Management of non-tubal ectopic pregnancies at a large tertiary hospital

Abstract

There are limited data on the management of non-tubal ectopic pregnancies (NTEP). We reviewed the management of these cases at a tertiary centre with a dedicated institutional protocol. All cases of confirmed NTEP were retrospectively identified from 2006 to 2014. Records were reviewed for presenting features, mode and success of initial management, preservation of fertility and length of hospital stay. The main outcome measure was the success rate of medical management with methotrexate. The 60 cases identified included 34 cornual, 14 Caesarean section scar, nine cervical and three cervical involving previous Caesarean scar. Primary surgical management was performed in 22 patients. Thirty-eight patients received medical therapy with single or multidose methotrexate. Successful medical management was observed in 33 (87%); however, length of stay was significantly longer compared with surgical patients (mean 14 ± 12 days versus 5 ± 2 days, P < 0.01). Hysterectomy was performed in three patients (one surgical group, two medical group). There was one case of methotrexate toxicity with no long-term adverse outcome. Medical management of NTEP is a safe first-line therapy for clinically stable patients desiring preservation of fertility despite a longer period of inpatient monitoring and follow-up.

Comparison of management regimens following ultrasound diagnosis of nontubal ectopic pregnancies: a retrospective cohort study

“…Our success rates for the conservative management of nontubal ectopic pregnancies are in keeping with similar studies …”

“…This study supports the emerging evidence that minimally invasive approaches are safe and effective treatment options for nontubal ectopic pregnancies in women desiring to conserve fertility. Higher success rates were shown when primary management was systemic or intra‐sac injection (88%) when compared with primary surgical management (57%); this result was found to be statistically significant.…”

“…Literature in this area predominantly comprises case reports and case series with only a few studies looking into optimal management protocols. Therefore, at present there is a paucity of evidence‐based guidelines for the management of these challenging cases …”

Effectiveness of conservative medical treatment for non-tubal ectopic pregnancies: a multicenter study

“…Ectopic pregnancy (EP) accounts for 1 to 2 % of all pregnancies. The term EP includes tubal ectopic pregnancy [1,2], which is the most common form, and non-tubal ectopic pregnancy (NTEP), which is rare and accounts for fewer than 10% of all EPs [3][4][5][6].. Compared with TEPs, they are associated with a higher mortality, life-threatening hemorrhage and emergency surgery such as hysterectomy [7,8].…”

Combination methotrexate and gefitinib: A potential medical treatment for inoperable nontubal ectopic pregnancy

“…Although medical management, including local administration of methotrexate into the trophoblastic tissue, is an option in select cases, it is not recommended for large interstitial pregnancies with fetal cardiac activity . A retrospective case series of 60 nontubal ectopic pregnancies with a median hCG of 13 659 IU/L, revealed primary surgical management was required in over one third of patients and in almost 60% of interstitial cases, with one in five medically treated cases requiring salvage surgery . A more effective medical treatment is clearly needed for cases such as the one presented here, where surgical management would put the patient at high risk of significant morbidity.…”