An Institutional Review of the Management of Ectopic Pregnancy

Abstract

Objective: The aim of this study was to review the management of ectopic pregnancy and identify areas that could be targeted for improvement in order to optimize health outcomes for women at our institution. Study design: A descriptive retrospective chart review was performed of 97 ectopic pregnancies over a 2-year period. Tubal rupture, diagnosis, and treatment were reviewed, and descriptive statistics obtained. Results: Fifty-four percent (54%) of patients were diagnosed by transvaginal ultrasound. Tubal rupture occurred in 36% of patients. Tubal ruptures that occurred after presentation happened within 1–3 days after presentation while awaiting diagnosis or after treatment, mostly with methotrexate. Followup of patients with uncertain diagnosis was incomplete 10% of the time. Fifty-four percent (54%) of patients had laparotomies. Laparotomies were performed without precise indications in 37% of cases, and 50% of attempted laparoscopic surgeries were converted to laparotomy. The rate of tubal conservation was 17%. Salpingostomy was not attempted in a majority of cases because of no precise indication or because the tube was deemed unsalvageable. When salpingostomy was attempted, it was unsuccessful 52% of the time as a result of persistent bleeding. Conclusions: Increasing the number of patients diagnosed at presentation by transvaginal ultrasound could decrease the number of tubal ruptures since patients ruptured shortly after presenting. Better documentation and timely laboratory testing and ultrasounds could be performed in order to improve follow-up of patients with uncertain diagnosis. The number of laparotomies could be decreased by performing this operation only when indicated and by improving laparoscopic skills so that fewer laparoscopic surgeries are converted to laparotomies. Attempting more salpingostomies, and using surgical techniques to control bleeding after salpingostomy, could increase the number of tubal conservation surgeries.