S K Kathpalia1, D Arora2, Namrita Sandhu3, Pooja Sinha3. 1. Professor and Head (Obst & Gynae), Andaman Nicobar Islands Institute of Medical Sciences, Port Blair 744104, India. 2. Senior Advisor (Obst and Gynae), Base Hospital, Delhi Cantt, India. 3. Resident (Obst and Gynae), Base Hospital, Delhi Cantt, India.
Abstract
BACKGROUND: Ectopic pregnancy or extrauterine pregnancy will invariably result in abortion or rupture. Though there are risk factors for ectopic pregnancy, but at times the condition can occur without any apparent predisposing factor. Cases admitted with provisional diagnosis of ectopic pregnancy were included in this prospective study. METHODS: Eighty suspected cases of ectopic pregnancy were incorporated in the study. The management was done based on standard practice. All the cases underwent urine pregnancy test, routine blood investigations including blood group, and transvaginal ultrasound. Serial βhCG was measured in cases where the diagnosis was not clear initially. RESULTS: Incidence of ectopic was 2.46 per 100 deliveries; there was no apparent risk factor in 28.7% and many cases had more than one risk factor. 'Triad' of ectopic was present in only 21 cases. Sixteen cases were asymptomatic and two were admitted as emergency. Ultrasound findings were inconsistent and wide ranging. In 37 doubtful cases, βhCG was measured serially.There was one case of suspected interstitial pregnancy confirmed on laparoscopy. Twenty-seven cases were managed medically, and 9 were managed expectantly. Forty-six cases were managed surgically either by laparoscopy or by laparotomy. Salpingectomy was performed in 37 cases, and salpingostomy in 7 cases either laparoscopically or by laparotomy. CONCLUSION: Ectopic pregnancy can be managed by laparotomy, operative laparoscopy, and medically and occasionally by observation alone. Management must be customized to the clinical condition and needs of future fertility of the patient.
BACKGROUND: Ectopic pregnancy or extrauterine pregnancy will invariably result in abortion or rupture. Though there are risk factors for ectopic pregnancy, but at times the condition can occur without any apparent predisposing factor. Cases admitted with provisional diagnosis of ectopic pregnancy were included in this prospective study. METHODS: Eighty suspected cases of ectopic pregnancy were incorporated in the study. The management was done based on standard practice. All the cases underwent urine pregnancy test, routine blood investigations including blood group, and transvaginal ultrasound. Serial βhCG was measured in cases where the diagnosis was not clear initially. RESULTS: Incidence of ectopic was 2.46 per 100 deliveries; there was no apparent risk factor in 28.7% and many cases had more than one risk factor. 'Triad' of ectopic was present in only 21 cases. Sixteen cases were asymptomatic and two were admitted as emergency. Ultrasound findings were inconsistent and wide ranging. In 37 doubtful cases, βhCG was measured serially.There was one case of suspected interstitial pregnancy confirmed on laparoscopy. Twenty-seven cases were managed medically, and 9 were managed expectantly. Forty-six cases were managed surgically either by laparoscopy or by laparotomy. Salpingectomy was performed in 37 cases, and salpingostomy in 7 cases either laparoscopically or by laparotomy. CONCLUSION: Ectopic pregnancy can be managed by laparotomy, operative laparoscopy, and medically and occasionally by observation alone. Management must be customized to the clinical condition and needs of future fertility of the patient.
Authors: Andrew W Horne; Julie L V Shaw; Amanda Murdoch; Sarah E McDonald; Alistair R Williams; Henry N Jabbour; W Colin Duncan; Hilary O D Critchley Journal: J Clin Endocrinol Metab Date: 2010-11-03 Impact factor: 5.958