Urooj Mahboob, Syeda Batool Mazhar


Background: Ectopic pregnancy is the most important cause of maternal mortality and morbidity in
the first trimester. Over the past few decades, the management of ectopic pregnancy has been
revolutionized; various modalities of treatment are currently in practice. The purpose of this study
was to determine the frequency of these modes of treatment of ectopic pregnancy and their outcome.
Methods: Fifty two patients diagnosed to have ectopic pregnancy at MCH Center unit II in the year
2004 and 2005 were included in the study. A cross-sectional analytical study was done. Four modes of
treatment were given according to patient’s condition, ultrasound findings and ß-hCG levels; these
were laparotomy, operative laparoscopy, methotrexate injection and conservative management. The
outcome measures included success of each treatment modality, need for second mode of treatment in
each group and duration of hospital stay. Results: A total number of 52 patients with ectopic
pregnancy were identified and studied. The rate of ectopic pregnancy was 1:100 deliveries.
Emergency laparotomy was performed in 30 (57.9%) women, 15 (28.8%) received methotrexate
injection. Seven women (13.3%) were managed conservatively and operative laparoscopy was not
used as primary treatment in any of the patient. All cases of laparotomy did not require any further
procedure. Twelve out of fifteen (80%) cases of medical treatment were successful while one (6.7%)
proceeded to emergency laparotomy, one (6.7%) to operative laparoscopy and one (6.7%) to
laparoscopy preceding laparotomy. Five out of seven patients (71.4%) on conservative treatment did
not require any further intervention while two (28.6%) of them resolved with methotrexate injection.
The duration of hospital stay in laparotomy, medically treated and conservatively managed groups
was 6.5, 5.9 and 1.7 days respectively. Conclusion: In the institutional setting ectopic pregnancy
accounted for 1% of total deliveries. More than half of all women with ectopic pregnancy presented
with acute abdomen and required emergency laparotomy. About 40% women could be managed with
non-surgical modalities with 80% success for methotrexate injection and 71% for conservative
treatment in the present study.
Keywords : Ectopic pregnancy, methotrexate, laparoscopy.


Hankins GD, Clark SL, Cunningham FG, Gilstrap LC.

Ectopic pregnancy. In: Dilmond E; Gilstrap. Operative

obstetrics. New York: Appleton & Lange; 1995:437-56.

Lehner R, Kucera E, Jirecek S, Egarter C, Husslein P.Ectopic

pregnancy. Arch Gynecol Obstet 2000; 263: 87-92.

Hill GA, Herbert CM. Ectopic pregnancy. In: Herbert CM,

Textbook of gynaecology. Philadelphia: WB Saunders 1993;


Mazhar SB, Mahmood G, Parveen F. Systemic methotrexate

for the treatment of ectopic pregnancy larger than 3.5 cms.

The XVIth Asian and Oceanic Congress of Obstetrics and

Gynaecology. June 14-19th, Kuala Lumpur, Malaysia 1998;


Khawaja NP, Rehman R, Durrani Z. Ectopic pregnancy at

gynaecology unit II Sir Ganga Ram Hospital, Lahore; study of

fifty cases. Pak J Obstet Gynecol 1998;11:61-5.

Symonds I M. Modern management in ectopic pregnancy,

Current obstetricians & gynecology 1998; 8:27-31.

Akbar N, Shami N, Anwar S, Asif S. Evaluation of

predisposing factors of tubal pregnancy in multigravidas

versus primigravidas. J Surg PIMS 2002; 25: 20-3.

Braun RD. Surgical management of ectopic pregnancy.

Online 2005. e medicine. [cited 2005 Oct 27].Available from:

URL: 3316.htm-94k.

Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomized

trial of comparing single dose systemic methotrexate and

laparoscopic surgery for the treatment of unruptured tubal

pregnancy. Br J Obstet Gynecol 2001; 108:192-203.

Grudzinskas JG. Miscarriage, ectopic pregnancy and

trophoblastic disease. In: Edmonds DK. Dewhurst ’s textbook

of obstetrics and gynaecology for postgraduates. 6 th ed.

Oxford: Blackwell Science 1999; .61-75.

The management of tubal pregnancy. Royal college of

obstetricians and gynecologists guidelines 2004;21:1-10.

Lozean AM, Potter B. Diagnosis and management of ectopic

pregnancy. Am Fam Physician 2005;72:1707-14.

Bangash N, Ahmed H. A study of 65 cases of ectopic

pregnancy during one year period in military hospital. Pak

Armed Forces Med J 2004;54:205-8.

Wasim T. Proportionate morbidity and risk factors of ectopic

pregnancy. Ann King Edward Med Coll 2004;10:298-300.

Ben Hmid R, Mahjoub S, Mourali M, El Houssaini S, Zeqhal

D, Zouari F, et al. Management of ectopic pregnancy. Tunis

Med 2006;84:238-41.

Korhoren J, Stenman UH, Ylostalo P. Methotrexate with

expectant management of ectopic pregnancy. Obstet Gynecol


Ylostal P, Cacciatore B, Sjoberg J. Expactant management of

ectopic pregnancy. Obstet Gynecol 1992;80:345-8.

Mazhar SB, Mahmud G, Rarveen F. Systemic methotrexate

for the treatment of ectopic pregnancies. J Obstet Gynaecol

Res 1999;80:44-5.

Barnhart KT, Gosman G, Ashby R, Sammel M. The medical

management of ectopic pregnancy; a meta-analysis comparing

single dose and multidose regimens. Obstet Gynecol 2003;


Soliman KB, Saleh NM, Omran AA. Safety and efficacy of

systemic methotrexate in the treatment of unruptured tubal

pregnancy. Saudi Med J 2006; 27:1005-10.

Dilbaz S, Caliskan E, Dilbaz B, Deqirmenci O, Haberal A.

Predictors of methotrexate treatment failure in ectopic

pregnancy. J Reprod Med 2006; 51:87-93.

OlofssonI J, Sundtrom I, Ottander U, Kjellberj L, Damber MG,

Clinical and pregnancy outcome following pregnancy; a

prospective study comparing expectancy, surgery and

systemic methotrexate treatment. Aeta Obstet Gynecol Scanol

; 80:744-9.

Stovall TG, Ling FW. Single dose methotrexate;an expanded

clinical trial. Am J Obstet Gynecol 1993; 168:1759-63.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] []