Management of tubal ectopic pregnancy in a tertiary care health center

Abstract

Background: Ectopic pregnancy is one of the life-threatening conditions that can be managed expectantly, medically or surgically but a timely diagnosis is of prime importance. A tubal ectopic pregnancy occurs, when a fertilised ovum implants in the fallopian tube instead of normal uterine cavity. Methodology: It is a prospective observational study of 60 women diagnosed with tubal ectopic pregnancy at KIMS Hospital, Secunderabad. Intrauterine pregnancy, molar pregnancy, pregnancies of unknown location, ectopic other than tubal, patients on methotrexate for any other indication or methotrexate hypersensitivity or contraindications to its administration, non-compliant patient or living far away from hospital were excluded. All the patients were managed on outpatient basis, except when the patient was haemodynamically unstable or there were signs of ruptured ectopic pregnancy clinically or on transvaginal scan (TVS). Patients with unruptured tubal pregnancy irrespective of β-hCG levels who were haemodynamically stable, with normal complete blood count (CBC), liver function test (LFT), renal function test (RFT), complied with regular follow up were selected for medical management. Patients were referred for surgical management in cases of tubal rupture and in patients whose β-hCG levels decrease is by ≤15% or a plateau was reached in serum β-hCG after two repeat doses of methotrexate. Results: In our study success rate was 95.24% (n=40). Two patients (4.76%) with methotrexate administration, had to be taken up for surgery due to poor response, even after 2 doses. Whereas 25% of subjects required surgical management. Surgery was the ultimate option in 25%(n=15). 8.33%(n=5) who underwent laparoscopy on an elective basis, while 11.67%(n=7) underwent emergency surgery (Total =12, 20%). 18. 5%(n=3) underwent laparotomy, one of them being converted from laparoscopy to open surgery. Type of surgery done, in any case was Salpingectomy. Conclusion: Intramuscular methotrexate has the advantage of tubal conservation and saves patients from surgical intervention. It is less invasive, does not need expertise like laparoscopy and less expensive, with the potential for considerable savings in treatment costs.

Keywords

• tubal ectopic pregnancy
• β-hcg
• methotrexate
• medical management