No abstract

During the period 1977-86, 193 women underwent surgery for ectopic pregnancy in the Medway Health District. 1 ectopic pregnancy was found for every 233 deliveries, an incidence of 0.43%, with a rising trend. The most common presenting symptom was abdominal pain (96%) and the most frequent physical finding was abdominal tenderness (91%). Past histories of appendicectomy (24%), infertility (19%), use of IUD (15%), and pelvic infection (13%) were elicited. In 95% of the cases, the pregnancy was tubal. 56% of the patients required blood transfusions and there were no maternal deaths. These findings confirm the rising incidence of ectopic pregnancy. During the study period, the diagnosis and management of ectopic pregnancy have changed significantly. The early use of plasma hCG, ultrasonography, and laparoscopy decreases the morbidity and mortality associated with ectopic pregnancy, allowing conservative tubal surgery when indicated.

The recent increase in the incidence of ectopic pregnancies was associated with rapid improvement in the diagnostic and therapeutic techniques. Quantitative serum B‐HCG radioimmunoassay and high resolution vaginal ultrasonography have facilitated early diagnosis of ectopic pregnancy allowing a more conservative approach to patient management. Different conservative surgical and medical lines of management recently developed were associated with and increased chance of subsequent intrauterine pregnancy with no increase in the incidence of repeat ectopic pregnancy. Outpatient systemic medical treatment seems to be a preferred alternative to conservative surgery. In selected cases, it is associated with a lower complication rate and promising result for fertility. (Br J Clin Pract 1996; 50(7): 376‐380.)

INTRODUCTIONEctopic pregnancy was first clearly described by Abulcasis, a famous Arabic writer on surgical topics.1 Although maternal deaths from ectopic pregnancy have declined, it is still the leading cause of death in the first trimester and accounts for 6–11% of all maternal deaths. From 1982 to 1984, 14 women died in England and Wales from this condition.2 The presence of ectopic pregnancy subjects women to the uncertainties of intra‐abdominal bleeding, laparotomy, extended hospital stay and fetal loss. Furthermore, they could face reduced future fertility.3