Clinico-epidemiology and outcome of ectopic pregnancy: An experience of 7 years in St. Stephen's hospital, Delhi

Ectopic pregnancy is an important cause of maternal morbidity & mortality in the first trimester. Treatment of ectopic pregnancy was limited to surgery. In spite of advancement of diagnosis & management it is still a very serious threat to maternal safety, so this case-series type of study was conducted on 58 ectopic pregnancies to study the clinico-epidemiology and outcome of medically managed ectopic pregnancy at a tertiary level hospital. Out of total 20,354 pregnancies, 443 (2.1%) were ectopic pregnancies. Most common site of ectopic pregnancy was Fallopian tubes in 94.8% cases followed by ovary in 3.4% cases and heterotopic in 1.7%. Age range was 17 years to 36 years with mean age 28.12 ± 4.10 years. Parity wise maximam were nulliparous (53.4%) followed by para one (25.9 %), para two (19%) and para three (17.2 %). Ectopic pregnancies on right side were found in 55.2% while in left side in 44.8% 75.8% had bleeding per vaginum and 74.1 % had pain abdomen as their chief complaints. History of abortion was found in 44% cases and past history of ectopic pregnancy was found in 8.6% cases whereas past history of pelvic inflammatory disease in 22.4% cases and infertility in 13.8% cases. 1.7% cases had IUCD in situ while 5.2% cases had history of past IUCD insertion. History of ovulation induction was present in 8.6% cases, 3.4% cases were IVF conceived and 1.7% underwent laparohysteroscopy for infertility treatment. In this study success rate of methotrexate therapy was found 93.1%. Emergency surgery was needed only in 6.9% of cases. So it can be concluded that bleeding per vegina and pain abdomen may be investigated for ectopic pregnancy and ectopic pregnancies should be treated first line with methotrexate before surgery.