Publication:

Clinical profile and treatment outcome of non-surgical management of tubal ectopic pregnancy in a tertiary care hospital: retrospective study

Background Tubal ectopic occurs when fertilized egg implants and develops in fallopian tube instead of normal endometrial cavity. Late diagnosis of condition leads to tubal rupture, life-threatening hemorrhage, warrants salpingectomy affecting future fertility of patient. When diagnosed early, non-surgical management can be offered preserving the tube. This study aimed to identify the factors which affect clinical course and treatment outcome of non-surgically managed tubal ectopic pregnancies.

Methods A retrospective study was conducted on 56 tubal ectopics in Department of Obstetrics and Gynaecology, BARC Hospital, Mumbai from January 2017 to December 2023. Associated risk factors, clinical profile, treatment outcomes of all cases were analysed based on case sheets by simple descriptive statistics and percentage method.

Results The 53.58% were in 31-40 years of age. The 46.42 % were multiparous. PID (20%) and assisted reproductive technology (ART) (17.5%) was identified risk factor. Pain in lower abdomen was commonest presenting symptom. Out of 56, 21 were (37.5%) eligible for non-surgical treatment. Of these 4 (19.05%) underwent successful expectant management. Remaining 17 (80.95%) received medical management with multidose methotrexate (MTX) of these 13 were successful. (success rate 76.47%).  Remaining 4 failed medical cases eventually underwent salpingectomy. Overall success rate of non-surgically managed cases was 17 out of 21 being 80.95%. No drug induced morbidity or blood transfusion was required in non-surgically managed cases. No mortality was recorded.

Conclusions ‘Suspicion of ectopic pregnancy (EP) in reproductive aged woman seeking medical attention’ is the key for its early diagnosis. Our study confirms non-surgical management: expectant or with multidose MTX is a viable therapeutic option in early tubal ectopic management with main advantage of preserving fallopian tube.