A fifteen year experience with ectopic pregnancy

The increasing importance of an ectopic pregnancy as a cause of maternal death presents a challenge that will be met when primary care physicians combine a high index of suspicion with the ability to recognize the patient most at risk. The major symptoms, abdominal pain, secondary amenorrhea and abnormal vaginal bleeding are well known, as are the major signs, abdominal tenderness, adnexal mass and tenderness on motion of the cervix. Less well known are factors in the clinical history which indicate the patient to be at high risk. These include primary or secondary infertility, previous abortion or ectopic pregnancy and previous tubal operation, either reconstructive or sterilizing. In addition, the use of an intrauterine contraceptive device or its recent removal because of abdominal pain or bleeding, or both, is highly significant. Of major importance is a history of recent uterine evacuation. Should the diagnosis of ectopic pregnancy be under consideration, procrastination by observation is no longer acceptable. An active effort must be made to confirm or deny the diagnosis, Culdocentesis should be performed in the emergency department or clinic. If positive, prompt laparotomy is indicated. Should the result of culdocentesis be unsatisfactory or negative, laparotomy should be undertaken with further delay. Ectopic pregnancy is a serious complication of pregnancy accounting for 6-13% of all maternal deaths in the U.S. Early diagnosis and treatment is absolutely necessary to ensure a successful outcome. In the period from January 1, 1965-December 31, 1979, 556 consecutive cases of ectopic pregnancy were treated at The Brookdale Hospital Medical Center in Brooklyn, accounting for less than 1% of all pregnancies handled in that period. 3 of these cases had an ovarian pregnancy, 8 had an abdominal, and 545 a tubal pregnancy. Relevant personal characteristics and aspects of obstetric history of these cases were studied. 85% of them had used no contraception prior to the ectopic pregnancy. Maternal age was not a factor in the occurrence of the ectopic pregnancy. The following factors in the clinical history were found to put the patient in a high-risk category: 1) primary or secondary infertility; 2) previous abortion or ectopic pregnancy; 3) previous tubal operation, either reconstructive or sterilizing; 4) recent uterine evacuation; and 5) the use of an IUD or its recent removal due to abdominal pain and/or bleeding. Major symptoms were found to be abdominal pain, common symptoms or early pregnancy, abdominal tenderness, adnexal mass, and tenderness on motion of the cervix. Culdocentesis and laparoscopy are effective diagnostic aids. Procrastination by observation should not be followed.