1. PRESENTATION AND MANAGEMENT OF ECTOPIC PREGNANCY AT DIANA PRINCESS OF WALES HOSPITAL. UNITED KNGDOM
Lilian Alabi-Isama, Mona Fawzy and Ibrahim Bolaji
Department of Obstetrics and Gynaecology, Division of Family Services
Hull York Medical School based at Diana, Princess of Wales Hospital, Northern Lincolnshire and Goole NHS Foundation Trust, Scartho Road, Grimsby, UK
INTRODUCTION
Ectopic pregnancy continues to be an important cause of maternal mortality. The prevalence of which has not changed in the last decades (figure 1). The risk of death is 0.35 per 100,000 estimated ectopic pregnancies (figure 2). One concern raised in the CEMACH report was the difficulty encountered in diagnosing ectopic pregnancy. According to the latest CEMACH report ( ), there were ten deaths from ectopic pregnancy and seven of them were due to substandard care. The rising incidence of ectopic pregnancy is related to increasing tubal disease and the use of in vitro fertilization (IVF). Its presentation can vary from minor symptoms to sudden collapse. It produces a diagnostic dilemma and a management problem. Transvaginal ultrasound in addition to human chorionic gonadotropin (hCG) has proven to be very reliable for its diagnosis.
Figure 3: The most frequent presenting symptoms were the triad of abdominal pain (90%), vaginal bleeding (80%) and amenorrhoea (75%). Five patients presented with urinary symptoms.
From Admission
No Of pts
Day 1
47 (77%)
Day 2
7 (12%)
Day 3
1 (2%)
Day 4
Day 6
Not Known
2 (3%)
Table 2: The admission to procedure time ranged between one and six days. Forty seven patients (77%) underwent treatment on the same day as their admission
Thirty six percent of the patients had a ß-hCG below our discrimination zone of 1500 and a quarter of them had immediate laparoscopy due to haemodynamic instability. Twenty one patients had the ß-hCG above our discrimination zone and twelve of the patients proceeded to laparoscopy (54%). The patients were managed differentially ranging from expectant management, medical and surgical treatment including laparotomy and laparoscopy. 77% had surgical treatment on the day of admission and 12% the next day.
Figure 1
CONCLUSION
The triad of B-hCG discriminatory zone, B-hCG doubling time and transvaginal scan can reliably diagnose ectopic pregnancy in most women and significantly reduce the interval between admission and treatment with most patients having treatment on the day of admission. Data from randomized trials are required to assess the role of salpingotomy and salpingectomy in surgically treated women.
Figure 2
MATERIALS AND METHODS
REFERENCES
All cases of ectopic pregnancy at the Diana, Princess of Wales Hospital Grimsby UK over a thirty months period from December 2002 through to April 2005 were retrospectively reviewed using a pre-designed proforma with respect to a number of parameters including gestational age at presentation, parity, mode of presentation, investigations, diagnosis and therapeutic interventions. There were no exclusion criteria. Data were processed using excel database.
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Ankum WM, Van der Veen F, Hamerlynck JVTH et al. What to do when human chorionic gonadotropin levels are below the discriminatory zone. J Reprod Med 1995; 40:525–528.
Kadar N, Caldwell BV, Romero R. A method of screening for ectopic pregnancy and its indications. Obstet Gynecol 1981; 52:162–166.
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Condous G, Okaro E, Khalid A, et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod 2005; 20:1404–1409.
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Mol BW, Hajenius PJ, Engelsbel S, et al. Is conservative surgery for tubal pregnancy preferable to salpingectomy? An economic analysis. Br J Obstet Gynaecol. 1997;104:834–839.
RESULTS
There were 62 patients identified as having been treated with an ectopic pregnancy during the 30 months period.
Gestation (weeks)
No. of Patients
< 4
6 (10%)
4 - 8
38 (62%)
8 - 10
7 (11%)
Unknown
10 (16%)
Table 1: The modal time of presentation was in the range 4-8wks gestation (62%).