Management of ectopic pregnancy in Tallinn Central Hospital Women’s Clinic (Estonia). How to swich to minimal invasion

Abstract

During last two years the management of ectopic pregnancy in Tallinn Central Hospital Women's Clinic underwent a considerable change. The majority of cases are treated laparoscopically, by means of direct methotrexate injection or expectantly. The aim of this retrospective descriptive study is to show the trends of management of ectopic pregnancy in our hospital during last two years. To show the trends we divided the mentioned period into four parts — September 1996 — April 1997, May 1997 — December 1997 and January 1998 — August 1998, September 1998 — January 1999.

Full Text

During last two years the management of ectopic pregnancy in Tallinn Central Hospital Women's Clinic underwent a considerable change. The majority of cases are treated laparoscopically, by means of direct methotrexate injection or expectantly. The aim of this retrospective descriptive study is to show the trends of management of ectopic pregnancy in our hospital during last two years. To show the trends we divided the mentioned period into four parts — September 1996 — April 1997, May 1997 — December 1997 and January 1998 — August 1998, September 1998 — January 1999. During the whole period 228 patients with ectopic pregnancy were treated in our hospital, 109 (47%) by means of laparotomie approach, 94 (42%) by laparoscopic approach and 19 (8%) by direct methotrexate injection. The same figures by periods: 59 (92%), 2 (3%) and 1 (1,5%) January 1977 - April 1997; 20 (38%), 29 (55%) and 4 (7%); May 1997 - December 1997; 21 (35%), 31 (52%) and 7 (9%) January 1998 - August 1998 and 9 (18%), 32 (64%) and 7 (14%) respectively. The rest 4 cases (2%) were followed expectantly. There were no cases of maternal death related to ectopic pregnancy. There were 2 cases of repeated ectopic pregnancies, 1 after laparoscopic salpingotomy (on contaralateral side) and 1 after direct methotrexate injection (on ipsilateral side), which were treated by means of laparoscopic salpingectomy. Besides possessing laporoscopic and ultrasound equipment we believe three more conditions are necessary to facilitate the more conservative and cost-effective management of ectopic pregnancy. They are patients' knowledge about early symptoms of ectopic pregnancy; outpatient department doctors knowledge about modern methods of diagnosis and laparoscopic surgery training of all doctors who take part in duties.