COMPARISON OF EFFICACY AMONG DIFFERENT THERAPEUTIC APPROACHES IN ECTOPIC PREGNANCY

Abstract

Ectopic pregnancy (EP) occurs when the fertilized ovum implants outside the endometrial cavity, with an incidence of 1% of all pregnancies [2,5,8]. Frequently, the products of conception grow in the fallopian tube. Other implantation sites are the ovaries or the cervix. The vast majority of EP cases affect the fallopian tube, with 70-76 % of these tubal EPs occurring in the ampullary portion, 11-16 % in the isthmic portion and about 2-10 % of in the fallopian tube’s fimbrial end[2,4,6,7,8].

Affected patients may face significant morbidity or even mortality. Prior tubal surgery or a prior tubal pregnancy are the most important risk factors for tubal pregnancy[4,6,7]. Women with an active or prior ascending infection with Chlamydia trachomatis or Neisseria gonorrhoeae are at an elevated risk of extrauterine pregnancy[1,3]. Extrauterine pregnancy may be wholly asymptomatic (intact tubal pregnancy),or it may present with pelvic pain that is worse on one side (tubal abortion) or with severe hemorrhagic shock (tubal rupture)[7,9]. Extrauterine pregnancies are most diagnosed in the 6th through 9th week of gestation [1,4].

Most patients present with nonspecific complaints. The symptom triad of mild vaginal spotting in the first trimester, aching pelvic pain, and secondary amenorrhea may indicate extrauterine pregnancy but can also arise in an intact intrauterine pregnancy or because of early miscarriage. Further suggestive manifestations include abdominal pain radiating to the shoulder(s), abdominal guarding or an acute abdomen, pain on the displacement of the vaginal portion of the cervix, hemorrhagic shock/hemodynamic instability (dyspnea, hypotension, tachycardia), and syncope [2,5,7,8].

 During the last decades, transvaginal ultrasound and beta-human chorionic gonadotropin (beta-HCG) levels became part of the clinical routine leading to the timely detection of ectopic pregnancies and better patient outcomes [1,7,9].