Journal Article

Ectopic pregnancy: a single-center experience over ten years

Moore, Pablo, Krysa, Lisa, Al Naimi, Ammar, Brüggmann, Dörthe, Louwen, Frank, Bahlmann, Franz

2021

Overview

Purpose The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality. Methods This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, β-human chorionic gonadotropin (β-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA). Results The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10 − 5 ) that was diagnosed in the 7th gestational week. The only association found was between the β-HCG level and LOS, with a linear regression β coefficient of 0.01 and a P -value of 0.04. Conclusion EP is a relatively common condition affecting approximately 1% of all pregnancies. β-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Abdomen / Abdominal Pain - physiopathology / Abortifacient Agents, Nonsteroidal - therapeutic use / Adult / Amenorrhea / Analysis / Cesarean section / Cesarean Section - statistics & numerical data / Chorionic gonadotropin / Chorionic Gonadotropin, beta Subunit, Human - blood / COVID-19 / Dizygotic ectopic / Douglas' Pouch / Ectopic pregnancy / Embryos / Endocrinology / Female / Gestational age / Glycoproteins / Gonadotropins / Health aspects / Heterotopic pregnancy / Humans / Implantation / Incidence / Intrauterine Devices / Laparoscopy / Length of Stay - statistics & numerical data / Medicine / Medicine & Public Health / Methotrexate - therapeutic use / Middle Aged / Morbidity / Mortality / Ovaries / Pain / Patients / Pituitary (anterior) / Pregnancy / Pregnancy complications / Pregnancy, Ectopic / Pregnancy, Ectopic - blood / Pregnancy, Ectopic - epidemiology / Pregnancy, Ectopic - physiopathology / Pregnancy, Ectopic - therapy / Pregnancy, Heterotopic - blood / Pregnancy, Heterotopic - epidemiology / Pregnancy, Heterotopic - physiopathology / Pregnancy, Heterotopic - therapy / Pregnancy, Ovarian - blood / Pregnancy, Ovarian - epidemiology / Pregnancy, Ovarian - physiopathology / Pregnancy, Ovarian - therapy / Pregnancy, Tubal - blood / Pregnancy, Tubal - epidemiology / Pregnancy, Tubal - physiopathology / Pregnancy, Tubal - therapy / Pregnant women / Regression analysis / Reproductive Medicine / Reproductive Techniques, Assisted - statistics & numerical data / Retrospective Studies / Risk Factors / Salpingectomy / Salpingostomy / Smoking - epidemiology / Statistical analysis / Surgery / Ultrasonic imaging / Young Adult / β-HCG