Treatment Management of Tubal Ectopic Pregnancy: A 4-Year Retrospective Single Center Experience

Abstract

Our study aimed to retrospectively analyze the treatment of tubal ectopic pregnancy cases treated in our clinic. Material and Methods: In this study, 113 patients who were diagnosed with an ectopic tubal pregnancy and treated with methotrexate (MTX) or surgical treatment at Süleyman Demirel University Hospital between November 2015 and November 2019 were retrospectively evaluated. Patients who had a successful outcome with single-dose MTX treatment were divided into two groups to compare the baseline beta-human chorionic gonadotropin (BhCG) values of patients who needed additional surgical treatment after single-dose MTX treatment. Apart from this comparison, the treatment modalities of these 113 patients diagnosed with ectopic tubal pregnancy were determined. The Shapiro-Wilks test evaluated the conformity of continuous variables to normal distribution. Mann-Whitney U test was used to compare paired groups that did not conform to normal distribution. Results: An analysis of the characteristics of the 113 patients included in the study showed that the mean age of the patients was about 29 years (17-45), 22 of them had a history of ectopic pregnancy, and 27 patients had clinical signs and symptoms of a ruptured tubal ectopic pregnancy. In an analysis of the treatment of 113 patients who underwent medical and surgical treatment for ectopic pregnancy in a 4-year period, it was found that among 51 patients treated with a single dose of MTX, 9 of them underwent surgical treatment due to surgical indications, and 8 patients were treated with an additional dose of MTX. When the BhCG values of patients whose treatment was completed with single-dose MTX were compared with the BhCG values of patients with unsuccessful responses to single-dose MTX treatment, it was found that the BhCG values were statistically significantly higher in the unsuccessful group (p=0.033). 62 patients were evaluated according to medical treatment contraindications, and relative contraindications and surgical treatment were applied without medical treatment. In total, we had 71 patients who received surgical treatment. All surgical treatments were completed laparoscopically. Of the 71 patients who underwent surgery, 38 patients underwent laparoscopic salpingostomy, and 33 patients underwent laparoscopic salpingectomy. Conclusion: In our 4-year retrospective review, surgical methods were the most commonly used in treating ectopic tubal pregnancy. Patient selection and treatment protocols should be improved in single-dose MTX treatment management.