A ten year survey of 193 ectopic pregnancies

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.

Human chorionic gonadotropin ratio of hemoperitoneum versus venous serum improves early diagnosis of ectopic pregnancy

“…For EP, the local hCG level of hemoperitonium is much higher than that of venous serum. The reasons for this finding may be that [1] blood filling the posterior pouch of Douglas or Morisson's space is from the implantation site of gestational sac, into which the hCG secreted by syntotrophablasts directly flows (hCG secreted into venous serum is relatively low); or that [2] the metabolism of hCG in the hemoperitoneum is slower than that in venous serum. In HCLP, blood in the posterior pouch is from ovarian vessels in which the hCG level is near that of the venous serum.…”

“…In developing countries, the incidence rates vary from one in 44 deliveries to one in 21 deliveries (1). In developed Western countries, the rates are between one in 233 and one in 280 deliveries (2), and the detection rates for unruptured EP range from 88% to 100% (3). However, this is not the case in developing countries.…”