Non tubal ectopic pregnancy: challenges in diagnosis and management

Abstract

Nontubal ectopic pregnancies (NTEP) are pregnancies that implant at sites other than the fallopian tube. Their overall incidence has been rising in recent years. NTEPs can occur at various sites such as in the cervix, ovary, abdomen, uterine cornua, interstitial part of tube, myometrium or caesarean scars. Absence of typical risk factors or tubal pathology makes the diagnosis and management of these NTEPs particularly challenging. Regardless of the location, early detection is critical for successful conservative treatment, improving outcomes and averting catastrophic complications in NTEP. This case series includes ten cases of NTEPs with unique locations and presentations. Four of them were caesarean scar pregnancies and two each of interstitial and cervical pregnancies. We also had two rarest types of NTEPs, one with intramyometrial pregnancy and the other with tubal stump ectopic pregnancy after salpingectomy done for ruptured tubal ectopic on the same side. The management of NTEPs encompasses medical treatment with methotrexate or surgical methods, most of them being uterus conserving and very rarely hysterectomy. The treatment in each case in our series was tailored according to the clinical presentation and need for conservation of future fertility. The outcome in all our cases was good in spite of difficulties faced in the diagnosis and decision for selection of the most appropriate modality of treatment. This case series emphasizes the fact that in spite of availability of advanced radiological aids, NTEPs can sometimes be difficult to diagnose. Hence a high degree of suspicion and proper counselling of the patients is needed to approach them judiciously so as to avoid severe complications.