CHANGING TRENDS AND TREATMENT MODALITIES FOR MANAGEMENT OF ECTOPIC PREGNANCY – A TERTIARY CARE CENTER EXPERIENCE
Creators: name: Dr. Archana Mehta
name: Dr. Kanika Sharma
name: Dr. Vikas Yadav
name: Dr. Rupam Singh
name: Dr. Shikha Maurya
Publisher: name: Zenodo
Year: 2023
Subjects: Ectopic pregnancy, Haemoperitorium, Systemic Methotrexate, Salpingectomy , Cesarean scar pregnancy

description: Background: Ectopic pregnancy accounts for approximately 1.5% to 2.0% of all pregnancies. It is catastrophic and life threatening condition if not diagnosed timely.  Although tubal ectopic pregnancy is the most common type of ectopic pregnancy but recently there is an increasing trend in the incidence of cesarean scar pregnancy (CSP). A high index of suspicion is required for early diagnosis of CSP. The choice of treatment including expectant, medical and surgical management depends on the location of the ectopic pregnancy, symptoms, gestational age, and desire to preserve Fertility. Aim:  The main aim of the study was to analyze the management trends in ectopic pregnancy including an evaluation of clinical profile, distribution of site and management modalities of the cases .Methods: The present Retrospective study was conducted over a period of one year in the Department of Obstetrics and Gynecology at School of Medical Sciences and Research, Greater Noida , Uttar Pradesh . A total of thirty two women admitted to our tertiary care hospital, through emergency and Outpatient Department with tubal ectopic pregnancy were analyzed. Results: Total number of 32 cases of ectopic pregnancies were admitted during one year study period from Jan 2022 to Dec 2022 against 1054 deliveries giving an incidence of about 3% . Out of these 14 (43.75%) cases were ruptured tubal ectopic and 18 cases (56.25%) were unruptured. Majority of cases were in the age group of 25 to 29 years (37.5%).  In present study, 11( 34.3% )of cases had no identifiable risk factors. Amongst the various risk factors studied, Pelvic inflammatory Disease (PID) was found in 6 (18.75%) cases. This was followed by history of previous abortions in 5 ( 15.6%). Greater incidence was noted among multigravida 12 (37.5%). The most common site of ectopic pregnancy was tubal in 27 cases (84.3%).The typical triad of amenorrhea, pain abdomen and bleeding was observed in 24( 75%) of cases. Approximately 43.75% of patients required surgical treatment. Open salpingectomy was the most common surgical route in 57.1%(8/14)  followed by Lap salpingectomy in hemodynamically stable patients  2 (14.28%). Salpingostomy was done for only one patient with incomplete family and in whom contralateral tube was absent .Around 43.75% cases(14/32) were managed medically using intramuscular methotrexate and one patient had expectant management .Medical management was successful in 13/14 cases (92.8.%). One case had failure to medical management and was taken up for surgery. There was only one case of ovarian pregnancy. Four cases of CSP were reported during the study period (12.5%). Out of these 4 cases one case was managed medically using systemic single dose methotrexate and other three cases needed surgical intervention in form of uterine artery embolization f/b D&C, laparoscopic excision of scar and total abdominal hysterectomy respectively. There was no maternal mortality. Conclusion.  Early diagnosis of ectopic pregnancy and timely intervention in the form of medical treatment / conservative surgery not only reduces maternal mortality but also preserves future fertility. With increasing incidence of cesarean sections an awareness should be created among the radiologists and obstetricians who are doing and interpreting early first trimester ultrasound to specifically look for the site of implantation of pregnancy in a scarred uterus.