Abstract
Review of medical management of ectopic pregnancy
Wishaw General Hospital; Hairmyres Hospital; Monklands Hospital
Tripathi P. Maharaj S.
Background :
Surgery for suspected ectopic pregnancy carries significant risks
of morbidity including haemorrhage, infection, future subfertility and
pelvic adhesions.The option of medical management carries potential
benefits
Medical management of ectopic pregnancy was introduced in three
hospitals of Lanarkshire trust in Sept’03.
The Lanarkshire early pregnancy assessment group which meets
quarterly drew up a local protocol based partly on the Lipscomb study of
1998/99 and RCOG green top guidelines.
Aims :
1) Determine the incidence of ectopic pregnancy in Lanarkshire
2) Determine the incidence of rupture and compare outcomes between
surgical and medical management.
3) Determine whether the medical management of ectopic pregnancy
increased incidence of rupture and if so under what circumstances.
Objectives :
1)Determine adherence with protocol for management of suspected
ectopic pregnancy in terms of selection criteria/ follow up criteria.
2)To assess treatment outcomes in terms of :
- side effects
- treatment failure
- hospital stay
- interventions performed and
whether these were appropriate
Methods and Materials :
We searched the PMS/HISS database, centering on SMR discharge data.
Search words were :
Ectopic pregnancy, tubal pregnancy
Extrauterine pregnancy, tubal abortion
Salpingectomy, salpingostomy.
Data from all three Lanarkshire hospitals for a 2 yr period from
01/09/02- 31/08/04 was included.
Results :
Total no of suspected ectopic pregnancies over the 2 yr period : 140
Out of these only about 23.5 % were managed medically, a further 3.5 %
expectantly, all the rest undergoing surgical management.
Based on LEPAG guideline, almost 30-40% surgeries in yr 1 across the three hospitals were avoidable.
Significant difference in length of stay and complication rate between medical and surgical management was found.
Incidence of rupture was 21% on medical management over two years across all three hospitals which was found to be significantly less than the background overall incidence of rupture.
A cumulative success rate of 75.7% and a compliant success arte of 83% for medical management was achieved which compared favourably with the Lipscomb data.
.
Conclusion :
Medical management of ectopic pregnancy is a viable option that offers greater patient satisfaction with lower rates of complications and length of hospital stay.
We established that incidence of rupture can be significantly reduced on medical management.
We will continue to prospectively monitor outcomes to get statistically significant results.