An ectopic pregnancy (EP) is defined as any pregnancy that occurs outside the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. The goal of this retrospective study is to address medical and conservative surgical management of unruptured fallopian tube EP as an effective manner to preserve tubes to prevent secondary infertility. This study was conducted between January 1, 2010, and April 30, 2024, in Ponni Hospital, Madurai. It included 319 women, out of 6248 pregnant women diagnosed with ectopic pregnancy by using an Inexecreen kit, trans-abdominal scan, trans-vaginal scan, and doubling of beta-human chorionic gonadotropin (β-HCG) in 48 hours and Magnetic Resonance Imaging (MRI). Medical and conservative surgical management were given to those patients effectively. Out of 319 patients, 62 patients (19.4%) had a ruptured ectopic pregnancy and underwent surgical treatment; 257 patients (80.6%) had an unruptured ectopic pregnancy. The conservative medical management was provided to 257 patients. Out of 257 patients, 235 patients were treated by injecting methotrexate and folic acid rescue when the criteria were met. 14 patients had salpingostomy and injection methotrexate (Inj. Methotrexate) and inj. Prostaglandin F2 alpha was administered into the tubal wall to preserve tubes. 8 patients had a live ectopic pregnancy; for those patients, Inj. Methotrexate was injected into the gestational sac through ultrasound guidance. 225 out of 257 patients reached out to us to seek fertility treatment; the remaining 32 patients were not seeking fertility. All fertility-seeking patients had successful pregnancies. We lost follow-up of 12 patients in this study. Out of 213 patients who came for fertility treatment, a 76.1% success rate was achieved with live birth, the recurrent ectopic pregnancy rate was 13.6%, the miscarriage and stillbirth rates were 10.3%. 32 patients, who were not seeking fertility, had quality life without surgical scars for ectopic pregnancy and cost-effective treatment. 25 patients out of 32 had laparoscopic sterilization later, and 7 patients followed temporary contraception as per our advice. This clinical data was retrieved from medical records.
References
[1]
Norvik, A. (2009) Ectopic Pregnancy—Etiology, Modern Diagnostic and Therapeutic Approach. Charles University. https://dspace.cuni.cz/bitstream/handle/20.500.11956/17181/120004092.pdf?sequence=1&isAllowed=y
[2]
Fylstra, D.L. (2012) Ectopic Pregnancy Not within the (Distal) Fallopian Tube: Etiology, Diagnosis, and Treatment. American Journal of Obstetrics and Gynecology, 206, 289-299. https://doi.org/10.1016/j.ajog.2011.10.857
[3]
Sreelatha, S. (2024) Risk Factors and Maternal Outcome in Ectopic Pregnancy. EC Gynaecology, 13, 1-4.
[4]
Liu, X., Liu, C. and Peng, Y. (2024) New Advances in the CAUSES and treatment of Ectopic Pregnancy: A Review. MEDS Clinical Medicine, 5, 26-31.
[5]
Eisaman, D.M., Brown, N.E. and Geyer, S. (2024) Relationship of β-Human Chorionic Gonadotropin to Ectopic Pregnancy Detection and Size. Western Journal of Emergency Medicine, 25, 431-435.
[6]
Gandhi, A., Pandit, S., Tank, P., Medhekar, M. and Umarjee, C. (2020) FOGSI GCPR on Ectopic Pregnancy. https://www.fogsi.org/wp-content/uploads/gcpr/Ectopic-Pregnancy.pdf
[7]
Ganitha, G. and Anuradha, G. (2017) A Study of Incidence, Risk Factors, Clinical Profile and Management of 50 Cases of Ectopic Pregnancy in a Tertiary Care Teaching Hospital. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6, 1336-1342. https://doi.org/10.18203/2320-1770.ijrcog20171388
[8]
Mullany, K., Minneci, M., Monjazeb, R. and C. Coiado, O. (2023) Overview of Ectopic Pregnancy Diagnosis, Management, and Innovation. Women’s Health, 19. https://doi.org/10.1177/17455057231160349
[9]
Hirschler, L.E. and Soti, V. (2023) The Utility of Monitoring β-Human Chorionic Gonadotropin Levels in an Ectopic Pregnancy. Cureus, 15, e34063. https://doi.org/10.7759/cureus.34063
[10]
Dong, Y., Zhang, H., Jin, K. and Li, H. (2024) Three-Dimensional Transvaginal Ultrasound Diagnosis of Interstitial Ectopic Pregnancy in a Unicornuate Uterus: A Case Report. Journal of Clinical Ultrasound, 52, 473-477. https://doi.org/10.1002/jcu.23641
[11]
Sharma, M. (2021) Chronic Ectopic Pregnancy Complicated by Septicemic Shock and Disseminated Intravascular Coagulation. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 11, 281-284. https://doi.org/10.18203/2320-1770.ijrcog20215122
[12]
Lawani, O., Anozie, O.B. and Ezeonu, P.O.(2013) Ectopic Pregnancy: A Life-Threatening Gynecological Emergency. International Journal of Women’s Health, 5, 515-521. https://doi.org/10.2147/ijwh.s49672
[13]
Sinha, P. (2022) A Guide to Problems in Early Pregnancy and Their Management. Cambridge Scholars Publishing, 97.
[14]
Patil, M. (2012) Ectopic Pregnancy after Infertility Treatment. Journal of Human Reproductive Sciences, 5, 154-165. https://doi.org/10.4103/0974-1208.101011
[15]
Lipscomb, G. (2007) Medical Therapy for Ectopic Pregnancy. Seminars in Reproductive Medicine, 25, 93-98. https://doi.org/10.1055/s-2007-970048
[16]
Talwar, P., Sandeep, K., Naredi, N., Duggal, B.S. and Jose, T. (2013) Systemic Methotrexate: An Effective Alternative to Surgery for Management of Unruptured Ectopic Pregnancy. Medical Journal Armed Forces India, 69, 130-133. https://doi.org/10.1016/j.mjafi.2012.08.032
[17]
Monteagudo, A., Minior, V.K., Stephenson, C., Monda, S. and Timor-Tritsch, I.E. (2005) Non-Surgical Management of Live Ectopic Pregnancy with Ultrasound-guided Local Injection: A Case Series. Ultrasound in Obstetrics & Gynecology, 25, 282-288. https://doi.org/10.1002/uog.1822
[18]
Natofsky, J.G., Lense, J., Mayer, J.C. and Yeko, T.R. (1999) Ultrasound-Guided Injection of Ectopic Pregnancy. Clinical Obstetrics and Gynecology, 42, 39-47. https://doi.org/10.1097/00003081-199903000-00008
[19]
Fernandez, H., Baton, C., Lelaidier, C. and Frydman, R. (1991) Conservative Management of Ectopic Pregnancy: Prospective Randomized Clinical Trial of Methotrexate versus Prostaglandin Sulprostone by Combined Transvaginal and Systemic Administration. Fertility and Sterility, 55, 746-750. https://doi.org/10.1016/s0015-0282(16)54241-1
[20]
Moghissi, K.S. (1999) Medical Treatment of Endometriosis. Clinical Obstetrics and Gynecology, 42, 620. https://doi.org/10.1097/00003081-199909000-00016
[21]
Kusaka, M., Tanaka, T. and Fujimoto, S. (1994) Local Etoposide Injection for Treatment of Tubal Pregnancy with Cardiac Activity. International Journal of Fertility and Menopausal Studies, 39, 11-13.
[22]
Castaño, E., Piñuñuri, R., Hirsch Birn, S. and Ronco Macchiavello, A.M. (2017) Folate and Pregnancy, Current Concepts. It Is Required Folic Acid Supplementation? RevistaChilena de Pediatría, 88, 199-206.
[23]
Deniz, S., Ali, B., Canan, U., Yılmaz, A.H., Olcay, I., Burcu, D., et al. (2024) Evaluation of the Parameters in Predicting Single-Dose Methotrexate Therapy Success for Ectopic Pregnancy. Journal of Obstetrics and Gynaecology Research, 50, 856-863. https://doi.org/10.1111/jog.15923
[24]
Salvi, P., Gaikwad, V., Bhadoriya, A. and Ponde, S. (2024) Medical Management of Cesarean Scar Ectopic Pregnancy: A Unique Approach. Cureus, 16, e55481. https://doi.org/10.7759/cureus.55481
[25]
Akdaş Reis, Y., Akay, A., Özkan, M., Fıratlıgil, F.B., Dereli, M.L., Kınay, T., et al. (2023) Do the Change in Β-Hcg Values between the 0th and 4th Days in Tubal Ectopic Pregnancy Treatment with a Single-Dose Methotrexate (MTX) Protocol Predict the Need for a Second Dose of MTX? Archives of Gynecology and Obstetrics, 309, 2585-2590. https://doi.org/10.1007/s00404-023-07116-3
[26]
Pereira, N., Bender, J.L., Hancock, K., Lekovich, J.P., Elias, R.T., Kligman, I., et al. (2015) Routine Monitoring of Liver, Renal, and Hematologic Tests after Single-or Double-Dose Methotrexate Treatment for Ectopic Pregnancies after in Vitro Fertilization. Journal of Minimally Invasive Gynecology, 22, 1266-1270. https://doi.org/10.1016/j.jmig.2015.07.014
[27]
Hagström, H., Hahlin, M., Sjöblom, P. and Lindblom, B. (1994) Pregnancy: Prediction of Persistent Trophoblastic Activity after Local Prostaglandin F2α Injection for Ectopic Pregnancy. Human Reproduction, 9, 1170-1174. https://doi.org/10.1093/oxfordjournals.humrep.a138653
[28]
Liu, J., Liang, Y., Su, Y., Lilenga, H.S. and Zhai, J. (2024) Reasons, Experiences and Expectations of Women with Delayed Medical Care for Ectopic Pregnancies in Chinese Urban Edges: A Qualitative Study. BMJ Open, 14, e076035. https://doi.org/10.1136/bmjopen-2023-076035
[29]
Lozeau, A.M. and Potter, B. (2005) Diagnosis and Management of Ectopic Pregnancy. American Family Physician, 72, 1707-1714.
[30]
Halperin, R., Vaknin, Z., Schneider, D., Yaron, M. and Herman, A. (2003) Conservative Management of Ectopic Pregnancy with Fetal Cardiac Activity by Combined Local (Sonographically Guided) and Systemic Injection of Methotrexate. Gynecologic and Obstetric Investigation, 56, 148-151. https://doi.org/10.1159/000073774
[31]
Awadi, A.M.E., Anbar, A.E.M.A.E. and Mohamed, A.S. (2024) Laparoscopic Tubal Salpingotomy versus Salpingectomy in Management of Tubal Ectopic: Impact on Future Fertility. Al-Azhar International Medical Journal, 5, Article 17. https://doi.org/10.58675/2682-339x.2198
[32]
Vejtorp, M., Vejerslev, L.O. and Ruge, S. (1989) Local Prostaglandin Treatment of Ectopic Pregnancy. Human Reproduction, 4, 464-467. https://doi.org/10.1093/oxfordjournals.humrep.a136927
