Conservative Management of Unruptured Ectopic Pregnancy—A Retrospective Study

An ectopic pregnancy (EP) is defined as any pregnancy that occurs outside the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. The goal of this retrospective study is to address medical and conservative surgical management of unruptured fallopian tube EP as an effective manner to preserve tubes to prevent secondary infertility. This study was conducted between January 1, 2010, and April 30, 2024, in Ponni Hospital, Madurai. It included 319 women, out of 6248 pregnant women diagnosed with ectopic pregnancy by using an Inexecreen kit, trans-abdominal scan, trans-vaginal scan, and doubling of beta-human chorionic gonadotropin (β-HCG) in 48 hours and Magnetic Resonance Imaging (MRI). Medical and conservative surgical management were given to those patients effectively. Out of 319 patients, 62 patients (19.4%) had a ruptured ectopic pregnancy and underwent surgical treatment;257 patients (80.6%) had an unruptured ectopic pregnancy. The conservative medical management was provided to 257 patients. Out of 257 patients, 235 patients were treated by injecting methotrexate and folic acid rescue when the criteria were met. 14 patients had salpingostomy and injection methotrexate (Inj. Methotrexate) and inj. Prostaglandin F2 alpha was administered into the tubal wall to preserve tubes. 8 patients had a live ectopic pregnancy;for those patients, Inj. Methotrexate was injected into the gestational sac through ultrasound guidance. 225 out of 257 patients reached out to us to seek fertility treatment;the remaining 32 patients were not seeking fertility. All fertility-seeking patients had successful pregnancies. We lost follow-up of 12 patients in this study. Out of 213 patients who came for fertility treatment, a 76.1% success rate was achieved with live birth, the recurrent ectopic pregnancy rate was 13.6%, the miscarriage and stillbirth rates were 10.3%. 32 patients, who were not seeking fertility, had quality life without surgical scars for ectopic pregnancy and cost-effective treatment. 25 patients out of 32 had laparoscopic sterilization later, and 7 patients followed temporary contraception as per our advice. This clinical data was retrieved from medical records.

Conservative treatment of unruptured Ectopic pregnancy in Jamaica

Medical treatment with methotrexate is now successfully replacing conservative surgical treatment in selected patients. We reviewed patients treated with methotrexate, compared to salpingectomy and salpingostomy between 1990 to 1995 and 2000 to 2003. For 1990-1995 there were 21 conservative surgical treatments (5.3% ectopic pregnancies). The ratio of ectopic to normal deliveries was 1:24. Medical treatment was done for 19 pregnancies (3.4% of ectopic pregnancies) for 2000 to 2003. During the period there was an ectopic rate of 1:16.8 births. Patients treated medically were similar to those treated surgically except that none reportedly having rebound tenderness and only 1/18 having an ultrasound scan showing a foetal heart and none with a gestational sac >4cm. In the medically treated group the success rate was 68% while in the surgically treated groups success was 100%. There was no significant difference in the parameters in the conservative surgical and medically treated

Extrauterine pregnancies-risk factors and management

Objective: To study the clinical progress, risk factors, management, and outcomes of suspected ectopic pregnancy (EP). Design: Retrospective clinical case study. Population: All 184 patients hospitalized for suspected EP during the period 1.1.2008-31.12.2011. Setting: Oulu University Hospital, Finland. Methods: The clinical progress, risk factors, management, complications and outcomes were based on studies of hospital records. Main outcome measures: Symptoms, serum quantitative human chorionic gonadotropin (hCG) levels, management, complications and outcome of patients. Results: At least one of the risk factors was found in 117 women (66%). There were 11 patients without symptoms. In the initial visit, the median hCG concentration was 1915 (20 - 73,000) IU/l. The most common treatment was surgical, 137/181 (76%), followed with medical treatment, 22/181 (12%) and expectant management, 22/181 (12%). Conclusions: Surgery was the most widely used treatment for EP. We might thus draw attention to more conservative management.

The outcomes of pregnancies after laparoscopic surgeries for pathologic changes on distal oviduct:A systematic review and meta-analysis

Objective This systematic review and meta-analysis were aimed to summarize the body of evidence on the prognosis after laparoscopic surgeries for pathological conditions on distal oviducts,then,furthermore,to evaluate prognostic factors for pregnancy outcomes.Methods We conducted a systematic review and meta-analysis to summarize the body of evidence on this topic,with the review question formulated as“what is the prognosis after the laparoscopic fimbrioplasty,salpingostomy,or salpingoneostomy for patients with pathologic conditions on the distal oviducts.”We searched Medline and EMBASE on June 1st,2020.Two investigators(HH and ZY)independently screened the references of all retrieved records for potentially eligible studies by firstly,through titles and abstract,and then full-text.A study would be included if it was a primary study reporting pregnancy outcomes of patients after laparascopic surgery.A meta-analysis of the rates of pregnancy,ectopic pregnancy,live birth,and miscarriage was performed using a random effect model.Results We identified 3861 records and included 21 reports with 2473 participants.The pooled estimate for the pregnancy rate was 35.1%(95%CI:30.7%–39.7%,I^(2)=78%,low certainty).The pooled estimates for the live birth rate,ectopic pregnancy rate,and miscarriage were 24.4%(95%CI:20.2%–28.8%,I^(2)=58%;1154 participants;low certainty),6.2%(95%CI:4.4%–8.2%,I^(2)=61%;2363 participants;low certainty),and 4.6%(95%CI:2.8%–6.9%,I^(2)=10%;544 participants;low certainty).Our analyses suggested that the more damaged tubal was associated with a decreased pregnancy rate,and patients with moderate or severe adhesion had lower pregnancy rates compared with patients with mild pelvic adhesion.Conclusion We estimated the pregnancy rate,ectopic pregnancy rate,and miscarriage rate of patients with distal tubal pathology after the laparoscopic fimbrioplasty or salpingostomy.Low certainty evidence suggested that laparoscopic surgery can restore the tubal function and cure infertility and should be considered as an alternative to in vitro fertilization.Tubal damage stage and adhesion are associated with worse pregnancy outcomes.

Laparoscopic management of recurrent ectopic pregnancy: A retrospective cohort study describing 10-years of experience in a tertiary care hospital

Objective:Recurrent ectopic pregnancy(REP)is rare,but can have severe consequences for patients.The aim of this study was to report outcomes of laparoscopic management of REP in our center.Methods:Retrospective cohort study including REP treated surgically at a single,tertiary-care academic medical center between 2009 and 2018.All patients undergoing laparoscopic salpingostomy or salpingectomy were included.Patients were then followed up to monitor outcomes of future reproductive events.Results:Of 41 eligible patients,14 suffered from ipsilateral recurrence including 5 cases of tubal stump pregnancy.In the other 27 cases,the REP occurred in the contralateral tube that was previously unaffected.All patients with ipsilateral recurrence underwent salpingectomy.In patients with contralateral recurrence,salpingectomy was carried out in 21 patients(77.8%)and salpingostomy in 6 patients(22.2%).32 patients(78%)subsequently sought to conceive either spontaneously or by in vitro fertilization.The subsequent live birth rates were 51.8%(14/27)in the salpingectomy group and 60.0%(3/5)in the salpingostomy group.Conclusion:Where trained laparoscopists and adequate facilities are available,it is possible to achieve acceptable reproductive outcomes after REP irrespective of the surgical approach.