3.Uluslararası Acil Tıp ve Aile Hekimliği Sempozyumu, Girne, Cyprus (Kktc), 29 November - 02 December 2018, pp.1
Ectopic pregnancy(EP) is the implantation of the embryo anywhere other than the uterine lining of the endometrium. The incidence of EP ranges from 0.25% to 2% of all pregnancies. In 95% of EPs, fertilized ovum implants in the fallopian tube, but rarely in other sites like ovaries, cervix, prior cesarean scar, spleen, omentum and other parts of the abdomen. Signs and symptoms classically include amenorrhea, abdominal pain, and vaginal bleeding. A ruptured EP can cause life-threatening hemorrhage in the abdominal cavity resulting with in increased heart rate, low blood pressure or hypovolemic shock. The death rate is about 1 per 2000 EPs. Early diagnosis of EP isn't easy but it allows life-saving and non-surgical medical treatments such as methotrexate.
The aim of this study was to highlight the clinical profile of EP patients and to examine treatment modalities in a tertiary center.
Materials and Methods:
In this retrospective study, 62 cases with the diagnosis of EP treated in our gynecology unit between January 2017 and Agust 2018 has been carried out. Age, gravidity, gestational age, clinical presenting features, mode of treatment, and type of surgical procedure were recorded.
The incidence of EP was 4.57 per 1000 (62/1630) deliveries. Among all patients, 40 cases (64.5 %) were diagnosed from our outpatient clinic while 22 cases (35.5%) were consulted by the emergency department. 51 cases (82.25%) were from urban areas and 11 cases (17.75%) were from rural areas. Majority of the patients (30.6%) belonged to 31-36 years age group. 56.4% of the women were multiparous. The classical triad of amenorrhea, vaginal bleeding, and abdominal pain was seen in 64 % of the study population. The mean of gestational age at the time of presentation was 6.32±1.17 week. 12 patients (19.3%) presented with ruptured EP and were operated within 24 hours, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, laparoscopic management was performed in 26 (41.9%) patients. In this surgical groups, salpingectomy was performed 22 (35.4% of total) and salpingostomy was performed in 4 (6.5% of total) patients. 43.5% of the patients received medical treatment with methotrexate. Three cesarean scar pregnancy were treated by curettage. Six EP cases resolved with complete tubal abortion. No mortality was observed.
EP is one of the most common gynecological emergencies with significant maternal morbidity and mortality. Despite the advances in diagnostic methods and management, EP is an important health problem that endangers the mother's life. Therefore, both gynecologists and emergency physicians should be aware of the differential diagnosis in patients with pelvic pain and menstrual irregularity. Early diagnosis makes the medical management and conservative surgery feasible. This may have a significant impact on the fertility and mortality rates of EP patients.
Keywords: Ectopic pregnancy, emergency, methotrexate, salpingectomy