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RCOG World Congress 2023
June 12 - 14, 2023 | London, UK
EP.1211
Surgical management of ectopic-pregnancy: Four-year experience from a Srilankan tertiary care center
Part of Topic
High Risk Pregnancy
Surgical management of ectopic pregnancy: A four-year experience from a Sri Lankan tertiary care center
M A M M Jayawardane1, 2, V.J. Meegoda1, K.G. Hewawitharana1, K.V.H. Nimana1, A. Fernando1,2
1University professorial unit of Obstetrics & Gynecology, Colombo South Teaching Hospital, Colombo, Sri Lanka, 2Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
INTRODUCTION
•Ectopic pregnancies have a rising incidence worldwide.
•Despite advances, early diagnosis and timely interventions remains a challenge.
•Surgery has become the traditional mainstay of management and laparoscopy offers significant advantages over laparotomy.
•The decision of tubal preservation needs to be decided based on a multitude of factors.
METHODOLOGY
•A prospective cross-sectional study to evaluate the clinical presentation, prevalance of risk factors, surgical techniques, patient’s preference in type of surgery and post procedure fertility among patients who underwent surgery for ectopic pregnancies at Colombo South Teaching Hospital university unit from 2018 March – 2022 March.
RESULTS
•During the four-year study period there were 9056 pregnancies at the unit with 57 ectopic pregnancies subjected to surgical interventions and 13 pregnancies managed conservatively giving an incidence of 7.7 per 1000 deliveries.
•Mean age of mothers who underwent surgery was 30 years & 11 months 9 22 – 43 years), which was higher compared to regional studies.
•Mean POA was 6+3 weeks at presentation with a majority between 5-7 (n=26, 45.6%).
•In the study population, it was found that the ectopic pregnancy rate was highest in primi gravida (n=25, 43.9%).
•Subfertility & treatment (29.8%), miscarriages (22.8%), use of IUCD (22.8%), pelvic surgeries (14%) & pelvic inflammatory disease (5.7%) were identified as common risk factors.
•The classical triad of symptoms; abdominal pain, per vaginal bleeding & amenorrhoea, was seen among the majority (45.6%) on presentation.
•Most of the ectopics were right-side tubal (42.1%), with 2 (3.5%) patients with scar ectopic and one patient (1.7%) with heterotopic pregnancy.
•All mothers were subjected to laparoscopic surgeries & no laparotomies were performed.
•Salpingotomy (n=38, 66.7%) was preferred over salphingectomy (n=19, 33.3%) by the majority of mothers.
•Laparoscopic salpingectomy was the surgical technique utilized (59.6%) for most patients.
•Most of the ectopics were found to be tubal ruptures (n=33, 60%), with 12 (n=12.8%) resulting in tubal moles and 10 (n=17.5%) ending up with tubal abortions
•Out of the mothers, 66.7% who had further fertility wishes became pregnant within six months of the ectopic pregnancy
DISCUSSION
In comparison to regional studies & international guidelines, Sri Lankan(SL) women have –
•Reduced incidence of ectopic pregnancies (7.7 per 1000) vs RCOG – UK incidence – 11 per 1000
•Higher mean age of SL pregnant mothers – 30.9 years vs 24.3 in Bangladesh & 24 years in Pakistan
•Considerable proportion of primigravida with ectopic – 43.9% vs 40% in 2015 SL study, 34.8% in India
•Low incidence of PID – 5.1% vs high incidence in other countries –– 65% in Nepal, 43.1% in Pakistan
•Low incidence of ruptured ectopics – 21% vs 95.6% in Bangladesh - All were diagnosed through USS prior to surgery.
•No laparotomies vs 85.7% in Nepal
CONCLUSIONS
•Early diagnosis and timely interventions lead to favorable outcomes even in patients with a ruptured tube.
•Tube preservation needs to be decided on an individual basis.