Proximal ectopic pregnancy: a descriptive general population-based study and results of different management options in 86 cases.

ABSTRACT

OBJECTIVE: To describe different approaches for diagnosis and management of proximal ectopic pregnancies (PP) in general population. DESIGN: Observational population based-study. SETTING: Regional ectopic pregnancy registry. PATIENT(S) Eighty-six PP registered from 1992 to 2008. INTERVENTION(S) Surgical (radical or conservative), medical, or combined therapies. MAIN OUTCOME MEASURE(S) Epidemiologic characteristics, clinical presentation, hCG level, treatments performed, failure rate, and recurrence. RESULT(S) Mean gestational age was 48.2 days. Estimated incidence of PP was 2.7%. Abdominal pain and vaginal bleeding were the commonest symptoms. Two patients were admitted in hypovolemic shock. Diagnostic modalities included transvaginal ultrasound, abdominal ultrasonography, and laparoscopy in 38 (44%), 7 (8%), and 39 (45%) cases, respectively. Mean hCG level was 10,759 IU/L. Thirty-four patients underwent primary cornual resection (39.5%) by laparoscopy (n = 32) or laparotomy (n = 2). Twenty-seven patients (31.4%) underwent primary conservative surgery by laparoscopy cornuostomy (n = 18) or extended salpigostomy (n = 9). Primary medical treatment with methotrexate was attempted in 14 patients (16.3%). Expectant management was attempted in one case (1.2%). Eleven cases received combined therapies (11.6%). Failure rates for medical and surgical treatments were 35.7% and 28%, respectively. No failures were noted among patients who received combined therapies. CONCLUSION(S) Proximal ectopic pregnancy remains a life-threatening condition. Diagnosis is challenging and requires a high index of suspicion. Despite available conservative strategies, management of PP remains heterogeneous.