EMERGENCY LAPAROTOMY AND DEATH IN ECTOPIC PREGNANCY: A RARITY NOWADAYS? A DESCRIPTIVE STUDY OF ECTOPIC PREGNANCY CASES IN A TERTIARY CARE HOSPITAL

Pregnancy implanted outside the endometrial cavity constitutes ectopic gestation. The reproductive performance can be poor following an ectopic pregnancy. The purpose of the study is to emphasize the importance of public awareness about the need for early reporting to hospital in doubtful cases, to analyze the risk factors for ectopic, to study the role of βHCG estimation and transvaginal sonography in early detection in order to preserve the fallopian tube by medical therapy and/or to do early elective surgery preventing emergency laparotomy and death from ectopic pregnancy. METHODOLOGY: All cases of ectopic gestations managed in a tertiary care hospital for a period of one year is reviewed, roughly around 70 cases. The objectives were to analyze demographic characteristics, risk factors, methods of diagnosis and to evaluate the protocol for ectopic management in the hospital. RESULTS: The study showed that the maximum number of ectopic was seen in the 26-30 age group and more commonly among multies. Maximum number of ectopic cases is seen between 5.1 to 6 weeks and 80% of the cases are seen in ≤8 weeks. 42/70 patients showed one or more risk factors like previous history of ectopic, LSCS, infertility treatment, sterilization and use of IUCD.82.9% patients presented either with pain alone or pain along with spotting/bleeding p/v. Earlier, majority of the cases were reported after tubal rupture resulting in shock, which sometimes even lead to death. In the present scenario, however, only 2 patients developed hypotension, 11 out of 70 alone required blood transfusion and none required laparotomy. Majority of cases of unruptured ectopic (83%) showed <66% rise in βHCG in 48 hours. Pelvic ultrasound and serum βHCG estimation has revolutionized the diagnostic process of ectopic pregnancy enabling detection in the unruptured stage itself in 50% of the cases and the rest in early stages of rupture. In most cases, medical line of management with methotrexate was successful. Women with live ectopic, heterotopic pregnancy, who were not suitable or have failed medical treatment with methotrexate, or those with intraperitoneal bleed and unstable general condition, were selected for surgical