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The predictive value of the ‘Hull & Rutherford’ classification for tubal damage
Article first published online: 19 OCT 2004
DOI: 10.1111/j.1471-0528.2004.00408.x
Issue
BJOG: An International Journal of Obstetrics & Gynaecology
Special Issue: Reproductive Medicine
Volume 111, Issue 11, pages 1236–1241, November 2004
Additional Information
How to Cite
Akande, V. A., Cahill, D. J., Wardle, P. G., Rutherford, A. J. and Jenkins, J. M. (2004), The predictive value of the ‘Hull & Rutherford’ classification for tubal damage. BJOG: An International Journal of Obstetrics & Gynaecology, 111: 1236–1241. doi: 10.1111/j.1471-0528.2004.00408.x
Publication History
- Issue published online: 19 OCT 2004
- Article first published online: 19 OCT 2004
- Abstract
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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.