Ectopic pregnancy: reappraisal of risk factors and management strategies


  • Swapna Mohan Department of Obstetrics & Gynecology, Government Medical College, Ernakulam, Kerala, India
  • Mariam Thomas Department of Obstetrics & Gynecology, Government Medical College, Ernakulam, Kerala, India



Ectopic pregnancy, Risk factors, Salpingectomy


Background: The incidence of ectopic pregnancy is increasing. The objective of this study was to analyze the risk factors, clinical characteristics, and management strategies in patients with ectopic pregnancy at a tertiary care referral centre in South India.  

Methods: Retrospective observational study was done for a period of seven years from April 2006 to March 2014 where in case files of 87 cases of ectopic pregnancies were analyzed for clinical profile, sonological data, management strategies and outcome.

Results: The incidence of ectopic pregnancy has increased from 8.3 in 2006 to 18.92/1000 live births in 2014. Risk factors associated were prior tubal ligation 21 (24.14%), history of pelvic inflammatory disease 11 (12.64%), prior ectopic 5 (5.75%), prior tubal surgery 4 (4.60%), infertility 13 (14.94%), prior pelvic surgery 22 (25.29%) and current use of Copper T - 3 (3.45%) cases. Common symptoms were lower abdominal pain in 80 (91.95%) and amenorrhea in 76 (87.35) cases. 9 cases presented in shock. Gray scale ultrasound showed complex adnexal mass in 42 (48.28%), tubal ring 19 (21.84%) and live fetus in 11 (12.64%). 72 cases were managed surgically, 11 medically and 4 by expectant management. Tubal rupture occurred in 30(41.67%). Among those managed surgically, laparotomy was done in 55 (76.39%), laparoscopy in 17 (23.61%) cases. Salpingectomy was done in 52 (72.22%), salpingostomy 9 (12.5%), salpingotomy 5 (6.94%), segmental resection 3 (4.17%), scar excision and repair 1 (1.39%), abdominal hysterectomy 1 (1.39%), and laparotomy for abdominal pregnancy in 1 (1.39%) case. There was no maternal death.  

Conclusions: The incidence of ectopic has been increasing. Prior sterilization particularly done along with caesarean is the most common risk factor in our region. Surgical management by laparotomy and salpingectomy continues to be the preferred mode of management of ectopic pregnancy in our institution since two third of patients are referred from periphery and present with considerable intraperitoneal hemorrhage. 


Centre for Disease Control and Prevention. Ectopic pregnancy mortality - Florida, 2009-2010. Morb Mortal Wkly Rep. 2012;61(6):106-9.

Chang J, Elam Evans JD, Berg CJ. Pregnancy related mortality surveillance - United States 1991-1999. MMWR Surveill Summ. 2003;52:1-9.

Bouyer J, Coste J, Fernandez H. Sites of ectopic pregnancy, a 10 year population based study of 1800 cases. Human Reprod. 2002;17:3224-30.

Ankum WM, Mol BWJ, Vander Veen R. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093-9.

Kurt TBanhart, Claris R, Amy C. Risk factors for ectopic pregnancy in women with symptomatic first trimester pregnancies. Fertil Steril. 1996;86:36-42.

Pisarka M, Carson SA, Buster SE. Ectopic pregnancy. Lancet. 1998;351:1115.

Dart RG, Kaplan B, Varaklis K. Predictive value of history and physical examination in patients with suspected ectopic pregnancy. Ann Emerg Med. 1999;33:283-90.

Jurkovic D, Marvelos D. Ultrasound diagnosis of ectopic pregnancy. Ultrasound Obstet Gynecol. 2007;30:1-7.

Schwartz RO, Di Pietro DL. β-HCG as a diagnostic aid for suspected ectopic pregnancy. Obstet Gynecol. 1980;56:197.

Fernandez H, Rain horn JD, Papiernik E. Spontaneous resolution of ectopic pregnancy. Obstet Gynecol. 1988;71:171.

The management of tubal pregnancy. RCOG guideline No: 21, 2004. Available at:

Nice Clinical Guideline (CG154). Ectopic pregnancy and miscarriage: Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage, December 2012. Available at:

Langer R, Bukovsky, Herman A. Conservative surgery for tubal pregnancy. Fertil Steril. 1982;38:427.

De Cherney AH, Boyers SP. Isthmic ectopic pregnancy- segmental resection as treatment of choice. Fertil Steril. 1985;44:307.

Dubuisson JB, Morice P, Chapron C. Salpingectomy. The laparoscopic surgical choice for ectopic pregnancy. Human Reprod. 1996;11:1199.

Tulandi T, Saleh A. Surgical management of ectopic pregnancy. Clin Obstet Gynecol. 1999;42(1):31-8.

Deanna D, Caminiti MD, Kathleen L. Smith. An institutional review of the management of Ectopic pregnancy. J Gynecol Surg. 2006;22(2):47-56.

Rose Jophy, Annamm Thomas. Ectopic pregnancy 5 years’ experience. J Obstet Gynecol India. 2002;52(4):55-8.

Promila Jindal, Sunitha Goyal. Clinical profile and outcome of ectopic pregnancies in northern India. Indian J Obstet Gynecol. 2013;(3):23-7.

Igwegbe A, Elenje G, Okpala B. An appraisal of the management of ectopic pregnancy in a Nigerian tertiary hospital. Ann Med Health Sci Res. 2013;3(2):166-70.

Lawani OL, Anozie OB, Ezeonu PO. Ectopic pregnancy: a life threatening gynecological emergency. Int J Women’s Health. 2013;19(5):515-21.

Chaudhary Payal, Manchanda Patil. Retrospective study on laparoscopic management of ectopic pregnancy. J Obstet Gynecol India. 2012;63(3):173-6.

Taheri M, Bharathan R, Subramanian A, Kelly T. A UK national survey of trends in ectopic pregnancy management. J Obstet Gynecol. 2014;34(6):508-11.

Majhi AK, Roy N, Karmakar KS, Banargee PK. Ectopic pregnancy-an analysis of 180 cases. J Indian Med Assoc. 2007;105(6):308-12.






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