ECTOPIC PREGNANCY MANAGEMENT IN AYUB TEACHING HOSPITAL ABBOTTABAD: A TEN YEAR SURVEY
AbstractBackground: Ectopic pregnancy is a common life-threatening emergency in the developing world. It isa cause of maternal morbidity and mortality in the first trimester and these mortalities can be reduced ifit is properly managed. The objective of this study was to assess the variable clinical presentations andoutcome of treatment of ectopic pregnancy in Ayub Teaching Hospital Abbottabad. Methods: Twohundred and fifty-five patients with ectopic pregnancy managed in Ayub Teaching Hospital over periodof 10 years, were included in the study. The clinical presentation, diagnostic modalities and out come oftreatment were recorded and analysed. Results: Out of 255 patients 43 (16.86%) had un-ruptured tubalpregnancy, 183 (71.76%) had ruptured ectopic pregnancy and 22 (8.62%) had chronic ectopicpregnancy. At laparotomy, salpingectomy was done in 229 (89.80%) patients, salpingo-ophrectomy in2 patients (0.78%), linear salpingostomy in 15 (5.88%) patients. Medical treatment was given to 5patients and 8 patients were treated conservatively. There was no maternal mortality. Conclusion: Inspite of various recent advances in the management of ectopic pregnancy, conventional surgicaltreatment by laparotomy is still the most widely used modality of treatment in our institution. Withappropriate and prompt management, maternal mortality due to ectopic pregnancy can be prevented.Keywords: Ectopic pregnancy, conventional surgical management, laparotomy, salpingectomy
Boyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of
ectopic pregnancy: a 10 year population-based study of 1800
cases. Hum Reprod 2002;17:3224–30.
Farquhar CM. Ectopic pregnancy. Lancet 2005;366:583–91.
Goldner TE, Lawson HW, Xia Z, Atrash HK. Surveillance for
ectopic pregnancy: United States, 1970–1989. MMWR CDC
Surveill Summ 1993;42(6):73–85.
Menon S, Sammel M, Vichnin M, Barnhart KT. Risk Factors for
Ectopic Pregnancy: A Comparison Between Adults and
Adolescent Women. J Pediatr Adolesc Gynecol 2007;20:181–5.
Piasarska MD, Carson SA. Incidence and risk factors for ectopic
pregnancy. Clin Obstet Gynecol 1999;42:2–8.
Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel
AC, Shaunik A, et al. Risk factors for ectopic pregnancy in
women with symptomatic first trimester pregnancies. Fertil Steril
Condous G. Lu, Van Huffel SV, Timmerman D, Bourne T.
Human chorionic gonadotrophin and progesterone level is in
pregnancies of unknown location. Int J Obstet Gynaecol
Kadar N, Bohrer M, Kemmann E, Shelden R. The discriminatory
human chorionic gonadotropin zone for endovaginal sonography:
a prospective, randomized study. Fertil Steril 1994;61:1016–20.
Khaleeque F, Sidiqui RI, Jafarey SN. Ectopic pregnancy: a three
year study. J Pak Med Assoc 2001;51:240–3.
Shoaib F. Ectopic pregnancy. A study of 50 cases. J Coll
Physicians Surg Pak 1994;4(2):65–70.
J Ayub Med Coll Abbottabad 2012;24(3-4)
Amoko DH, Buga GA. Clinical Presentation of Ectopic
Pregnancy in Transkei, South Africa. East Afr Med J
Sherman D, Langer R, Sadovsky G, Bukovsky I, Caspi E.
Improved fertility following ectopic pregnancy. Fertil Steril
Gracia CR, Barnhan KT. Diagnosing ectopic pregnancy: decision
analysis comparing six strategies. Obstet Gynecol 2001;97:469–
Gazvani MR. Modern Management of Ectopic Pregnancy. Br J
Hosp Med 1996;56:597–9.
Barnhart KT. Ectopic Pregnancy. N Eng J Med 2009;361:379–
Shrestha J, Saha R. Comparison of laparoscopy and laparotomy
in the surgical management of ectopic pregnancy. J Coll
Physicians Surg Pak 2012;22:760–4.
Yakasai IA, Abdullahi J, Abubakar I. Management of ectopic
pregnancy in Aminu Kano Teaching Hospital Kano Nigeria: A 3-
year. Global Adv Res J Med Med Sci 2012;1(7):181–5.
Bhatla N (Ed). Jeffcoate’s Principles of Gynaecology. New
Delhi: Arnold; 2001.p. 208–24.
Ekici E, Yapar EG, Gökmen O, Danişman N, Ozmen S. Ectopic
pregnancy: transvaginal sonographic findings of 152 cases.
Ultrasound Obstet Gynecol 1993;3:271–5.
Pouly JL. Strategy for treatment of ectopic pregnancy:
conservative treatment. In: Sutton C, Diamond MP (Eds).
Endoscopic surgery for gynaecologists, 2nd ed. London: WB
Saunders; 1998.p. 150–7.
Dubuisson JB, Aubriot FX, Cardone V. Laparoscopic
salpingectomy for tubal pregnancy. Fertil Steril 1987;47:225–8.
Feichtinger W, Kemeter P. Conservative treatment of ectopic
pregnancy by transvaginal aspiration under sonographic control
and methotrexate injection. Lancet 1987;1(8529):381–2.
Gordon AG, Lewis BV, Decherney AH (Eds). Atlas of
Gynecologic endoscopy 2nd ed. London: Mosby-Wolfe; 1995.p.
Sy Sy T, Diallo Y, Toure A, Diallo FB, Balde AA, Hyjazi Y, et
al. Management of ectopic pregnancy in Conkry, Guinea. Med
Trop (MARS) 2009;69:565–8.
Sowter M, Frappell J. The role of laparoscopy in the
management of ectopic pregnancy. Rev Gynaecol Practice
Saraj A, Wilcox J, Najmabadi S, Stein S, Johnson M, Paulson R.
Resolution of hormonal markers of ectopic gestation: a
randomized trial comparing single-dose intramuscular
methotrexate with salpingostomy. Obstet Gynecol 1998;92:989–
Sowter M, Farquhar C, Petrie K, Gudex G. A randomized trial
comparing single dose systemic methotrexate and laparoscopic
surgery for the treatment of unruptured tubal pregnancy. Br J
Obstet Gynaecol 2001;108:192–203.
Lipscomb G, Bran D, McCord M, Portera J, Ling F. Analysis of
three hundred fifteen ectopic pregnancies treated with single-dose
methotrexate. Am J Obstet Gynecol 1998;178:1354–8.
Lipscomb G, McCord M, Stovall T, Huff G, Portera S, Ling F.
Predictors of success of methotrexate treatment in women with
tubal ectopic pregnancies. N Engl J Med 1999;341:1974–8.