Incidence, diagnosis and management of ectopic pregnancies: A review

Abstract

Background: Ectopic pregnancy; the conceptus implanting outside the uterine cavity, arises in 1.3-2.4% of all pregnancies which put the lives of many young women in peril. It causes major maternal morbidity and mortality and its incidence is increasing worldwide. Though the set medical practices to address the grave situation are improved, it still remains worrying to note in third world countries. Methods: We review the incidence, causes, diagnosis, and management of ectopic pregnancy. The evidence presented is from a combination of selected published papers identified from Medline and a reflection of clinical practice in our unit. Results: Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management with methotrexate is an effective option in most clinically stable patients. Patients, who have failed medical management or presented with ruptured ectopic pregnancy are most frequently managed with excision by laparoscopy or, less commonly, laparotomy. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. Conclusion: This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic pregnancies, and reviews the existing data regarding recurrence and future fertility.

Medical management/Non-surgical of ectopic pregnancy: Case report and review of literature

“…[1,2] Early diagnosis and treatment remains the option in reducing morbidity and mortality. [3][4][5][6][7][8] A high index of suspicion is important as the presentation may not be with the typical six weeks amenorrhoea with abdominal pain and/or vaginal bleeding. [1,5] Management options are surgical, medical and expectant management.…”

“…[1,9] The main stay of treatment in our environment and most developing nations is the surgical management typically the open salpingectomy with its attendant disadvantages including anaesthetic and surgical risks as well as family disruption from prolonged hospital stay and income loses. [2][3][4][9][10] Laparoscopic salgingectomy reduces morbidity and hospital stay but the skill and facilities for it are not readily available and its high cost were available puts it out of reach of the average patient. [1][2][3][4] Medical management also known as the non-surgical approach is not widely practiced in our environment despite its several advantages over the traditional open salpingectomy including its less invasiveness, reduced cost and absence of anaesthetic risk, surgical risk and need for hospital admission.…”

“…[2][3][4][9][10] Laparoscopic salgingectomy reduces morbidity and hospital stay but the skill and facilities for it are not readily available and its high cost were available puts it out of reach of the average patient. [1][2][3][4] Medical management also known as the non-surgical approach is not widely practiced in our environment despite its several advantages over the traditional open salpingectomy including its less invasiveness, reduced cost and absence of anaesthetic risk, surgical risk and need for hospital admission. [2][3][4][5][11][12] It however requires early presentation and diagnosis before tubal rupture in addition well motivated patients who must fulfil the required strict criteria after proper patient selection.…”

“…[1][2][3][4] Medical management also known as the non-surgical approach is not widely practiced in our environment despite its several advantages over the traditional open salpingectomy including its less invasiveness, reduced cost and absence of anaesthetic risk, surgical risk and need for hospital admission. [2][3][4][5][11][12] It however requires early presentation and diagnosis before tubal rupture in addition well motivated patients who must fulfil the required strict criteria after proper patient selection. [1][2][3] We present a case of successful medical management of a tubal ectopic pregnancy in a patient with a strong aversion for surgical intervention after 3 previous surgeries with a turbulent post-operative period in her last surgery.…”

“…[2][3][4][5][11][12] It however requires early presentation and diagnosis before tubal rupture in addition well motivated patients who must fulfil the required strict criteria after proper patient selection. [1][2][3] We present a case of successful medical management of a tubal ectopic pregnancy in a patient with a strong aversion for surgical intervention after 3 previous surgeries with a turbulent post-operative period in her last surgery.…”