Proximal ectopic pregnancy: a descriptive general population-based study and results of different management options in 86 cases

Fertil Steril. 2011 Mar 1;95(3):867-71. doi: 10.1016/j.fertnstert.2010.10.025. Epub 2010 Nov 3.

Abstract

Objective: To describe different approaches for diagnosis and management of proximal ectopic pregnancies (PP) in general population.

Design: Observational population based-study.

Setting: Regional ectopic pregnancy registry.

Patient(s): Eighty-six PP registered from 1992 to 2008.

Intervention(s): Surgical (radical or conservative), medical, or combined therapies.

Main outcome measure(s): Epidemiologic characteristics, clinical presentation, hCG level, treatments performed, failure rate, and recurrence.

Result(s): Mean gestational age was 48.2 days. Estimated incidence of PP was 2.7%. Abdominal pain and vaginal bleeding were the commonest symptoms. Two patients were admitted in hypovolemic shock. Diagnostic modalities included transvaginal ultrasound, abdominal ultrasonography, and laparoscopy in 38 (44%), 7 (8%), and 39 (45%) cases, respectively. Mean hCG level was 10,759 IU/L. Thirty-four patients underwent primary cornual resection (39.5%) by laparoscopy (n = 32) or laparotomy (n = 2). Twenty-seven patients (31.4%) underwent primary conservative surgery by laparoscopy: cornuostomy (n = 18) or extended salpigostomy (n = 9). Primary medical treatment with methotrexate was attempted in 14 patients (16.3%). Expectant management was attempted in one case (1.2%). Eleven cases received combined therapies (11.6%). Failure rates for medical and surgical treatments were 35.7% and 28%, respectively. No failures were noted among patients who received combined therapies.

Conclusion(s): Proximal ectopic pregnancy remains a life-threatening condition. Diagnosis is challenging and requires a high index of suspicion. Despite available conservative strategies, management of PP remains heterogeneous.

MeSH terms

  • Abortifacient Agents, Nonsteroidal / therapeutic use*
  • Adolescent
  • Adult
  • Combined Modality Therapy
  • Female
  • Humans
  • Incidence
  • Laparoscopy*
  • Methotrexate / therapeutic use*
  • Pregnancy
  • Pregnancy, Ectopic* / drug therapy
  • Pregnancy, Ectopic* / epidemiology
  • Pregnancy, Ectopic* / surgery
  • Recurrence
  • Registries
  • Risk Factors
  • Salpingostomy
  • Treatment Outcome
  • Young Adult

Substances

  • Abortifacient Agents, Nonsteroidal
  • Methotrexate