MANAGEMENT OF ECTOPIC PREGNANCY: A TWO-YEAR STUDY
Abstract
Background: Ectopic pregnancy is the most important cause of maternal mortality and morbidity inthe first trimester. Over the past few decades, the management of ectopic pregnancy has beenrevolutionized; various modalities of treatment are currently in practice. The purpose of this studywas 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 year2004 and 2005 were included in the study. A cross-sectional analytical study was done. Four modes oftreatment were given according to patient’s condition, ultrasound findings and ß-hCG levels; thesewere laparotomy, operative laparoscopy, methotrexate injection and conservative management. Theoutcome measures included success of each treatment modality, need for second mode of treatment ineach group and duration of hospital stay. Results: A total number of 52 patients with ectopicpregnancy 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 methotrexateinjection. Seven women (13.3%) were managed conservatively and operative laparoscopy was notused as primary treatment in any of the patient. All cases of laparotomy did not require any furtherprocedure. 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%) tolaparoscopy preceding laparotomy. Five out of seven patients (71.4%) on conservative treatment didnot 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 groupswas 6.5, 5.9 and 1.7 days respectively. Conclusion: In the institutional setting ectopic pregnancyaccounted for 1% of total deliveries. More than half of all women with ectopic pregnancy presentedwith acute abdomen and required emergency laparotomy. About 40% women could be managed withnon-surgical modalities with 80% success for methotrexate injection and 71% for conservativetreatment in the present study.Keywords : Ectopic pregnancy, methotrexate, laparoscopy.References
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;
-60.
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;
-20.
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:http://www.emedicine.com/med/topic 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
;88:775-8.
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;
:778-84.
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.
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
