Outcome of management of ectopic pregnancy

Abstract

Background: Ectopic pregnancy is a life-threatening condition and one of the most common acute abdominal emergencies. It affects approximately 2% of all pregnancies and remains an important contributor to maternal morbidity and mortality among first trimester deaths.
Objectives: To study the clinical presentation, risk factors, management, and outcome of ectopic pregnancy.
Methods: All patients who presented with clinical signs and symptoms of ectopic pregnancy and were eventually diagnosed as ectopic pregnancy (n=90) were enrolled in this study after obtaining the proper informed consent in local language. Patients were subjected to a urinary pregnancy test, serial serum beta-HCG levels, baseline investigations TAS, and TVs. The diagnosis was established on the basis of clinical presentation, abnormally low beta-hCG doubling rates every 48 hours or plateauing levels with no evidence of intrauterine pregnancy or sonographic identification of a gestational sac outside the uterus.
Results: Nearly 57.8% of patients had some underlying risk factors for ectopic pregnancy. The overall success rate of treatment with surgical intervention (96.9%) was found to be higher compared to medical management (78.9%) and expectant management (71.4%). Out of 7 patients (7.8%) who were managed expectantly, 2 patients developed failure to expectancy in view of rising serum -hCG levels, which were then successfully treated with single-dose MTX. Out of 19 patients (21.1%) who underwent medical treatment either with single-dose methotrexate or multidose methotrexate, failure of index treatment was seen mainly in patients who had initial serum -hCG levels > 3500 and ectopic pregnancy sac size >3.5cm. Out of 64 (71.1%) patients who were managed surgically, 62 patients were successfully treated while 2 patients developed failure to primary treatment. Among them, one of the patients underwent laparoscopic salpingostomy and other Laparoscopic milking. Both developed persistent trophoblast disease (evidenced by plateauing serum -hCG levels after the primary treatment), who were later on treated with single-dose methotrexate.
Conclusion: Ectopic pregnancy should be suspected in every woman of reproductive age group, who presents with unexplained abdominal pain. A high index of suspicion is required for early diagnosis and appropriate management. Overall, the success rate of surgical management is higher than either medical or expectant management.