Surgical Management Of Ectopic Pregnancy Research Articles

EXTRAUTERINE MOLAR PREGNANCY: A CASE OF TUBAL PARTIAL MOLAR PREGNANCY

Molar pregnancy can occur outside the uterine cavity. Ectopic molar pregnancy although a rare entity does exist. The patient presents with features similar to ruptured or unruptured ectopic gestation. Management requires surgical removal of the conceptus and follow-up. Diagnosis with histopathological examination of the specimen is the gold standard. Here, we report an unusual case of 30 years female with a left tubal partial hydatidiform mole. The initial suspicion was made with preoperative raised serum beta Human Chorionic Gonadotropin levels and the diagnosis was confirmed with the histopathological examination of the specimen. The patient was followed up with serial weekly serum beta Human Chorionic Gonadotropin monitoring and remission was achieved. Therefore, sending samples for histopathological examination after surgical management of ectopic pregnancy is mandatory to detect molar ectopic pregnancy in order to make a proper follow-up and to prevent persistent gestational trophoblastic diseases.

Laparoscopic Approach for the Management of Ectopic Pregnancy in a District Level Hospital, Cox's Bazar

Introduction: An ectopic pregnancy occurs when a fertilized egg implants and grows outside of the uterine cavity. Ectopic pregnancy usually occurs as a result of delay or prevention in the passage of the blastocyst to the uterine cavity resulting in its premature implantation in the extrauterine tissues. It usually occurs in 2% of all pregnancies and is a major cause of maternal morbidity and mortality when misdiagnosed or left untreated and subsequent successful pregnancy is less than 50% of patients. About 95% of ectopic pregnancies originate in the tubes. Infrequently, it affects the ovary, the bicornuate uterus, and the cervix. The diagnosis of ectopic pregnancy has been performed using laparoscopy. Additionally, it is widely used for the surgical treatment of ectopic pregnancy. The benefit of laparoscopy for ectopic pregnancy over laparotomy is well-known. Laparoscopic surgery has been widely adopted and new technical innovations, procedures, and evidence-based knowledge are persistently emerging. The laparoscopic advantage over open surgery has also been confirmed in different fields. It is associated with shorter operative time, less intraoperative blood loss, reduce postoperative pain, less analgesic requirement, a shorter hospital stay, faster recovery, cost- effectiveness, and lower rate of postoperative complications. This study aimed to compare the outcome of laparoscopic management with laparotomy in the management of ectopic pregnancy. Methods: This was a prospective cross-sectional study that was carried out in a district level hospital at Cox's Bazar. This study was conducted from May 2020 to May 2022. A total of 59 subjects were selected for the study as per inclusion criteria. Result: Among 59 respondents, most of the subjects were of the 15-25 years age group which constituted 81.36%, followed by 13.56% of the 26-35 years age group, and the rest 5.08% were of >35 years age group. Laparoscopy was done on 40 (67.20%) patients and laparotomy was done on 19 (32.80%) patients. Approximately, 25% of laparoscopy patients and 52% of laparotomy patients had prior surgery. Prior ectopic surgery was performed on around 8.47% of laparoscopy patients and 13.55% of laparotomy patients. Regarding the comparison of laparoscopy and laparotomy procedure, total blood loss was less (30-50ml) in laparoscopy and more (≥60ml) in the laparotomy procedure. Hospital stay was also less (1-2 days) in laparoscopy and more (≥3 days) in laparotomy, duration of operation was shorter (20-30min) in laparotomy and comparatively longer (30- 60 min) in laparoscopy. Previous surgery was done on 25% and 52.17% patients who underwent laparoscopy and laparotomy respectively. Previous ectopic pregnancy was diagnosed on 8.33% and 47.83% of laparoscopy and laparotomy patients respectively. Moreover, previous PID was found in 5.55% patients who underwent laparoscopy and none who underwent laparotomy. 2.77% of patients who underwent laparoscopy had a history endometriosis. Recovery to normal activity was early in laparoscopy and late in laparotomy. Moreover, 27 (67.5%) patients conceived among 40 who underwent laparoscopy, and 3 (15.78%) patients conceived among 19 who underwent laparotomy. Conclusion: The management of ectopic pregnancy with laparoscopy may be the most helpful operation with the highest possible level of safety and effectiveness. Laparoscopy has both a diagnostic & therapeutic role in ectopic pregnancy. Laparoscopy is feasible and safer than laparotomy in surgical management of ectopic pregnancy.

Laparoscopy versus Laparotomy in the Surgical Management of Ectopic Pregnancy: Integrative Literature Review

Background: Ectopic pregnancy (EP) is a common gynecological emergency in resource-limited countries, where laparotomy is the conventional therapy despite the fact that laparoscopic surgery is considered the best option. There is a lack of prospective randomized evidence comparing laparoscopic surgery with laparotomy in the surgical care of women with REP. Objectives: To summarize current evidences comparing laparoscopy versus laparotomy in the surgical management of ectopic pregnancy. Methodology: PubMed, Web of Science, Science Direct, EBSCO, and Cochrane Library were utilized to identify the articles. In the current review, all pertinent articles related to both our topic and other articles were used. Other articles not related to the objective of the review were excluded. The research team looked through a standardized format in which the data had been extracted. Results: According to PRSIMA guidelines, our study included 13 published studies that were registered to extract final data from a total of 110 studies found after searching the mentioned databases, which were then used for title screening. Some were excluded from screening of abstracts and others due to different inclusion criteria, after full-text review. These 13 studies were used to compare laparoscopy versus laparotomy in the surgical management of EP, establishing that laparoscopic treatment of EP may be the most beneficial method with the highest level of safety and efficacy. Conclusion: Laparoscopic surgery is increasingly being used as the method of choice for treating EPs. When compared to laparotomy, laparoscopic treatment for EP raises concerns about safety, viability and results in fewer postoperative adhesions. Laparoscopy is also more practicable and proven to be more efficient in terms of blood loss, requirement for blood transfusion, need for analgesia, and time of postoperative hospital stay.

Delays to Surgery in Emergency Department Cases of Ectopic Pregnancy: A Quality Improvement Study

ObjectiveCreate a process map for emergency department (ED) presentations of surgical ectopic pregnancy, and identify areas of management amenable to quality improvement. MethodsA retrospective chart review of all patients undergoing surgical management of ectopic pregnancy at a large, urban, academic tertiary care centre from 2015 to 2017 was performed. ResultsSeventy-three patients were included. There were 6 (8.2%) unstable A cases (recommended time to operating room [OR] 0–2 hours), 23 (31.5%) stable A cases, and 44 (60%) B cases (recommended time to OR 2–8 hours). The percent of patients who were in the OR within the recommended time window were 6 (100%) for unstable A cases, 13 (56%) stable A cases, and 29 (65.9%) stable B cases, respectively (P = 0.139). Notable time delays include the time from gynaecology referral to the time seen by gynaecology (29.7% of total wait time for stable A cases from ED to OR) and the time the OR was booked to the time the patient was brought to the OR (53.2% of total wait time for stable B cases). Of the patients seen by physician at the emergency department first, the time from triage to the OR was significantly shorter for patients that received bedside ultrasound only (0.67 ± 0.5 hours vs. 2.1 ± 1.8 hours [P = 0.007]). ConclusionThis is the first study to map the ED presentation of surgical ectopic pregnancy. The management of ectopic pregnancy would benefit from the development of surgical triage decision aids, a surgical care pathway, and increased use of screening bedside ultrasound.

Racial and ethnic disparities in the surgical management of tubal ectopic pregnancy

To evaluate racial and ethnic disparities in the surgical management of ectopic pregnancy over time. Retrospective cohort study. None. Surgically-managed cases of patients with tubal ectopic pregnancy within the American College of Surgeons National Surgical Quality Improvement Program database between 2010 and2019. None. Surgical approach (laparoscopic compared with open) and procedure (salpingectomy compared with salpingostomy/other). Of 7791 patients undergoing surgical management of tubal ectopic pregnancy, 21.8% identified as Hispanic, 24.5% as Black, 9.4% as Asian/other, and 44.3% as White. Use of laparoscopy increased 1.3% per year from 81.4% in 2010 to 91.0% in 2019 (95% confidence interval [CI], 0.010-0.016). Odds of undergoing laparoscopic surgery were lower in Black (adjusted odds ratio [aOR] 0.52; 95% CI, 0.45-0.61) and Hispanic patients (aOR 0.52; 95% CI, 0.44-0.61) compared with White patients and remained similar over time. The use of salpingectomy increased by 1.1% per year from 80.6% in 2010 to 94.7% in 2019 (95% CI, 0.009-0.014). Odds of undergoing salpingectomy were higher among Black (aOR 1.78, 95% CI 1.43-2.23) and Hispanic patients (aOR 1.54; 95% CI, 1.24-1.93) and lower among Asian patients (aOR 0.73, 95% CI, 0.56-0.95) compared with White patients. These ratios remained similar for Black and Asian patients over time. Despite the increased use of laparoscopy and salpingectomy in the surgical management of ectopic pregnancy over time, Black and Hispanic patients remain less likely to undergo minimally invasive surgery and more likely to undergo salpingectomy compared with White patients.

EP40.27: Relevant ultrasonographic findings for timely surgical management of ectopic pregnancy in Caesarean section scar

EP40.27: Relevant ultrasonographic findings for timely surgical management of ectopic pregnancy in Caesarean section scar

CLINICAL TRENDS OF ECTOPIC PREGNANCY - A STUDY IN A TERTIARY CARE HOSPITAL OF WEST BENGAL, INDIA

Background: Ectopic pregnancy (EP) is the single most important cause of maternal morbidity and mortality in the first trimester and its rising trend throws a great challenge to the obstetrician and gynecologist due to its varied presentation. Aim: To study the incidence, clinical trends, risk factors and surgical management of ectopic pregnancy in a tertiary care hospital. Materials and methods: Retrospective study conducted among the diagnosed cases of ectopic pregnancies admitted during a period of 3 years and a total of 474 cases were studied. Data collected from BHT, Labor ward registers, Gynae ward registrars, Operation Theatre registers, Intensive care unit (ICU) and high dependency units (HDU) records. All the parameters were tabulated and analyzed after data entry. Results: Peak age of incidence were among 26-30 years (32.27%), more common in multigravida (74.69%), commonly presented at gestational age between 6-8 weeks (50.42%) risk factors associated with 73.18% of cases. Most commonly presented with lower abdominal pain (75.31%) followed by short h/o amenorrhea (68.35%). Classical triad presents in 37.97% of cases. Clinically extreme pallor and hemodynamically shock stage presented in 26.58% and 33.33% cases respectively. The commonest site of affection was Ampulla of the tube (50.84%) and most common operation done was Salpingectomy (83.54%). There was no mortality. Conclusions: Early diagnosis and proper management becomes the key of success. High degree of suspicion, identification of risk factors, availability of modern investigations and timely intervention will definitely help to reduce the morbidity and mortality associated with EP.

Socioeconomic Analysis of the Surgical Management of Ectopic Pregnancies: An Analysis of the National Inpatient Sample

To identify racial and socioeconomic disparities in the surgical management of ectopic pregnancy. Retrospective study. The National Inpatient Sample was sampled from 2015 to 2017 for inpatient hospitalizations for ectopic pregnancy. Cohorts were identified by surgical treatment type-open procedure vs laparoscopic procedure. Race/ethnicity, primary payer status, and median household income were primary variables of interest. Univariate and multivariable analyses were conducted. Nationwide inpatient analysis. Women presenting for ectopic pregnancy treatment. Type of surgery. Outcome measures were laparotomy vs laparoscopy for treatment. A total of 18 725 cases were identified, 8325 open and 10 400 laparoscopic. Hispanic women were more likely to receive open procedures as treatment for ectopic pregnancy than White women (odds ratio 1.226, p <.001). Women with private insurance were more likely to receive open procedures than women who used self-pay for treatment (odds ratio 0.809, p <.001). Women of lower median income status, <$60 000, were more likely to receive open procedures than women of the fourth quartile income group. Black women predominantly made up the first quartile income group. When controlling for covariates, Black women were not more likely to receive 1 method of surgical procedure over another. Income appears to be related to surgical management of ectopic pregnancy with women of lower median incomes receiving laparotomies over laparoscopic procedures. Equal access to healthcare remains a prudent need in communities of color. Further studies are needed to elucidate surgical decision-making in the management of ectopic pregnancy.

A case of cornual molar ectopic pregnancy: Salutary lesson from a rare disease

Cornu of the uterus is one of the uncommon sites of ectopic pregnancy. Molar cornual ectopic pregnancy is extremely rare and only few cases are reported in the literature. A 25-year-old gravida 3, para 1, abortion 1 lady reported with complaints of amenorrhea of 9 weeks and pain in the lower abdomen for 1 day. Sonography revealed an anechoic structure of 20 mm at the left adnexa with evidence of hemoperitoneum. The patient was managed with laparoscopic cornuostomy. Histopathologic analysis demonstrated placental tissue with features consistent with a complete molar pregnancy. It is emphasized that histopathological examination of the retrieved tissues should be considered after each case of surgical management of ectopic pregnancy to rule out molar pregnancy.

Conservative surgical management of ectopic pregnancy and its role in preservation of future fertility

Background: Maternal Mortality is one of the most important issues in our country. Ectopic Gestation is one of the few reasons which contribute to it. The first successful surgical management of a tubal ruptured ectopic pregnancy occurred in 1883. In those times mortality was approximately 60%. Since then lot of development in management of ectopic pregnancy has taken place which has resulted in reduction of related mortality. But still it remains as one of the important topics as now due to more infections (i.e PID) and resulting ectopic gestations and further operative salphingectomies, there is a reduced chance of patient to conceive naturally afterwards. Hence role of conservative surgeries comes to the front.&#x0D; Aims and Objectives: Role of Conservative Surgical Management of Ectopic pregnancy and its relation to future fertility.&#x0D; Materials and Methods: This Study was undertaken at GICE Clinic, Cure Hospital, Kalyani, West Bengal India from January, 2008 to January 2019. During this period 64 patients were diagnosed and operated for Ectopic pregnancy.&#x0D; Results: Forty (62.5%) cases were in between 20-30 years of age. Forty-four (68.7%) cases had no issue. Forty-eight (75.0%) cases were from low socio-economic group. Sixty patients (93.7%) had the history of amenorrhea. It was also observed that history of induced abortion was in 20 (31.2%) cases, PID in 12 (18.7%) cases, appendectomy – 6 (9.4%) cases and history of previous IUCD insertion - 4 (6.3%) were found to be common amongst ectopic gestation cases. Twenty-four (37.5%) cases underwent linear salpingostomy, 8 (12.5%) cases had segmental resection with end to end anastomosis whereas 16 (25.0%) cases had salpingectomy and 16 (25.0%) cases had salpingo-opherectomy with tubectomy [opposite tube] were advocated. In 4(6.3%) cases of linear salpingostomy and 4 (6.3%) cases of segmental resection, the cases had to be re-operated again for unstable haemodynamic condition within 24 hours and were subsequently advocated to salpingectomy.&#x0D; Conclusion: Linear Salpingostomy was found to be a better option for women who desire to become future mother, than that of segmental resection and salpingectomy on affected tube (although pregnancy was reported as opposite tube)

An Audit of Management of Ectopic Pregnancy in a Major Tertiary Healthcare Service

Background: Ectopic pregnancy remains the most common cause of early pregnancy mortality, with management options differing according to clinical presentation and investigations. This audit aims to investigate the indications for medical and surgical management of ectopic pregnancy at a tertiary hospital network, in order to assess variances in practice and adherence to local hospital protocols. Methods: A retrospective audit of the management of women with a diagnosis of ectopic pregnancy was performed over 12 months from July 2018 to June 2019, at three hospitals in the largest healthcare network in Victoria, Australia. Information collected included patient demographics, risk factors for ectopic pregnancy, pathology and radiology results, documented indication for surgery, and any complications of treatment. A subgroup analysis of data was done to investigate changes and deficiency in management of ectopic pregnancy compared to local hospital protocol. Results: Over a 12-month period, 138 women were diagnosed with an ectopic pregnancy, of which 99 (72%) received surgical management and 39 (28%) received medical management. Four women within the medical group were excluded from analysis, one due to loss of follow-up and three patients who were diagnosed with nontubal ectopic pregnancies. About 94% (33/35) of women who received methotrexate were within hospital guidelines for medical management and 91% (32/35) were successfully managed without surgery. All women who received surgical management underwent a salpingectomy and 97% (96/99) had clear indications documented for surgery within local protocol. Conclusion: Overall, the majority of women with ectopic pregnancy were treated according to local guidelines. Expectant management and the option of salpingostomy as a surgical alternative could be considered in the local guidelines. The dissemination of this clinical audit data is aimed at continuing clinical governance and improvements in outcomes.

Risk Factors for Blood Transfusion in Women Requiring Surgical Management of Ectopic Pregnancy

Study Objective To identify preoperative risk factors associated with blood transfusion in women undergoing surgery for ectopic pregnancy. Design Retrospective cohort study. Setting Academic-affiliated community hospital system. Patients or Participants Patients who underwent surgery for ectopic pregnancy between January 2014 and October 2017. Interventions Review and analysis of patient characteristics and perioperative care. Measurements and Main Results In this cohort of 252 women, the overall transfusion rate was 8.7% (n=22). Increasing age (mean 33.1y vs 29.8y, p=0.0087), decreased systolic blood pressure (SBP) on presentation (113.0mmHg vs 123.1mmHg, p=0.0024), lower minimum SBP (93.8mmHg vs 111.9mmHg, p Conclusion There is a high rate of transfusion in women undergoing surgical treatment of ectopic pregnancy. Identification of preoperative, potentially modifiable risk factors should aid in targeting interventions to improve transfusion rates in this young population.

Posterior colpotomy versus laparoscopy for surgical management of ectopic pregnancy

Background and aim: to assess the the posterior colpotomy ap- proach versus laparoscopic approach in the surgical management of ectopic pregnancy in stable patients. Methods: A prospective cohort study conducted on 40 women with ectopic pregnancy, divided into two groups; Group 1 included 20 patients for whom laparoscopic salpingectomy was done and group 2 included 20 patients for whom salpingectomy was done via pos- terior colpotomy approach. Operative and postoperative data were collected and analyzed. Results: Operative time was significantly shorter in group 2; 45 ± 8.1 min versus 56.5 ± 13 min in group 1(P 0.05). There was no significant difference between the two groups regarding patient characteristics, clinical data, hospital stay and the need for blood transfusion. Conclusion: Posterior colpotomy is a promising approach for surgi- cal treatment of tubal ectopic pregnancy especially if laparoscopy is not available.

1612 Comparison of Short Term Outcomes after Laparoscopic Salpingostomy Versus Salpingectomy for the Surgical Management of Ectopic Pregnancy

Study Objective To investigate the differences in complication rates between laparoscopic salpingostomy and salpingectomy. Design Propensity score matched retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program database. Patients or Participants Women with surgical management of ectopic pregnancy between 2010-2017. Interventions Laparoscopic salpingectomy and salpingostomy. Measurements and Main Results Of 8,092 ectopic pregnancies, 989 were treated with laparoscopic salpingostomies and matched to laparoscopic salpingectomies at a ratio of 1:2 using propensity scores for the likelihood of undergoing salpingostomy. Propensity scores were calculated using preoperative demographic and clinical characteristics. After matching, no significant differences exist between salpingostomy and salpingectomy in preoperative hematocrit (36.1+/-4.4% vs 35.8+/-4.7%, p=0.91), transfusion rate (1.9% vs 2.0%, p=0.19), age (29.8+/-5.7yrs vs 30.1+/-5.7yrs, p=0.31), and comorbidities (5.8% vs 4.7%). Mean operating times between salpingostomy and salpingectomy showed no difference, (60.7+/-27.2min vs 58.9+/-36.4 min, p=0.78) or conversion to laparotomy (0.2% vs 0.06%, p=0.99). Wound contamination was higher with salpingectomies (3.4% vs 0.02%). The composite complication rate was 10.1%. Postoperative transfusions (6.5% vs 5.8%, p=0.003), reoperation (2.0% vs 0.5%, p Conclusion Laparoscopic salpingostomy is associated with higher risk of complications compared to laparoscopic salpingectomy when treating ectopic pregnancies; though the magnitude of this effect is small given the cohort size. This should be considered when counseling patients on salpingectomy versus salpingostomy.

1138 Repeat Laparoscopy for Pregnancy of Unknown Location

Video Objective To demonstrate the importance of total salpingectomy when surgical management of ectopic pregnancy is warranted. Setting The patient is a 41 year old G6P4014 at 6 weeks gestation who presented with abdominal pain and vaginal bleeding. She underwent an initial dilation and curettage and bilateral salpingectomy for pregnancy of unknown location (PUL). Pathology returned without evidence of pregnancy tissue. Interventions The patient required additional imaging including a transvaginal ultrasound and magnetic resonance imaging scan. She underwent repeat surgical intervention with removal of the remaining portion of the right fallopian tube and intra-operative frozen pathology to confirm the diagnosis and definitive treatment of the ectopic pregnancy. Conclusion This is a unique case where initial surgical management failed to identify a pregnancy of unknown location. In the setting of a suspected tubal ectopic pregnancy requiring salpingectomy, performing a complete salpingectomy is essential. Additionally, the use of intra-operative frozen pathology can aid in confirming the diagnosis and successful treatment of a PUL.

Laparoscopy-assisted suprapubic salpingectomy ‘Kaya technic’ - a low-cost treatment of ectopic pregnancy

We aimed to demonstrate the feasibility and total cost of laparoscopy-assisted suprapubic salpingectomy (LASS), which utilises conventional open surgery equipment without any sealing or coagulation devices and reduces port sites compared to conventional laparoscopy (CL). Fifty-seven consecutive, age-matched patients presenting with a tubal pregnancy were enrolled. In the LASS group, a 10 mm reusable umbilical optical trocar and a 10 mm suprapubic trocar was used. The other 30 patients were managed with multiport CL. All of the patients were asked to use the visual analogue scale and Patient and Observer Scar Assessment Scale to evaluate their cosmetic satisfaction. The duration of surgery was 21.19 ± 2.33 minutes for the LASS group and 36.9 ± 4.9 minutes for the CL group (p < .001). The postoperative 6th-hour VAS score was 2.44 ± 0.5 for the LASS group and 3.03 ± 0.8 for the CL group (p: .005). All of the PSAS and OSAS parameter scores were significantly lower in LASS group than CL group. In conclusion, the LASS procedure is a feasible method for treating ectopic pregnancies with a shorter surgical duration, lower VAS scores, and better cosmetic scores than CL.Impact statementWhat is already known on this subject? Laparoscopy or laparotomy may be performed for the surgical management of ectopic pregnancy. Conventional laparoscopy has some advantages such as shorter hospital stay and recovery time and the better cosmetic results. However, the equipment used in conventional laparoscopy and single incision laparoscopy are more expensive than conventional open surgery equipment.What the results of this study add? Laparoscopy-assisted suprapubic salpingectomy (LASS) method has shorter operation time, lower VAS scores, better cosmetic scores and cheaper than conventional laparoscopy.What the implications are of these findings for clinical practice and/or further research? The LASS procedure looks like a feasible method for treating ectopic pregnancies and the feasibility of this procedure should be confirmed by a larger series of patients and randomised trials.

National rates, trends and determinants of inpatient surgical management of tubal ectopic pregnancy in the United States, 1998-2011.

To describe the frequency and temporal trends of inpatient hospitalization for tubal ectopic pregnancy as well as patients' characteristics, determinants and the current national trends in surgical management of ectopic pregnancy. We conducted a retrospective, cross-sectional analysis of patients who were treated for tubal ectopic pregnancy in an inpatient hospital setting in the United States from 1998 to 2011 using data from the Nationwide Inpatient Sample databases. National frequency and significant changes in the rate of surgical management of tubal ectopic pregnancy in the inpatient setting are described. The study included 334 639 tubal ectopic pregnancies for women aged 18-50 in the United States from 1998 to 2011. The rate of tubal ectopic pregnancy (per 10 000 maternal admissions) decreased from 77.2 in 1998 to 40.5 in 2011. The proportion of tubal ectopic pregnancies for which salpingostomy was performed decreased from 17.0% in 1998 to 7.0% in 2011, while the rate of salpingectomy increased from 69.3% in 1998 to 80.9% in 2011. The temporal change in surgical choice was not different in states with comprehensive in vitro fertilization insurance mandates. The rate of tubal ectopic pregnancy managed in the inpatient setting in the United States decreased 5% annually between 1998 and 2011. The rate of salpingectomies performed annually increased whereas that of salpingostomy decreased over time. The surgical approach selected for the management of tubal ectopic pregnancies was not influenced by a state's in vitro fertilization mandate status.

Comparison of Four Methods of Treating Ectopic Pregnancy: A Retrospective Cohort Study.

Objective To compare the results of expectant management, single and multidose methotrexate (MTX) and surgical management of ectopic pregnancy (EP). Materials and Methods In this retrospective cohort study, the original files of 233 patients who were treated for EP between May 2009 and December 2016 were analyzed. The patients were assigned to the following groups based on the applied treatment methods: Group 1, expectant management (n = 24), Group 2, single-dose MTX (n = 144), Group 3, multiple-dose MTX (n = 25), and Group 4, surgical intervention (n = 40). The following parameters were recorded and assessed: sociodemographic characteristics, pelvic ultrasonography findings (gestational sac, ectopic mass appearance, positive fetal cardiac activity), serum beta-human chorionic gonadotropin (β-hCG) levels on Day 0, Day 4, and Day 7, and surgical procedures in women that underwent surgical interventions. Results The sociodemographic characteristics were similar in all four groups. The percentage of ectopic mass and positive fetal cardiac activity was greater and the diameter of the mass was larger in Group 4 than in the other groups. The β-hCG values on Day 0, Day 4, and Day 7 were statistically different between the groups (p < 0.001). The cutoff value for the β-hCG change for EP resolution was 18% between Day 0 and Day 4 (AUC = 0.726, p < 0.001) and 15% between Day 4 and Day 7 (AUC = 0.874, p < 0.001). The probability of the requirement for an additional dose of MTX was 0.78 (95% CI 0.71 – 0.87; p < 0.001) times lower in patients who had a > 18% decrease in β-hCG levels from Day 0 to Day 4 in comparison to those who had a decrease < 18% from Day 0 to Day 4. The probability of the requirement for an additional dose of MTX was 1.64 (95% CI 1.25 – 2.16; p < 0.001) times greater in patients whose reduction in β-hCG levels from Day 4 to Day 7 was < 15% in comparison to those who had > 15% reduction from Day 4 to Day 7. Conclusions Additional dose requirements for patients with EP may be predicted early in the changes in β-hCG levels between Day 0 and Day 4. Further prospective studies are required to elucidate this issue.

Hospital admission and surgical approach to tubal ectopic pregnancy in Australia 2000 to 2014: A population-based study.

There are several accepted approaches to management of ectopic pregnancy, both surgical and non-surgical. When a surgical approach is used, there appears to be an equipoise between tubal preservation and removal. We sought to determine the patterns of surgical management of ectopic pregnancy in Australia since the year 2000. Data regarding hospital admissions for ectopic pregnancy were extracted from the Australian Institute of Health and Welfare national procedural dataset for the years 2000-2013. Surgical procedures were classified as open or laparoscopic, and involving salpingotomy or salpingectomy (tubal removal). The results were stratified into age bands. Over the study period hospital admission rates for ectopic pregnancy rose in women under the age of 30, without an increase in surgical procedures, while the rate of surgical procedures fell in women in older age groups. Rates of management of ectopic pregnancy via laparotomy fell in all age groups, as did rates of tubal preservation. Since the year 2000 there have been changes in the management ofectopic pregnancy, with significant reductions in open surgery and tubalpreservation.

197 - Trends in the Surgical Management of Ectopic Pregnancy with the Addition of MIS Faculty

Study Objective: To assess the trend towards minimally invasive surgical management of ectopic pregnancies at a university-affiliated Ob/Gyn residency program with the establishment of a Minimally Invasive Gynecologic Surgery (MIGS) Section with fellowship-trained faculty.