A 12-year survey of 681 ectopic pregnancies.

BACKGROUND

Since 1970, incidence of ectopic pregnancy has increased nearly three-fold worldwide. Ectopic gestation is the most common cause of mortality associated with pregnancy in the first trimester, and may adversely affect subsequent fertility.

METHODS

A total of 681 patients with ectopic pregnancies seen during a 12-year span were analyzed for clinical evaluations including etiology, diagnosis and therapy.

RESULTS

The ratio of ectopic pregnancies to deliveries was 1:52. The largest figure occurring in multiparous patients was in the 26 to 30 year age bracket. A previous abdominal operation or previous antibiotic therapy substantiating antecedent pelvic inflammatory disease is a prime etiologic factor in ectopic pregnancy. The most significant physical finding was abdominal or rebounding tenderness associated with adnexal or cul-de-sac fullness. The diagnosis was initiated by urine beta-hCG (ELISA) or serum beta-hCG (RIA) and ultrasonography in the majority of patients. Nighty-three percent of ectopic pregnancies were tubal pregnancies, and therapy consisted primarily of total salpingectomy. There were no maternal deaths in this series.

CONCLUSIONS

Although newer diagnostic modalities are becoming more common, a correct diagnosis of ectopic pregnancy still relies heavily on clinical signs and symptoms. After a correct diagnosis is made, conservative surgical treatment or chemotherapy with preservation of the tube is the first choice for treatment. Thus to achieve a higher potential for a later pregnancy in the future for these women, routine salpingectomy should be the last resort.