Contemporary management of ectopic pregnancy

Over the five years 1975-79 at Yale-New Haven Hospital, ectopic pregnancy changed from a disease requiring acute emergency are utilizing radical surgery for a ruptured ectopic to a disease requiring chronic, observant care utilizing conservative treatment for the unruptured ectopic. One hundred ninety-five cases of ectopic pregnancy have been retrospectively reviewed to determine how laparoscopy, ultrasound and beta pregnancy testing have affected this change. Over the reviewed period of time, the rate of diagnosed and treated unruptured ectopic pregnancies increased from 8% to 35%. Those patients with ectopic pregnancies having laparoscopy prior to laparotomy rose from 11% to 29.5%. Ultrasound diagnosed intrauterine pregnancy in 13% of those patients suspected of having an ectopic pregnancy by defining an intrauterine gestational sac and demonstrated a mass in 85% of patients diagnosed as having an ectopic pregnancy, although the mass was not always the ectopic pregnancy. Beta pregnancy testing, available only over the past two years, was positive in 99%, with only one false negative. One hundred twenty-eight culdocenteses were done, with 85% positive, and was the most important factor in deciding on emergency versus expectant care. These factors have allowed us to treat ectopic pregnancy expectantly, making the diagnosis sooner and more accurately, leading to an increase in conservative treatment and employing salpingostomy as opposed to salpingectomy as the rate of unruptured ectopic pregnancy increases.