Study of Management In Patient with Ectopic Pregnancy

NJIRM 2011; Vol. 2(3). July- September eISSN: 0975-9840 pISSN: 2230 - 9969
91

Study of Management in Patient with Ectopic Pregnancy

Dr. Divyesh Panchal*, Dr.Gunvant Vaishnav*, Dr. Kunal Solanki**

*Assistant Professor, Department of Obstetric and Gynecology, Government Medical College, Baroda, ** Assistant Professor,
Department of Surgery, AMC MET Medical College, Ahmadabad, Gujarat India.
Abstracts: Background: ectopic pregnancy has always challenged ingenuity of the Obstratrition and
Gynaecologist by its bizarre clinical picture. If it is not attended in time, it may lead to maternal morbidity and
mortality. It is one, which can mimic practically each and every gynaecological disorder as well as many
surgical catastrophes Method: The present study consist of 60 cases of ectopic pregnancy from may 2007to
September 2009 admitted at department of obstetrics and Gynaecology at our hospital. All data was collected
in to pre designed structured Performa. Results: In present study 71.66% patients are in age group of 21-30
years of age, this may be because this time period is the maximum fertile period and use of contraception is
infrequent and occasional. 80% of patients were or more then two parity. Out of 60 patient in 70.75% case
aetiology was made out with majority case with infection. In only one patient was heaving post operative
infection, suggested by presence o adhesion. Conclusion: Due to advance diagnostic technique, conservative
treatment is also possible and with recent surgical technique, the morbidity and mortality is drastically
reduced. [ Panchal D et al NJIRM 2011; 2(3) : 91-94]
Key Words: Ectopic Pregnancy, Conservative, Management
Author for correspondence: Dr. Divyesh Panchal, Assistant Professor, Department of Obstetric and
Gynecology, Government Medical College, Baroda. E-mail: divyeshpanchal@gmail.com

Introduction: Till today ectopic pregnancy has
always challenged ingenuity of the Obstratrition
and Gynaecologist by its bizarre clinical picture. If it
is not attended in time, it may lead to maternal
morbidity and mortality. It is one, which can mimic
practically each and every gynaecological disorder
as well as many surgical catastrophes.

With the rapid decline in the number of
intrauterine pregnancy, during the past decade,
the frequency of extrauterine pregnancy become
more apparent because of attitudinal change in
sexual activity, young population, the rising
incidence of venereal disease, the effective role of
Morden antibiotics, therapy in salpingitis, use of
contraceptive measures and assisted reproductive
technique
1
.

Due to advance in modern technology like
diagnostic laparoscopy, radioimmunoassay of
HCG and ultrasonography diagnosis has become
less difficult. Yet each method is heaving its own
limitation. An accurate history and physical
examination and its correlation to the modern
diagnostic technology are believed to be the most
important in the diagnosis. To diagnose ectopic
pregnancy, one has to be ectopic minded.
Modern anaesthesia, blood transfusion facilities,
transport facilities, immediate resuscitation as well
as adequate and proper surgery are the keystone
of success in reducing the maternal morbidity and
further successful obstetric career.

Thus, in spite of advance in modern technique of
diagnosis and management of ectopic pregnancy, it
still remains a very serious threat to maternal
safety and hence an open field to study till deeply.

In a present study we have tried to analyse 60
cases of ectopic pregnancy admitted to our
institute during period of may 2007 to September
2009 with keeping in mind objective to analyse
modalities of treatment used and maternal
morbidity and mortality in study group.

Material and Methods The present study consist
of 60 cases of ectopic pregnancy from may 2007to
September 2009 admitted at department of
obstetrics and Gynaecology at our hospital. All data
was collected in to pre designed structured
Performa. Detail included was age, presenting
symptoms, parity, antenatal care, use of
contraception, family history, antenatal
investigation, surgical management, detail
Study of Management In Patient with Ectopic Pregnancy


NJIRM 2011; Vol. 2(3). July- September eISSN: 0975-9840 pISSN: 2230 - 9969
92

obstetric history was taken to take in to account
antibiotic prophylaxis, pre and post operative
procedure and complication if any. Data was
collected and tabulated as shown in result.
Statistical analysis was done using Microsoft Excel.

Result: Detail analysis of data is shown in table
below:
Table 1: Age wise distribution
Age No. of patient (%)
<21 3(5)
21-30 43(71.66)
31-35 10(16.66)
>35 4(6.66)

Table 2: parity wise distribution
Parity No. of patient (%)
0 11(18.33)
1 21(35)
2 18(30)
3 7(11.66)
>3 3(5)

Table 3: Aetiology Age wise distribution
Aetiology No. of patient (%)
Infection 33(55)
Previous surgery 9(15)
Infertility 7(11.66)
Non Identified 15(25)

Table 4: Symptom wise distribution
Age No. of patient (%)
Abdominal pain 59(98.33)
Amenorrhoea 51(85)
Bleeding P/V 41(68.33)
Fainting 21(35)
Other 22(36.66)

UPT was positive with 95% accuracy in preset
study, while USG was positive with 93.33%,
combined USG and UPT is positive with 98.66%
accuracy and Laparoscopy was with 100% accuracy
Positive
Table 5: Treatment wise distribution
Treatment No. of patient (%)
Surgical
a. Laprotomy
59(98.33)
51 (85)
b. Laparoscopy
c. Combined
1(1.66)
1(1.66)
Medical 2(3.33)
Failure 1(1.66)

Table 6: Site of ectopic pregnancy
Site No. of patient (%)
Ampulatory 32(53.33)
Isthemic 19(31.66)
Fimbrial 3(5)
Interstitial 2(3.33)
Ovarian 2(3.33)
Abdominal 1(1.66)
Cornual 1(1.66)

Table 7: Type of surgery wise distribution
Treatment No. of patient (%)
Conservative Surgery
a. Milking
b. Salpingotomy
c. Partial Salpingotomy
d. Ovarian Wedge
resection

0 (0)
1(1.66)
13 (21.66)
1(1.66)
Radical Surgery
a. Total Salpingotomy
b. Total Salpingotomy -
oophorectomy
c. oophorectomy

31 (61.66)
3(5)
1(1.66)

Discussion: In present study 71.66% patients are in
age group of 21-30 years of age, this may be
because this time period is the maximum fertile
period and use of contraception is infrequent and
occasional. 80% of patients were or more then two
parity. Out of 60 patient in 70.75% case aetiology
was made out with majority case with infection. In
only one patient was heaving post operative
infection, suggested by presence o adhesion.
according to Shah J P et al
1
ectopic pregnancy was
more after post partum TL because oedematous
congested friable tube increases the chance of
incomplete occlusion.

In present study abdominal pain and amenorrhoea
was present in 98.33% and 85% cases suggestive of
most common presentation of patient with ectopic
pregnancy. Same finding was observed by Roes et
Study of Management In Patient with Ectopic Pregnancy


NJIRM 2011; Vol. 2(3). July- September eISSN: 0975-9840 pISSN: 2230 - 9969
93

al (92.4% and 78%) and Chudhary et al
2
(94.3% and
73.4%), 15% of cases were without history of
amenorrhoea suggesting presentation of Ectopic
Pregnancy before missed period. Fainting was
present in 35% case which is comparable with
study of Chudhary et al
2
.

On examination 26.66% patient were presented
with marked pallor and 18.33% with shock.
Abdominal tenderness was present in 90% case in
contrast to 62.9% in Valmiki D R et al
3
(62.9%).
Bleeding per vaginum was preset in 48.33% cases.
Cervical tenderness was present in 76.66% while
tenderness in fornix was present in 85% cases,
which may be due to fluid collection which causes
irritation of peritoneum.

In majority of cases (61.66%) laprotomy was done
because of poor general condition. Once case of
laproscopy was converted to peritoneum because
of massive adhesion. In study carried out by
Martyan et al
4
leprotomy due to poor general
condition was done in only 21% cases.

In study done by Pratibha vaidya et al
5
, milking was
done in 2.33% cases and partial salpingectomy was
done in 13.25% case, which is coparable with
present study (21.66%). Total salpingectomy was
done by them in majority of case (66.3%), which
was same as present study (61.66%).

Commonest site for ectopic pregnancy is tubal in
present study (98.33%), which is same as Boueyer
6

et al (95.5%).In Present Series, almost 65.55% of
cases required BT infusion in Between 2-4 units.

In post operative complication 3.33% patients have
abdominal distension and other 3.33% patients
had pyrexia. No mortality is noted in this series,
may be because of early and aggressive
resuscitative measures with good antibiotic cover
and early availability of blood and blood product.

Conclusion: In the present study, it has been
observed that Ectopic Pregnancy still remain the
most lethal and morbid gynaecological emergency.
Increase incidence of ectopic pregnancy attributed
to increases incidence of IUCD, MTP, abortion,
reconstructive tubal surgery, Tubal ligation in early
reproductive age etc. Lower abdominal pains,
painful vaginal examination with menstrual
irregularity are constant finding of EP. Due to
advance diagnostic technique, conservative
treatment is also possible and with recent surgical
technique, the morbidity and mortality is
drastically reduced.

References:
1. Shah J P et al. Study of Ectopic Pregnency
;IPGM 1991. Vol. 32(1): 17-20.
2. Chudhary et al, The management of Ectopic
Pregnancy, Irish Medical journal;2008 :
101(3);22-28.
3. Valmiki D R et al. Managment of ectopic
Pregnency with massive hemoperitonium by
leproscopic surgery with autolog blood
transfusion. J Minimum Invasive Gynecol.;
13(1):43-48.
4. Martyan et al. Prospective study with improved
diagnostic accuracy. Ann. Emergency
medicine;1996;28;107.
5. Pratibha vaidya et al Thesis, Department of
Obstetric and Gynecology, LTMG hospoital
Bombay, 1998, 45-56.
6. Bouyer J, Saurel-Cubizolles MJ, Grenier C,
Aussel L, Job-Spira N. Ectopic pregnancy and
occupational exposure of hospital personnel.
Scandinavian Journal of Work, Environment
and Health 1998;24:98-103.