Document Detail


Efficacy and safety of a clinical protocol for expectant management of selected women diagnosed with a tubal ectopic pregnancy.
MedLine Citation:
PMID:  23303651     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To validate the efficacy and safety of our clinical protocol for expectant management of selected women diagnosed with tubal ectopic pregnancy. METHODS: This was a prospective observational study carried out in the Early Pregnancy Unit (EPU) of a London inner city university teaching hospital from the 1(st) of January 2008 to the 31(st) of May 2011. All women presenting with suspected early pregnancy complications were assessed clinically and by transvaginal ultrasound. Those with a conclusive ultrasound diagnosis of ectopic pregnancy were selected for either surgical or expectant management. Selection criteria for expectant management were clinically stable women with no or minimal abdominal pain, no evidence of significant haematoperitoneum on ultrasound scan, ectopic pregnancy measuring <30mm in mean diameter with no evidence of embryonic cardiac activity, serum β-hCG <1500 iu/l and woman's consent). All women selected for expectant management were followed up as outpatients until the ectopic pregnancy regressed spontaneously (resolution of clinical symptoms, serum β-hCG <20IU/l/negative urine pregnancy test) or surgical intervention was required. We recorded the rate of interventions, complications and length of follow up. RESULTS: During the study period 339/11520 (2.9% 95% CI 2.59 - 3.21) women were diagnosed with tubal ectopic pregnancy. Six women opted to participate in an ongoing randomized controlled trial and were excluded from further analysis. 165/333 [49.6% (95% CI 44.2 - 55.0)] of the remaining women met the criteria for expectant management.146/333 [43.8% (95%CI 38.5 - 49.1) of them opted for expectant management and 104/333 (31.2% [95% CI 26.2 - 36.2]) of all tubal ectopics resolved without requiring any intervention. All women with failed expectant management were treated by laparoscopic salpingectomy/salpingotomy and none of them required a blood transfusion. CONCLUSION: Our clinical protocol for expectant management of tubal ectopic pregnancies eliminates the need for medical or surgical treatment in more than a third of women diagnosed with tubal ectopic pregnancy with a minimum risk of adverse outcomes.
Authors:
Dimitrios Mavrelos; Helen Nicks; Amna Jamil; Will Hoo; Eric Jauniaux; Davor Jurkovic
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-10
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
University College Hospital, Gynaecology Diagnostic and Outpatient Treatment Unit, London, United Kingdom.
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