A Clinical Experience of Ectopic Pregnancies with Initial Free Intraperitoneal Fluid

Abstract

Introduction: Extra-uterine pregnancy or Ectopic Pregnancy (EP) is a major health problem for pregnant women, presenting as a potentially life-threatening emergency in the first trimester. There are three major options for the treatment of EP: expectant management, surgical treatment and medical management. The presence of free intraperitoneal fluid in EP-diagnosed patients is crucial for treatment planning and evaluation. Aim: To compare the outcomes of both the expectant management and medical treatment with methotrexate (MTX) in ectopic pregnancies with free intraperitoneal fluid. Materials and Methods: This retrospective cohort study included a total of 91 ectopic pregnancies with or without rupture in which the women had initial free intraperitoneal fluid and were haemodynamically stable. Serial b-HCG measurements were used to assess the outcome of expectant management and medical treatment with MTX. For the statistical analysis, the SPSS statistical software package, version 22.0 (Chicago, IL, USA), was used. For the quantitative variables that were not distributed normally, the Kruskal-Wallis test and the MannWhitney U test were performed for the evaluation of differences between the groups. Results: It was observed that the success rate with expectant management was 81% (initial b HCG concentration 626±443 mIU/mL). With a single dose of MTX, it was 76% (initial b HCG concentration 2124±1647 mIU/mL) and with a total single or double dose of MTX, it was 88% (initial b HCG concentration 2252±78 mIU/mL) from among EP with or without rupture in women with initial free intraperitoneal fluid during diagnosis. There was no significant difference between the groups with regard to ultrasonography findings. Conclusion: Expectant management or medical treatment with methotrexate should be the first line treatment for ectopic pregnancies with initial free intraperitoneal fluid, albeit with rupture, in patients who are haemodynamically stable, along with b-HCG follow-up.

Keywords

• chorionic gonadotropin
• haemoperitoneum
• methotrexate