Effectiveness and success rate of medical management of ectopic pregnancy in Latifa Hospital (2010–2013), Dubai, UAE

Abstract

Aim: To evaluate the effectiveness of medical treatments of ectopic pregnancy which conserves the patient's reproductive potential. Materials and methods: Retrospective study carried out on patients with ectopic pregnancy who were admitted to gyne ward in Latifa Hospital, Department of Obstetrics & Gynecology, a tertiary care hospital in Dubai over a period of 3 years from January 2010 to December 2013 and were treated with MTX injection (using single dose regimen 50 mg/m2 body surface area) with follow up of βhCG in day 7 and 2nd dose of MTX was given for those with increased, persistent level of βhCG, or for those whom βhCG level failed to decrease >15%. Success criteria was resolving of ectopic pregnancy with no surgical intervention (although for scar pregnancy ERPOC done for some cases but this was considered minor procedure). Failure criteria was need for either laparotomy or laparoscopic salpingectomy. Microsoft Excel was used for statistical analysis and for presentation of the data in the form of tables and graphs. Continuous variables are reported as means with standard deviation. Categorical variables are reported as percentages. Chi-square test, T-test, Z-test for 2 sample proportions and Mann–Whitney U-value were used to compare between categorical variables. P values of <0.05 are used for statistical significance. Results: There were a total of 115 patients with ectopic pregnancy who received MTX in Latifa Hospital from the period of 1st January 2010 to 31st December 2013. 70 (60.9%) patients had successful MTX treatment and 32 (27.8%) patients had failed MTX treatment, while 13 (11.3%) patients had no follow up. 70 patients, 23 (20%) patients were diagnosed as pregnancy of unknown location. 63 (54.8%) patients had only adnexal mass without free fluid in POD, while 20 (17.4%) patients had both adnexal mass & mild free fluid in POD, scar pregnancy was seen in 9 (7.8%) patients. There was 3 viable scar pregnancies while there was no viable adnexal mass included, there was no difference in the success rate of MTX treatment in relation to size or site of ectopic mass. The mean maternal age in our study was 30.2 years ± 5.4 (SD), MTX treatment success was more with higher age group. 103 (89.6%) patients conceived spontaneously, 8 (6.9%) patients conceived after ovulation induction treatment either by oral Clomiphene or by injections and 4 (3.5%) underwent assisted reproductive techniques. there was no difference in the success rate of MTX treatment with different groups. Most common risk factor was history of previous pelvic surgery and success was more with patients who have this risk factor. Patients who presented with abdominal pain and tenderness had higher failure rate than those who were asymptomatic. Those with low level of βhCG pretreatment and whom βhCG level decreased >15% in day 7 post-treatment had higher success rate. Conclusion: EP is a common and serious problem with both high maternal morbidity and mortality. Systemic MTX should be considered as the first line treatment in hemodynamically stable women with an intact ectopic pregnancy especially for those with the desire to preserve fertility. Asymptomatic patients had higher success rate of MTX treatment than patients with abdominal pain and tenderness. Low level of βhCG pretreatment and decrease the level >15% in day 7 post-treatment are considered predictive factors for the success of MTX treatment in EP.