Study of 50 cases of modern management of ectopic pregnancy

Background: In recent years, an increased incidence of ectopic gestation has been noted, which can be attributed to different reasons. Cases with ectopic gestation were studied and objectives were to study the incidence in various age groups, to study predisposing factors, to study different modes of clinical presentation, to study different sites of ectopic pregnancy and to study changing trends of modern management from radical surgical method to laparoscopic and medical management.Methods: A study of 50 cases of tubal ectopic pregnancy was carried out from May 2009 to June 2011 in tertiary health centre. Patients managed with following treatment modalities were selected for study. (1) Medical management (MTX), (2) Laparoscopic management: salpingostomy, salpingectomy, (3) Laparotomy management: salpingostomy, segmental resection, fimbrial expression, salpingectomy.Results: Lower abdominal pain was most common presenting symptom of ectopic pregnancy in 96% cases. The classical triad of symptoms (amenorrhea, abdominal pain and vaginal bleeding) was present in only 28% cases. PID contributed 24% cases and previous abortion contributed 28% cases indicating these two as the common risk factors. Ampulla was the commonest site for ectopic pregnancy, in 52% cases. Salpingostomy performed mainly at this site. In 6% cases ectopic pregnancy in infundibulum were treated with fimbrial expression and fimbriectomy. 22% patients were managed medically (methotraxte). These were the cases having unruptured ectopic pregnancy and ectopic mass <4 cm. Laparoscopy was done in 34% cases, in 2 cases it was converted to laparotomy. While open laparotomy was done in 40% cases.Conclusions: Ectopic pregnancy is a treatable problem. Ultrasonography plays central role in the diagnosis and management. Mode of therapy is determined by a combination of clinical symptoms, sonography findings and serum b-HCG values. Surgical management is still a cornerstone of management of ectopic pregnancy. But now scope of medical and laparoscopic management is also there. In recent years laparotomy has been replaced by laparoscopic surgery which is more conservative, minimally invasive and less time consuming which leads to quick recovery.