Interventional Challenges in Non-Tubal Ectopic Pregnancy

Objective: Non-tubal ectopic pregnancies (EPs) are rare and potentially life threatening. The number is rising due to various risk factors and there are no uniform guidelines in the management of EPs. This study was done to assess risk factors and challenges in the management of EPs. Materials and methods: This is a retrospective observational descriptive study that was done at SDM College of Medical Sciences & Hospital, Shri Dharmasthala Manjunatheshwara University Dharwad, Karnataka India. Data was collected from the medical records section of all the patients of non-tubal ectopic pregnancies managed in our hospital from January 2020 to June 2021. The collected data were analyzed for demographic characteristics, risk factors and management. Results: The incidence of ectopic pregnancies in our institute was 6-7 per 1000 pregnancies, of which 20% of the ectopic pregnancies were non-tubal. The incidence was higher than the other studies, which could be due to our center being a tertiary care referral center. Cesarean scar ectopic pregnancies were the most common accounting for 60% of cases. The management varied from conservative to minimally invasive surgery to hysterectomy hysterectomy with bilateral internal iliac artery ligation, depending upon the clinical presentation, duration of gestation, presence of fetal cardiac activity and hemodynamic stability. The other non-tubal ectopic pregnancies were cervical, ovarian, corneal and heterotopic. Cervical pregnancy beyond 12 weeks of gestation was rare which was managed by conserving the uterus. Conclusion: Non-tubal ectopic pregnancies are rare. Early diagnosis requires a high index of suspicion if missed can lead to an array of complications leading to loss of fertility, morbidity, and mortality. The key step to avert the complications is early diagnosis and individualized treatment.