Ectopic pregnancy--changing trends.

This study is an attempt to have an overall view of the changing trends in the clinical presentation, diagnostic modalities and management of ectopic pregnancy over a period of three and a half decades. The incidence of ectopic pregnancy was one in 368 during the 15-year period from 1959-1973 (group A) and has increased to one in 160 during the latter part of the study period from 1988-1993 (group B). Medical termination of pregnancy, abortion, intra-uterine contraceptive device and previous tubal ligation were the important risk factors recently (group B). Unruptured tubal pregnancy was diagnosed in 9.8% (group B) as compared to only 3% in group A. However, as most of the patients came to the hospital with disturbed pregnancy, the use of ultrasonography and urine gravindex test was helpful in only 14% in the latter part of the study. The characteristic clinical features like pain abdomen with amenorrhoea, vaginal bleeding and positive culdocentesis were the most reliable diagnostic criteria in both the groups. There is an increasing trend towards conserving the tubes and methotrexate use recently.