The predictive value of the 'Hull & Rutherford' classification for tubal damage

Abstract

Objective: This study explores the predictive value for live birth following tubal reconstructive surgery of the 'Hull and Rutherford' (H&R) classification system. Design: Retrospective cohort study. Setting: Tertiary infertility referral service, University of Bristol. Population: Infertile women younger than 40 years with tubal damage undergoing tubal surgery. Methods: Women (n = 192) were grouped according to three severity grades of disease based on the H&R classification. Essentially, the main features of grade I tubal damage were filmy adhesions, whereas grades II and III referred to unilateral severe damage and bilateral severe damage, respectively. Standard surgical techniques were employed. Pregnancy and live birth rates were calculated and compared using time-specific univariate Kaplan-Maier curves and multivariate Cox's regression analysis. Main outcome measures: Pregnancy, ectopic and live birth within three years of surgery. Results: A significant trend towards higher ectopic pregnancy rates (P < 0.001) with increasing severity of tubal damage was noted, but not miscarriage rates. Univariate analysis revealed significant differences in the live birth rates of 69%, 48% and 9% for grades I, II and III, respectively. Multivariate analysis (controlling for age, duration of and primary infertility) confirmed these differences to be significant with risk ratios of 13.7 (95% CI: 4.49-41.9) and 6.54 (95% CI: 2.48-17.24) for grades I and II disease, respectively, compared with grade III disease, used as the reference. Conclusions: The H&R classification is a simple classification system that is able to distinguish women into three distinct groups giving a favourable, fair and poor prognosis for live birth following tubal surgery.