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

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.