Study of Risk factors and treatment modalities of ectopic pregnancy

Andola, Shruthi; Ramesh, R.; Desai, Ratnamala M; Krutika, S A

doi:10.4103/jfmpc.jfmpc_1279_20

Cited by 7 publications

(8 citation statements)

References 18 publications

(18 reference statements)

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“…Some patients will be asymptomatic. Predisposing risk factors include prior EP, use of assisted reproductive therapy (ART), pelvic inflammatory disease (PID), prior surgery, and intrauterine devices (IUD) [4].…”

Section: Introductionmentioning

confidence: 99%

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

2021

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Ectopic pregnancy (EP) is a term used to describe any pregnancy which does not implant into the uterine cavity. There are several types of EPs: tubal, interstitial, ovarian, abdominal, heterotopic, cervical, and cesarean scar. Ectopic pregnancies can acutely rupture and are the number one cause of maternal death in the first trimester of pregnancy. Therefore, prompt recognition and accurate localization have significant clinical implications on patient outcome. Unfortunately, EPs have many mimickers, which can make the diagnosis challenging in certain cases. In this review, we aim to describe and illustrate sonographic findings of each type of EP, as well as present mimickers and various imaging pitfalls. We will clarify how to avoid potential misdiagnoses that could adversely affect patient outcomes. Lastly, we will briefly address management of each type of EP and discuss potential complications.

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Section: Introductionmentioning

confidence: 99%

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

2021

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“…The most common surgical procedure was salpingectomy (S) alone (62.67%) followed by salpingectomy + contralateral tubal ligation (S+C/TL) in 22.66% of cases. In comparison, in the study by Andola et al [ 18 ], the main modality of treatment was surgery (88.09%) and the secondary modality was medical management (7.1%). Laparoscopic unilateral salpingectomy was the most common surgery (35%) and unilateral salpingectomy was done in 15% of cases and laparoscopic salpingostomy in 10% of cases.…”

Section: Discussionmentioning

confidence: 93%

“…Other sites were ovary (6.78%) and cornua (5.08%). Andola et al [ 18 ] found that the most common site was ampullary (61.90%), followed by fimbrial (11.90%), isthmal (9.52%), ampullary + isthmal (7.14%), cornual (4.76%), cervical (2.38%), and ovary (2.38%). Ampulla of the fallopian tube remains the commonest implantation site in cases of EP on account of being the most distensible and thick portion in the whole fallopian tube - allowing for a better space for implantation similar to the uterus [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Profile, Risk Factors and Outcomes of Ectopic Pregnancy in a Tertiary Care Hospital: A Prospective Indian Study

Nalini,

Singh,

et al. 2023

Cureus

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Objectives To determine the clinical profile, management and outcomes in patients of ectopic pregnancy (EP) presenting to the hospital. Methods A prospective observational study was done on 75 women with ectopic pregnancy among a total of 1350 women who attended the Gynecology department over a period of 18 months from December 2020 until June 2022. The details of patients such as age, socioeconomic status, referral, symptoms, obstetric history, and signs and symptoms were recorded. Ultrasound was done and the site of ectopic pregnancy was determined. Management of patients was done according to hospital protocol; outcomes were recorded. Results The frequency of EP in the present study was 5.55%. The majority of the cases (60%) were between 20-30 years of age, from the lower middle class (57%), referral cases (63%), and multigravida (i.e. >G4) (31%) cases. Amenorrhea was the most common symptom seen in 73 (97.33%) cases. On ultrasound, the most common finding was tubo-ovarian mass (33.33%). In the majority of patients [28 (37.33%)], the ampullary region in the fallopian tube was the site of EP. History of pelvic inflammatory disease was most common risk factor [26 (19.5%)]. Surgical management was done in 74 cases and one case was managed medically. Salpingectomy alone was done in 47 (62.67%) cases. Rupture ectopic pregnancy was seen in 71 (95%) cases where all cases needed blood transfusion. One patient needed ventilatory support/ICU admission and had mortality. Conclusion We report a frequency of 5.55% for EP. The patients with EP were in the age groups of 20-40 years and belonged primarily to lower socioeconomic class. The most common symptom was amenorrhea. The most common site of ectopic pregnancy was the ampullary region. Rupture ectopic is a common worrisome complication. Early diagnosis of the site and surgical management is the key to better management of ruptured cases.

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“…Patients with early pregnancy and risk factors should be referred to a tertiary care facility in the primary care setting to rule out ectopic pregnancy. 5 Expectant management, methotrexate medication, or surgery are all options for managing ectopic pregnancies. Methotrexate, however, is generally contraindicated in patients with initial β-hCG levels of >5000 mIU/ml, gestational sac size of >4 cm, existence of fetal cardiac activity, and hemoperitoneum, which point to significant failure rate for the therapy.…”

Section: Introductionmentioning

confidence: 99%

Strategies to improve the early detection and management of ectopic pregnancies in primary care

Alharbi,

Mazi,

Aljassar

et al. 2023

Int J Community Med Public Health

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Even in the advanced era of today, maternal morbidity and mortality are quite high; however, most pregnancy-related complications can be successfully prevented by early diagnosis and timely management. The primary care setting is of utmost importance in this regard, as it is the first line of contact between patients and physicians, and regular antenatal care services are provided by most of primary care settings. Ectopic pregnancy is one of the most prevalent pregnancy disorders and is further associated with high-risk complications and mortality. The clinical manifestations may mimic non-ectopic pregnancy conditions, making it difficult to develop diagnostic standards. However, ultrasonography and human chorionic gonadotropin (β-hCG) levels can ensure early diagnosis. Conservative treatment is pursued since surgical management is linked to multiple significant side effects. In most situations, pharmacotherapy using methotrexate in a single- or multi-dose regimen is the preferred course of treatment. Performing ultrasonography as soon as a pregnancy is confirmed to determine the location of the pregnancy, monitoring β-hCG levels, and ensuring prompt referral in the event of a possible ectopic pregnancy that cannot be treated conservatively are all important ways that primary care settings can play a significant role in early diagnosis and prompt management. Additionally, obstetric ultrasonography training for family physicians can help in the early detection of ectopic pregnancy, which can lead to favourable results. The purpose of this research is to review the available information about strategies to improve the diagnosis and management of ectopic pregnancy in primary care.

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Study of Risk factors and treatment modalities of ectopic pregnancy

Cited by 7 publications

References 18 publications

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

Clinical Profile, Risk Factors and Outcomes of Ectopic Pregnancy in a Tertiary Care Hospital: A Prospective Indian Study

Strategies to improve the early detection and management of ectopic pregnancies in primary care

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