustration by GGS Inc.
)



An advantage of laparoscopic salpingostomy is that the operation is less invasive, thus recovery time is quicker and less painful as compared to a laparotomy; the average duration of recovery following laparoscopy is 2.4 weeks, compared to 4.6 weeks for laparotomy. An abdominal incision, on the other hand, allows the surgeon a better view of and easier access to the pelvic organs. Several studies have indicated a reduced rate of normal pregnancy after salpingostomy by laparoscopy versus laparotomy.


Diagnosis/Preparation

It has been estimated that 40–50% of ectopic pregnancies are incorrectly diagnosed when first presenting to emergency room medical personnel. Often the symptoms of ectopic pregnancy are confused with other conditions such as miscarriage or pelvic inflammatory disease. Diagnosis is usually based on presentation of symptoms, a positive pregnancy test, and detection of a pregnancy outside of the uterus by means of ultrasonography (using a machine that transmits high frequency sound waves to visualize structures in the body).

Diagnosis of hydrosalpinx or other defects of the fallopian tubes may be done surgically, using a laparoscope to visualize the fallopian tubes. Alternatively, a hysterosalpingogram may be performed, in which the uterus is filled with a dye and an x ray is taken to see if the dye flows through the fallopian tubes.

Aftercare

If performed through an abdominal incision, a salpingostomy requires three to six weeks for full recovery. If salpingostomy is performed laparoscopically, the recovery time can be much shorter (an average of 2.4 weeks). There may be some discomfort around the incision for the first few days after surgery, but most women are walking by the third day. Within a month or so, patients can gradually resume normal activities such as driving, exercising, and working.


Risks

Complications associated with the surgical procedure include reaction to anesthesia, excessive bleeding, injury to other organs, and infection. With an ectopic pregnancy, there is a chance that not all of the products of conception will be removed and that the persistent tissue will continue growing. If this is the case, further treatment will be necessary.


Normal results

In the case of ectopic pregnancy, the products of conception will be removed without significantly impairing fertility. If salpingostomy is being performed to restore fertility, the procedure will increase a woman's chance of conceiving without resorting to artificial reproductive techniques.


Morbidity and mortality rates

Abdominal pain occurs in 97% of women with an ectopic pregnancy, vaginal bleeding in 79%, abdominal tenderness in 91%, and infertility in 15%. Persistent ectopic pregnancy after surgical treatment occurs in 5–10% of cases. Ectopic pregnancy accounts for 10–15% of all maternal death; the mortality rate for ectopic pregnancy is approximately one in 2,500 cases.

Alternatives

Some ectopic pregnancies may be managed expectantly (allowing the pregnancy to progress to see if it will resolve on its own). This may occur in up to 25% of ectopic pregnancies. There is, of course, a chance that the fallopian tube will rupture during the period of observation. Treatment with methotrexate is gaining popularity and has been shown to have success rates similar to laparoscopic salpingostomy if multiple doses are given and the patient is in stable condition. Salpingectomy is another surgical option and is indicated if a tube has ruptured or is seriously damaged.


Resources

PERIODICALS

Hajenius, P. J., B. Mol, P. Bossuyt, W. Ankum, and F. Van der Veen. "Interventions for Tubal Ectopic Pregnancy (Cochrane Review)." The Cochrane Library 1 (January 20, 2003).

Tay, J. I., J. Moore, and J. J. Walker. "Ectopic Pregnancy." British Medical Journal 320 (April 1, 2000): 916–19.

Tenore, Josie L. "Ectopic Pregnancy." American Family Physician (February 15, 2000): 1073–79.

Watson, A., P. Vandekerckhove, and R. Lilford. "Techniques for Pelvic Surgery in Subfertility (Cochrane Review)." The Cochrane Library 1 (January 20, 2003).


ORGANIZATIONS

American College of Obstetricians and Gynecologists. 409 12th St., SW, PO Box 96920, Washington, DC 20090-6920. http://www.acog.org .


OTHER

Braun, R. Daniel. "Surgical Management of Ectopic Pregnancy." eMedicine. January 13, 2003 [cited March 16, 2003]. http://www.emedicine.com/med/topic3316.htm .

Daiter, Eric. "Ectopic Pregnancy." OBGYN.net . [cited March 16, 2003]. http://www.obgyn.net/pb/cotm/9902/9902.htm .

"Early Diagnosis and Management of Ectopic Pregnancy." American Society for Reproductive Medicine (Technical Bulletin). March 2001 [cited March 16, 2003]. <http://www.asrm.org/Media/Practice/ectopicpregnancy.PDF> .

"Hysterosalpingogram." The Harvard Medical School Family Health Guide." [cited March 16, 2003]. <http://www.health.harvard.edu/fhg/diagnostics/hystero/hystero. html> .

"Salpingostomy." The McGill Gynecology Page. August 27, 2002 [cited March 16, 2003]. <http://sprojects.mmip.mcgill.ca/gynecology/lapmain.html> .


Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Salpingostomies are usually performed in a hospital operating room by a surgeon or gynecologist, a medical doctor who has completed specialized training in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics.

QUESTIONS TO ASK THE DOCTOR



  • Why is a salpingostomy being recommended?
  • How will the procedure be performed?
  • If an ectopic pregnancy is suspected, how will the diagnosis be confirmed?
  • What alternatives to salpingostomy are available to me?


User Contributions:

savina
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Apr 17, 2007 @ 8:08 am
hello doctor,
i had an ectopic pregnancy n i had undergone a mini laprotomy->left salphingotomy,doctors said me that i have 100% chance to concieve again,but i am scared that will i get ectopic pregnancy again.will it happen again?
What remedies can be taken for me to have normal pregnancy,should i need to take sum test for that before planning to get concieved.i had surgery on march13,2007.how long gap can be taken to plan to get concieved.
can u breifly explain and send to my mail id
thank u
sharonda harris
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Dec 4, 2007 @ 1:13 pm
Hello,

I had a etopic pregnancy two years ago and just yesterdy I found out that I am pregnant. Will I have a normal birth? Will this occur again? Can you please let me know if this will cause me to have complication in this preganacy?
monica mendez
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Jun 4, 2008 @ 9:21 pm
doctor i have been pregant 7 time i have one child 4 misscarige and two etopic and only have one tube. is there and thing that can be done for scar tissue inside the tube. please i cant aff ivf and i want a baby more than anything in this world. please reply.
kalpana
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Jun 6, 2008 @ 11:23 pm
hello doctor,
i had an ectopic pregnancy n i had undergone laproscopi->left linear salphingostomy,doctors said me that i have 80% chance to concieve again,but i am scared that will i get ectopic pregnancy again.will it happen again?
What remedies can be taken for me to have normal pregnancy,should i need to take sum test for that before planning to get concieved.i had surgery on april 28th,2008.how long gap can be taken to plan to get concieved.
can u breifly explain and send to my mail id
thank u
Heather
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Dec 23, 2008 @ 10:10 am
Hello Dr
I had an etopic pregnancy and it was surgically removed on Dec 17, 2008 what are my chances of having another one again. Will I still be able to conceive the next time around with no complicaions. The etopic pregnancy was on my left side and it was attached to my left ovary so I did not loose my falopian tube neither my left ovary so Im still in tact. Thank God for that. So can you give me a little brief discription on my question.
Thank You!!
Samantha
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Jan 19, 2009 @ 6:18 pm
I just got out of the hospital yesterday after surgery from a ruptured ectopic. They removed my tube. After reading information on website after website, it is commonly said that I have a 50% chance of fertility after a ruptured ectopic. Is this true?
Joshna
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Apr 27, 2009 @ 4:04 am
Hello Dr
I had an etopic pregnancy and it was surgically removed on March 11TH 2009 what are my chances of having another one again. Will I still be able to conceive the next time around with no complicaions. The etopic pregnancy was on my RIGHT side and my falopian tube was removed . So can you give me a little brief discription on my question. how long gap can be taken to plan to get concieved and to particiapte in sex with my partner.
can u breifly explain and send to my mail id

Thank you
connie
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May 26, 2009 @ 10:22 pm
Doctor
I have surgery March 14, 2009 to remove my etopic pregnecy on my left side and lost my left tube also. Well my doctor told us that we should at least wait 2-3 months before trying to concieve. Is this true or should I wait longer before we decide to get pregnet. Please write back.
THANK YOU
Beatriz
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Jun 8, 2009 @ 1:13 pm
Hello Dr.,
I had an ectopic pregnancy and i had laproscopi to remove the pregnancy unfortunately i dont remember what tube was effected if it was the right or left tube. I was wondering if you could tell me what side it was if the incision is on the left side of my stomach
CYNTHIA
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Aug 4, 2009 @ 2:14 pm
I HAVE BEEN LOOKING FOR INFORMATION ON SURGERY FOR TUBAL BLOCKAGE FOR QUITE A WHILE. THE ONLY REASON I FOUND THIS WEBSITE IS BECAUSE I WORK IN A HOSPITAL AND KNOW THE MEDICAL TERMINOLOGY FOR WHAT I WAS LOOKING FOR. I CAME ACROSS OTHER WOMEN (BLOGS) THAT HAVE SIMILAR ISSUES. I WISH THAT IT WAS EASIER TO OBTAIN THIS WEBSITE. I HAVE SEEN A REPRODUCTIVE ENDOCRINOLOGIST BECAUSE I HAVE TUBAL BLOCKAGE. I ASKED ABOUT LAPAROSCOPY BUT I WAS TOLD I WOULD HAVE A BETTER CHANCE FOR CONCIEVING VIA ARTIFICIAL MEANS. ANYWAY I JUST WANTED TO THANK THE PERSON WHO MADE THIS WEBSITE AND GAVE ME OPTIONS.
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May 3, 2010 @ 8:08 am
hello doctor,
i had an ectopic pregnancy n i had undergone a mini laprotomy->left salphingotomy,doctors said me that i have 100% chance to concieve again,but i am scared that will i get ectopic pregnancy again.will it happen again?
What remedies can be taken for me to have normal pregnancy,should i need to take sum test for that before planning to get concieved.i had surgery on feb 12,2010.how long gap can be taken to plan to get concieved.
can u breifly explain and send to my mail id
thank u

Read more: Salpingostomy - procedure, recovery, test, tube, pain, complications, time, infection, operation, pregnancy, cells, risk, rate, Definition, Purpose, Demographics, Description http://www.surgeryencyclopedia.com/Pa-St/Salpingostomy.html#ixzz0ms9e45MO
Ann
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Jun 27, 2010 @ 9:21 pm
My tubes are tied and I'm pregant can I have this baby
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Aug 13, 2010 @ 10:10 am
I have an ectopic pregnancy 3 years back, doc. removed my right tube and checked the left tube, which was normal, but after one and half year i again have laproscopy bec. doc did not able to see my left tube open in dye test. In the second laproscopy some adhesions were removed and some infection is found, doc found the left tube open, i took anti-biotics treatment, now its been almost 1 and half year after that but i stll have not conceive, Please advice me doctor what treatment to follow to get pregnant?? and can it be possible for me to conceive naturally in future?
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Aug 17, 2010 @ 8:20 pm
I want to ask if rupture of fallopian tube happend to my girlfrend is that any possibility that she can have children again in that case whats the risks?
sonali
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Oct 14, 2010 @ 11:11 am
hello doctor,
i had an ectopic pregnancy after IVF n i had undergone laproscopi->left linear salphingostomy, i am scared that will i get ectopic pregnancy again.will it happen again?
What remedies can be taken for me to have normal pregnancy,should i need to take sum test for that before planning to get concieved.i had surgery on 2 SEP 2010.how long gap can be taken to plan to get concieved.
can u breifly explain and send to my mail id
thank u
Report this comment as inappropriate
Dec 22, 2010 @ 11:11 am
Hello Dr,i had an ectopic and my right fallopian tube was removed on the 29th of Dec 2010,i have a boy age4,pls what is my chances of getting pregnant again and for how long can i wait before conceiving again and what are the precautions for me to take in other not to have another ectopic.pls reply into my E-mail .Thanks
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Apr 6, 2011 @ 10:22 pm
i have experienced ectopic pregnancy twice (right and left fallopiantube). so my question is, is there any possibility for my to get pregnant?
Report this comment as inappropriate
Jul 27, 2011 @ 9:09 am
hello doctor,
i had an ectopic pregnancy n i had undergone laproscopi->left linear salphingostomy,doctors said me that i have 80% chance to concieve again,but i am scared that will i get ectopic pregnancy again.will it happen again?
What remedies can be taken for me to have normal pregnancy,should i need to take sum test for that before planning to get concieved.i had surgery on april 28th,2008.how long gap can be taken to plan to get concieved.
can u breifly explain and send to my mail id
tayebeh
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Jul 27, 2011 @ 3:15 pm
hi.iam 25 years old.i had ectopic peregnancy &my right fallopian tube injured&bleeding&now i lose my tube.i want to ask you can i pergnant?when?i used clomophin &letrozol tab &injection hcg in mid of my cycle but iam not pergnant why?pelease help me.thanks
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Sep 6, 2011 @ 6:06 am
Hello Dr
I had an etopic pregnancy and it was surgically removed on Aug 08, 2011. what are my chances of having another one again. Will I still be able to conceive the next time around with no complicaions. The etopic pregnancy was on my right side and it was attached to my right ovary so I did not loose my falopian tube neither my right ovary so Im still in tact.
What remedies can be taken for me to have normal pregnancy,should i need to take sum test for that before planning to get concieved.how long gap can be taken to plan to get concieved.
So can you give me a little brief discription on my question.
Thank You!!
Report this comment as inappropriate
Sep 29, 2011 @ 4:16 pm
Dear Doctor, I recently was about a month pregnant and Etopic pregnancy was discovered on the 24/9/11 on
Right rube. Because of scarring to the right tube, I had the Laparoscopic right salpingectomy surgery.
My left tube appeared normal and I was given anti-biotics.
I can't help but be very worried if I will be able to have a normal healthy pregnancy again, is there anything I can
Do to continue to keep my left tube healthy? I.e via my lifestyle or can I request regular check-ups?
God forbid if this happened again and I had no tubes how can I have my own children ?
I didn't have any infections so I am still finding it hard to believe, or swallow this could happen to me for no reason.

Thanks
andleeb
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Dec 14, 2011 @ 8:08 am
i ad an right tubal intact ectopic pregnency one n a half year bach. i have been trying to concieve from one year, but not successfull. please tell me that what can i do to conceive fast and to have healthy one pregnency .please answer me on my e-mail id which is andleebnauman@yahoo.com.
Elaine Ortiz
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Feb 7, 2012 @ 7:19 pm
For the Williams Family.
Love,
The Ortiz Family
natalie
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Nov 3, 2012 @ 8:20 pm
Hi Doctor,

I am very worried about 5 years ago i had an ectopic pregnancy on the left side which was successfully removed then 4 months after i fell pregnant with my daughter who is very well and healthy, my only concern is i really want to try for another baby but i am so scared to take the risk of it being another ectopic pregnancy i am only 29 and cant not afford ivf or any interventions. Please can you advise me on what the best way is to prevent this happening again. I have been on evra contraception patches for about 2 years and recently been feeling a niggling pain on my right side.

Please help me.
sherly
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Nov 10, 2012 @ 12:00 am
HI DOCTOR ,I had rt salphingectomy 10 days before.It s an open surgey under general anaesthesia.My left tube appeared normal.Am scare that will i get ectopic pregnancy again?will it happen again?How long gap can be taken plan to get conceived?nw am having rt side leg pain is there.wt is the cause of tis?how many mnths resting period?PLEASE HELP ME. THANK YOU.MY EMAIL ID:sherly.santhosh86gmail.com
resmy
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Dec 24, 2012 @ 12:00 am
Dr.I had rt.salphingectomy on two weeks ago. I had bleeding in between. Now I have abdomenal pain and cramps.it's radiating to my left thigh too.please give some advices..
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May 2, 2013 @ 2:14 pm
Hi;doctor i,m 28yrs i had laparotomy with salpingectomy 10 days -before after ruptured ectopic but i still have scanty vaginal bleeding is it normal?and what is the best contraceptive method as i was using iud and when i use it?
umme habiba
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Sep 8, 2013 @ 3:03 am
i had also ectopic pregnancy & laparoscopic salpingostomy was done 2wks ago.this procedure causes early recovery.
lubina
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Sep 30, 2013 @ 7:07 am
In dec 2012 I have salphengectomy in right tube.now I am pregnent scanning test is again tubular pregnency in right tube how please reply me
Azonsokey
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Jul 3, 2014 @ 9:09 am
Dr I will be 24 on the 10th of this month .l had laporascopic salppingotomy I had one tube removed it was done on the 21st of March this year . My husband in bordering that we should try again now in July . Please am scared it okay to try now please help me.
Krystal
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Aug 11, 2014 @ 9:21 pm
I need help can't seem to find my answer anywhere. I had a csection in jam 2009 then October 2013 I had my right tube removed due to an ectopic; they reopened the area I had been cut before. Now I am pregnant due dec 5, 2014 and I want to know if I can do a vaginal birth? Please reply; thank you.
kashifa
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Sep 4, 2014 @ 1:01 am
I am a mother of 2yr girl. I had a miscarriage on 12th May. Then i had an ectopic pregnancy on my right n foetus was removed by salpingostomy leproscopy on 31st Aug(5days before). The tube has been left open.how much time will it tak the tube to recover n after how much time should i plan for getting pregnant and what r the chances of having normal pregnancy. Have i to take any precautions or tests.please reply. I m very tense n scared.
samantha king
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Nov 8, 2014 @ 1:13 pm
Hi dr.I have 10% of my left you my right tube is totally gone I want to know is there any way that I can get my left you fixed to attach to my uterus or wherever it needs to be attached to so I can have another baby successfully
cassilla
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Nov 28, 2014 @ 8:20 pm
I had anectopic pregnancy where my left tube was removed and my right was repaired. Will i be able to have a normal pregnancy and how long should i wait to conceive and what types of food should i be eating.

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