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Is surgical intervention for ectopic pregnancy in a low resource set-up avoidable?

Anindita Sinha Babu1, Jayeeta Roy2, Dipanwita Das1

  • 1Assistant Professor, Department of Pathology, College of Medicine and Jawaharlal Nehru Memorial Hospital , WBUHS, Kalyani, Nadia, West Bengal, India .

Journal of Clinical and Diagnostic Research : JCDR
|November 12, 2014
PubMed
Summary

Ectopic pregnancy management in a tertiary care center showed a high surgical burden. Medical management should be prioritized where applicable to reduce resource strain and improve patient outcomes.

Keywords:
Ectopic pregnancyLow-resource set-upMedical managementRetrospective studySurgical management

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Area of Science:

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Public Health

Background:

  • Ectopic pregnancy is a life-threatening first-trimester complication with adverse effects on future fertility, especially after salpingectomy.
  • Medical management is increasingly advocated, necessitating earlier diagnosis for conservative treatment feasibility.
  • This study evaluated the feasibility of conservative management (medical and surgical) for ectopic pregnancy in a tertiary care setting.

Purpose of the Study:

  • To determine the demographic profile and risk factors associated with ectopic pregnancy.
  • To analyze the clinical presentation of ectopic pregnancy cases.
  • To investigate the treatment modalities employed for ectopic pregnancy.

Main Methods:

  • A retrospective record-based study was conducted.
  • Data from all diagnosed ectopic pregnancy cases between January 2011 and December 2012 were analyzed.
  • The study was based in a tertiary care hospital.

Main Results:

  • 234 ectopic pregnancy cases were recorded, representing 1.5% of deliveries and 5.4% of gynecological emergencies.
  • The majority of patients were multigravida (74.4%) aged 26-30 years (35.9%).
  • Pelvic inflammatory disease (38.5%) and a history of induced abortion (35.9%) were significant risk factors. Most patients presented between 4-7 weeks of gestation with shock in 44.9% of cases. Surgical treatment was overwhelmingly favored (98.3%) over medical management (offered to only 4 cases).

Conclusions:

  • Ectopic pregnancy imposes a substantial surgical burden on hospital resources.
  • Surgery is often performed even in cases amenable to medical treatment, indicating a need for a shift in clinical practice.
  • There is a critical need to promote medical management of ectopic pregnancy whenever appropriate to optimize resource utilization and patient care.