CONTEMPORARY MANAGEMENT OF ECTOPIC PREGNANCY

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  • 1 January 1981
    • journal article
    • research article
    • Vol. 26  (10) , 519-523
Abstract
Over the 5 yr period 1975-79 at Yale-New Haven Hospital [Connecticut, USA], ectopic pregnancy changed from a disease requiring acute emergency care utilizing radical surgery for a ruptured ectopic to a disease requiring chronic, observant care utilizing conservative treatment for the unruptured ectopic. Cases (195) of ectopic pregnancy were retrospectively reviewed to determine how laparoscopy, ultrasound and .beta.-pregnancy testing have affected this change. Over the reviewed period of time, the rate of diagnosed and treated unruptured ectopic pregnancies increased from 8 to 35%. Those patients with ectopic pregnancies having laparoscopy prior to laparotomy rose from 11 to 29.5%. Ultrasound diagnosed intrauterine pregnancy in 13% of those patients suspected of having an ectopic pregnancy by defining an intrauterine gestational sac and demonstrated a mass in 85% of patients diagnosed as having an ectopic pregnancy, although the mass was not always the ectopic pregnancy. Beta pregnancy testing, available only over the past 2 yr, was positive in 99%, with only 1 false negative. Culdocenteses (128) were done, with 85% positive, and was the most important factor in deciding on emergency vs. expectant care. These factors have allowed ectopic pregnancy to be treated expectantly, making the diagnosis sooner and more accurately, leading to an increase in conservative treatment and employing salpingostomy as opposed to salpingectomy as the rate of unruptured ectopic pregnancy increases.