OP05.07: The impact of obesity on the medical management of ectopic pregnancies and pregnancies of unknown location

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The World Health Organization characterizes obesity as a pandemic global health issue. Obesity poses challenges in the management of ectopic pregnancy, through difficulties in ultrasonography and increased surgical risks. We investigated whether being overweight was a barrier to diagnosis or successful medical management of ectopic pregnancy. A retrospective study was performed on 114 consecutive patients who underwent medical management of ectopic pregnancy or pregnancy of unknown location (PUL) between 1st Jan 2009 and 31st Dec 2011. The patients were divided into two groups based on body mass index (BMI); Group 1 (BMI < 30; 83 women) and Group 2 (BMI ≥ 30; 31 women). Obese women did not have more pre-treatment ultrasound scans (2 vs. 2, P = 0.20) or serum beta-HCG measurements (3 vs. 3, P = 0.17). A diagnosis of PUL was more common in Group 2 (23.5% vs. 40%). In women with an ectopic mass, the largest diameter was similar between the two groups (14.2 vs. 12.8 mm, P = 0.31). The initial beta-HCG at presentation tended to be higher in Group 2, (1208 vs. 1703 IU/L, P = 0.07), while the progesterone was significantly higher (21.3 vs. 29.6 ng/ml, P = 0.03). Interestingly, the average percentage rise in serum HCG over 48-hours was lower in Group 2 (60.4% vs. 33.7%, P = 0.03) resulting in similar beta-HCG levels just prior to methotrexate (1880 vs. 1698 IU/L, P = 0.29). The overall success rate was higher in Group 2 (70.1% vs. 86.7%) with similar requirements for further methotrexate (34.6% vs. 30.0%). The time between presentation and discharge was similar (29.3 vs. 33.3 days, P = 0.12), although the obese group required more beta-HCG monitoring (2 vs. 3, P = 0.003). A combination of ultrasound scanning and beta-HCG measurements is an effective combination in the diagnosis and medical management of ectopic pregnancy and PUL in our obese population. Encouragingly, the medical management of such pregnancies is just as effective in obese women thus avoiding the associated surgical risks.