Study of Advances in Management of 68 Cases of Ectopic Gestation

Introduction In recent years due to various reasons and better diagnostic facilities, increased incidence is noted in ectopic gestation. Main objective behind this study is to know the incidence of ectopic pregnancy in various age groups, to study it predisposing factors, its clinical presentation and to study the changing trends of modern obstetric management from radical surgeries to medical and laparoscopic management. Methods A study of 68 cases of tubal ectopic pregnancy was carried out from August 2013 to July 2014 at a tertiary health care center. Patients managed with following modalities were selected for study. (1) Medical management (MXT) (2) Laparoscopic managementsalpingostomy, salpingectomy (3) Laparotomy management salpingostomy, segmental resection, fimbrial expression, salpingectomy. Results Lower abdominal pain was most common presenting symptom of ectopic pregnancy in 88 %cases. The classical triad of symptoms ( amenorrhea, abdominal pain and vaginal bleeding) was present in only 42 % cases. PID contributed 4 % cases and previous abortion contributed 7 % cases indicating these two as the common risk factors. Ampulla was the commonest site of pregnancy, in 63 % cases. Salpingostomy was performed in this site.10 % cases were treated medically (methotrexate). These were the cases having unruptured ectopic pregnancy and ectopic mass less than4cm. laparoscopy was done in 10 % cases and oopn laparotomy in 82 % cases. Conclusions ectopic pregnancy is a treatable problem. Ultrasonography plays a central role in the diggnosis ad management. Mode of therapy is determined by a combination of clinical symptoms, USG findings and serum HCG values. Surgical management is still the cornerstone of management of ectopic pregnancy. But new scope of medical and laparoscopic management is also there.