Experience with ectopic pregnancies at the tertiary care center and lessons learnt

Abstract

Introduction: Ectopic pregnancy is one of the life-threatening complications that can occur in any sexually active woman during reproductive age. Changing trends have been observed because of the availability of assisted reproductive techniques, better diagnostic facilities, conservative management approach, newer drugs for medical termination of pregnancy, and newer contraceptives. Materials and Methods: This was a cross-sectional study of all cases of ectopic pregnancy managed at the tertiary care center from January 2009 to December 2013. In all, there were 64 cases of ectopic pregnancies. Most of the women were between 20 and 30 years age and all except three were married. Risk factors could be identified in about 50% of women only. Results: The classical triad of amenorrhea, pain, and bleeding per vaginum was seen in 28.12% of subjects. Most of them were tubal ectopic pregnancies but we had one case of secondary abdominal pregnancy, two cases of heterotrophic pregnancy, one case of twin tubal pregnancy, and two cases of cornual pregnancy. All the cases were managed by laparotomy. An unsuccessful attempt to terminate a second-trimester pregnancy by the medical method should arouse suspicion of cornual pregnancy. Conclusion: History of use of levonorgestrel – emergency contraceptive pills should be looked for apart from other risk factors. Though not mandatory, ultrasonography should be done to rule out ectopic pregnancy, before terminating a pregnancy by the medical method.