Clinical profile and treatment outcome of non-surgical management of tubal ectopic pregnancy in a tertiary care hospital: retrospective study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20243157Keywords:
Tubal EP, MTX, Non-surgical managementAbstract
Background: Tubal ectopic occurs when fertilized egg implants and develops in fallopian tube instead of normal endometrial cavity. Late diagnosis of condition leads to tubal rupture, life-threatening hemorrhage, warrants salpingectomy affecting future fertility of patient. When diagnosed early, non-surgical management can be offered preserving the tube. This study aimed to identify the factors which affect clinical course and treatment outcome of non-surgically managed tubal ectopic pregnancies.
Methods: A retrospective study was conducted on 56 tubal ectopics in department of obstetrics and gynaecology, BARC hospital, Mumbai from January 2017 to December 2023. Associated risk factors, clinical profile, treatment outcomes of all cases were analysed based on case sheets by simple descriptive statistics and percentage method.
Results: The 53.58% were in 31-40 years of age. The 46.42 % were multiparous. PID (20%) and assisted reproductive technology (ART) (17.5%) was identified risk factor. Pain in lower abdomen was commonest presenting symptom. Out of 56, 21 were (37.5%) eligible for non-surgical treatment. Of these 4 (19.05%) underwent successful expectant management. Remaining 17 (80.95%) received medical management with multidose methotrexate (MTX) of these 13 were successful. (success rate 76.47%). Remaining 4 failed medical cases eventually underwent salpingectomy. Overall success rate of non-surgically managed cases was 17 out of 21 being 80.95%. No drug induced morbidity or blood transfusion was required in non-surgically managed cases. No mortality was recorded.
Conclusions: ‘Suspicion of ectopic pregnancy (EP) in reproductive aged woman seeking medical attention’ is the key for its early diagnosis. Our study confirms non-surgical management: expectant or with multidose MTX is a viable therapeutic option in early tubal ectopic management with main advantage of preserving fallopian tube.
References
Hendriks E, Rosenberg R, Prine L. Ectopic pregnancy: diagnosis and management. Am Family Physician. 2020;101(10):599-606.
Demirdag E, Guler I, Abay S, Oguz Y, Erdem M, Erdem A. The impact of expectant management, systemic methotrexate and surgery on subsequent pregnancy outcomes in tubal ectopic pregnancy. Ir J Med Sci. 2017;186(02):387-92.
Gaskins AJ, Missmer SA, Rich-Edwards JW, Williams PL, Souter I, Chavarro JE. Demographic, lifestyle, and reproductive risk factors for ectopic pregnancy. Fertil Steril. 2018;110(7):1328-37.
Jauniaux E, Jurkovic D. Ectopic pregnancy: 130 years of medical diagnostic challenges. Int J Obstetr Gynaecol. 2018;125(13):1672.
Naveed AK, Anjum MU, Hassan A, Mahmood SN. Methotrexate versus expectant management in ectopic pregnancy: a meta-analysis. Arch Gynecol Obstetr. 2022;305(3):547-53.
Korhonen J, Stenman UH, Ylöstalo P. Serum human chorionic gonadotropin dynamics during spontaneous resolution of ectopic pregnancy. Fertil Steril. 1994;61(4):632-6.
Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. Williams obstetrics. Cunningham FG, editor. 26th edition New York: McGraw-Hill Medical. 2022;220-234.
Banu AS, Indu NR, Rohini E, Hiremath PB, Hiremath R. A retrospective study of ectopic pregnancy. Int J Reproduct Contracept Obstetr Gynecol. 2022;11(1):144-8.
Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: A case‐control study. Aust N Zeal J Obstetr Gynaecol. 2006;46(6):521-7.
Tahmina S, Daniel M, Solomon P. Clinical analysis of ectopic pregnancies in a tertiary care centre in Southern India: a six-year retrospective study. J Clin Diagnostic Res. 2016;10(10):QC13.
Kharat D, Giri PG, Fonseca M. A study of epidemiology of ectopic pregnancies in a tertiary care hospital of Mumbai, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(9):3942-6.
Samantaray SR, Mohapatra I, Vivekanada A. A clinical study of ectopic pregnancy at a tertiary care centre in Telangana, India. Int J Reprod Contracept Obstet Gynecol. 2020;9(2):682-7
Ilanjselvi M, Priya KS. Prospective study on ectopic pregnancy in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2021;10(5):1890.
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.
Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005;173(8):905-12.
Solangon SA, Van Wely M, Van Mello N, Mol BW, Ross JA, Jurkovic D. Methotrexate vs expectant management for treatment of tubal ectopic pregnancy: An individual participant data meta‐analysis. Acta Obstetr Gynecologica Scandinavica. 2023;102(9):1159-75.
Chatterjee S, Dey S, Chowdhury RG, Ganguli D. Ectopic pregnancy in previously infertile women subsequent pregnancy outcome after laparoscopic management. Al Ameen J Med Sci. 2009;2(1):67-72.
Shah N, Khan NH. Ectopic pregnancy: presentation and risk factors. J College Physicians Surgeons Pak. 2005;15(9):535- 8.
Barnhart K, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol. 2003;101(4):778-84.
Stika CS, Anderson L, Frederiksen MC. Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience. Am J Obstet Gynecol. 1996;174(6):1840-8.
Sagiv R, Debby A, Feit H, Cohen-Sacher B, Keidar R, Golan A. The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy. Int J Gynecol Obstet. 2012;116(2):101-4.
Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril. 2007;87(3):481-4.
Lipscomb GH, Puckett KJ, Bran D, Ling FW. Management of separation pain after single-dose methotrexate therapy for ectopic pregnancy. Primary Care Update for OB/GYNS. 1998;5(4):175.
Chan BS, Bosco AA, Buckley NA. Navigating methotrexate toxicity: Examining the therapeutic roles of folinic acid and glucarpidase. Brit J Clin Pharmacol. 2024.
Sivalingam VN, Duncan WC, Kirk E, Lucy AS, Andrew WH. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011;37(4):231-40.
Stulberg DB, Cain L, Dahlquist IH, Lauderdale DS. Ectopic pregnancy morbidity and mortality in low-income women, 2004-2008. Hum Reprod. 2016;31(3):666-71.
Knight M, Nair M, Tuffnell D. Saving Lives, Improving Mothers’ Care Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–14. 2016.