Analysis of ectopic pregnancies requiring life-saving urgent surgery

This study aims to analyze the demographic, ultrasonographic, and laboratory findings as well as the outcomes of patients with ectopic pregnancy (EP) who underwent life-saving urgent surgery.

A retrospective cross-sectional study was conducted at the Tersiyer Referral Hospital between January 01, 2016 and January 01, 2020. The study included 469 cases of EP. Data for these patients were extracted from hospital records and patient files. For the analysis of life-saving urgent surgeries, only patients presenting with severe signs and symptoms during hospital admission, follow-up, or after methotrexate (MTX) therapy were included.

The mean age of the patients was 31.2 (+-5.65) years, with the youngest being 15 years old and the oldest 49 years old. A history of EP was noted in 15.1% of patients, and 29.4% were smokers. The reasons for consulting a doctor included no complaints in 37 patients (7.9%), delayed menstruation in 37 patients (7.9%), abdominal pain in 128 patients (27.3%), abdominal pain with vaginal bleeding in 108 patients (23.0%), and only vaginal bleeding in 159 patients (33.9%). In four patients (0.9%), the ectopic focus could not be identified via ultrasound, while in 255 patients (54.3%) the ectopic focus was located in the right adnexal area. The mean preoperative hemoglobin level was 12.4 (+-1.33) g/dL, with a median hemoglobin value of 12.6 (range: 7.2-14.7 ) g/dL. A comparison of demographic data, ultrasound findings, and pre- and postoperative laboratory results between patients who underwent surgery without MTX therapy and those who underwent surgery following MTX therapy revealed significant differences in terms of age, parity, maximum diameter of the ectopic focus, preoperative hemoglobin levels, preoperative white blood cell counts, presence of free fluid in the abdomen, and contraceptive methods.

EP holds a significant place among gynecological emergencies. Any delay in diagnosis can lead to life-threatening conditions, where the only viable treatment at this stage is life-saving urgent surgical intervention.