COMPARATIVE STUDY OF MEDICAL AND CONSERVATIVE SURGICAL METHODS FOR UNRUPTURED ECTOPIC PREGNANCIES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2016, Vol 5, Issue 13
Abstract
AIMS AND OBJECTIVES To study and compare medical (Methotrexate) versus surgical (Laparoscopic salpingostomy) conservative management for unruptured ectopic pregnancy. MATERIALS AND METHODS This is a prospective study conducted at CKM Government Maternity Hospital, Warangal, Telangana. The recruitment period was from July 2012 to June 2013 and these patients were followed for 2 years from July 2013 to June 2015. An institutional ethical clearance was obtained and an informed consent was taken from the patients who were selected for the study. Of the 63 unruptured ectopic pregnancy cases, 31 patients were given multiple dose methotrexate and 32 underwent conservative surgical management (Laparoscopic salpingostomy) according to the inclusion and exclusion criteria. The distribution of patients was studied according to the age, parity, literacy status, presence of risk factors and followed up with serum β HCG levels. The success and failure with both the treatments were defined and the patients were followed up till 2 years for fertility outcome. RESULTS Most of the patients were nulliparous (71.4%), illiterates (77.7%) and belong to age group 21–25 years (53.9%). Half of them had prior risk factors (55.5%) for ectopic pregnancy. Mean β HCG levels came down to normal from day 4 after salpingostomy, but there was a consistent fall till day 28 after methotrexate treatment. Complications were seen with both the treatments. The rate of success was comparatively more for salpingostomy patients (84.3%), but the difference is not statistically significant. The successful patients were followed up for tubal patencies, ectopic pregnancies and recurrent ectopic pregnancies and the differences were not statistically significant with both medical and conservative surgical treatments. CONCLUSION Conservative surgical treatment and medical treatment are both almost equally effective to preserve the subsequent fertility of the women. According to our study, the difference in success and failure for both the treatments (Medical and surgical) and the difference in fertility outcome in 2 years - pregnancy rate and recurrent ectopic with both medical and conservative surgical is not statistically significant. However, for firm conclusion to be drawn randomized multicentric trials have to be done.
Authors and Affiliations
Padma , Garuda , Kambham , Swathi , Purushotham
Keywords
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- EP ID EP118075
- DOI 10.14260/jemds/2016/134
- Views 107
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