Unruptured tubal ectopic pregnancy: analysis and management
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20221924Keywords:
Conservative management, Unruptured tuba ectopic pregnancy, Systemic methotrexateAbstract
Background: From its indirect reference by Abulcasis and till the nineteenth century the ectopic pregnancy was known as a universally fatal accident. Many patients with early resolving ectopic pregnancies escape surgical treatment. Preservation of future fertility became possible with the introduction of conservative surgical procedures and with the use of methotrexate. Aim and objectives of the study were: to analyse the age group, gravida, risk factors, clinical presentation, treatment given and outcome of the unruptured ectopic pregnancy.
Methods: We studied twenty-five women admitted to our tertiary care hospital, through emergency or outpatient department with tubal ectopic pregnancy from January 2017 through September 2021.
Results: 25 cases were studied during a 5 years study period between January 2017 and September 2021 in a tertiary care hospital, Mumbai. Maximum incidence of tubal gestation occurred between the age group of 36-40 years (36%). Greater incidence was noted in multigravida accounting for 68%. Risk factors seen were advanced maternal age (36%) previous history of induced abortion (24%), previous history of abdominal or pelvic surgery in 20%. The typical triad of amenorrhoea, pain abdomen and bleeding were observed in majority of cases. Significantly a greater number of cases had ampullary pregnancy (52%), followed by cornual (24%) and fimbrial (24%). Out of 25 cases of unruptured tubal ectopic pregnancies, 68% cases were treated by purely surgical intervention while 8% cases were managed medically by methotrexate however in 24% cases, the medical treatment failed and they ended up having surgical intervention.
Conclusions: In conclusion, this study showed that medical treatment of unruptured ectopic pregnancy with systemic methotrexate seems to be an option for some patients with unruptured tubal pregnancy.
References
Lurie S. The history of the diagnosis and treatment of ectopic pregnancy: a medical adventure. Eur J Obstet Gynecol Reprod Biol. 1992;43(1):1-7.
Nama V, Manyonda I. Tubal ectopic pregnancy: diagnosis and management". Arch Gynecol Obstet. 2009;279(4):443-53.
Tharaux-Deneux C, Bouyer J, Job-Spira N, Coste J, Spira A. Risk of ectopic pregnancy and previous induced abortion. Am J Public Health. 1998;88:401.
Ory SJ. Chemotherapy for Ectopic Pregnancy. Obstet Gynaecol. Clin North Am. 1991;18:123-33.
Pal A, Gupta KB, Sarin R. A study of ectopic pregnancy and high-risk factors in Himachal Pradesh. J Indian Med Assoc. 1996;94:172-3.
Wakankar R, Kedar K. Ectopic Pregnancy-A rising Trend. Int J Sci Study. 2015;3(5):18-22.
Jacob S, Nath AG. Ectopic pregnancy, risk factors, infertility, contraception. Changing trends risk factors ectopic pregnancy- a case Control study. J Evol Med Dent Sci. 2017;6(12780):831-6.
Murugesan A, Prabhu KMM. A retrospective study of ectopic pregnancies in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2016;5(8):2537-40.
Shetty S, Shetty A. A Clinical Study of Ectopic Pregnancies in a tertiary Care Hospital of Mangalore, India. Innov J Med Heal Sci. 2014;4:305-9.
ICMR-task free project -Multicentric case control study of ectopic pregnancy in India. J Obstet Gynaecol India. 1990;40.
Jacob S, Nath AG. Ectopic pregnancy, risk factors, infertility, contraception. Changing trends risk factors ectopic pregnancy- a case control study. J Evol Med Dent Sci. 2017;6(12780):831-6.
Diquelou JY, Pia P, Tesquier L. The role of Chlamydia trachomatis in the infectious etiology of extra-uterine pregnancy. J Gynecol obstet Biol Reprod (Paris) 1988;17:325-32.
Marchbanks PA, Coulam CB, Annegers JF. An association between clomiphene citrate and ectopic pregnancy: A preliminary report. Fertil Steril. 1985;44(2):268-70.
Pranathi P, Madhavi Y. A clinical analysis of ectopic pregnancies in a tertiary care hospital in Hyderabad. Asian Pacific J Health Sci. 2018;5(1):14-24.
Jabbar FA, Al-Wakeel M. A study of 45 cases of ectopic pregnancy. Int J Gynecol Obstet. 1980;18(3):214-7.
Zuber I, Chaurasia V. Spectrum of ectopic pregnancy in tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2018;7(4):1435.
Udigwe, Umeononihu O, Mbachu I. Ectopic pregnancy: A 5 year review of cases at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. Niger Med J. 2010;51(4):160.
Igwegbe A, Eleje G, Okpala B. An appraisal of the management of ectopic pregnancy in a Nigerian tertiary hospital. Ann Med Health Sci Res. 2013;3(2):166.
Panti A, Tanko B, Yakubu A, Egondu S, Ikechukwu N, Lukman O. Ectopic pregnancy at Usmanu Danfodiyo University Teaching Hospital Sokoto: A ten year review. Ann Niger Med. 2012;6(2):87.
