Non-Tubal Ectopic Pregnancies — YRD
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Non-Tubal Ectopic Pregnancies (1465)

Genevieve Kan 1 , Karen Reidy 1 2 3 , Jayshree Ramkrishna 1 , Ricardo Palma-Dias 1 2 3 , Catarina Ang 4
  1. Ultrasound Department, Pauline Gandel Imaging Centre, The Royal Women's Hospital, Melbourne, VIC, Australia
  2. Pregnancy Research Centre, Department of Perinatal Medicine, The Royal Women’s Hospital, Melbourne, VIC, Australia
  3. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
  4. Gynaecology and Cancer Services, The Royal Women’s Hospital, Melbourne, VIC, Australia

Introduction:

Ectopic pregnancies occur in approximately 1% of pregnancies1. The fallopian tubes are the most common site for ectopic pregnancies. Non-tubal ectopic pregnancies refer to those implanted in locations other than the fallopian tubes, and account for 5.0%-8.3% of ectopic pregnancies2. Most literature in this area has been restricted to small case reports and series, with limited data on optimal protocols.

Objective:

The objective of this study is to compare the various management regimens for non-tubal ectopic pregnancies. Treatment modalities included single- or multi-dose methotrexate, intrasac methotrexate injection with or without potassium chloride, surgical treatment and combination regimens. The main outcome of interest was the success of initial planned management, or whether further unplanned intervention was required. Secondary outcomes studied were time to resolution, determined as achieving βHCG<20IU and/or resolution on ultrasound, and complications.

Methods:

This was a retrospective audit of 114 consecutive non-tubal ectopic cases identified by imaging at a tertiary women’s health hospital in Melbourne, Australia, from January 2004 to November 2014. We examined pregnancy sites, risk factors, clinical presentation, US/MRI imaging results and other demographic data, whilst assessing results of treatment modalities. Timing to resolution and complications were recorded. 

Results:

A diagnosis of non-tubal ectopic pregnancy was made on imaging for 114 pregnancies. Nine pregnancies originally diagnosed as non-tubal ectopics were excluded: at surgery, 7 were found to be tubal, whilst 2 pregnancies diagnosed as ovarian ectopics were re-classified as pregnancies of unknown location. Three further cases, diagnosed at our institution, were managed elsewhere and were excluded. (n=102)

Ectopic site classification following complete investigation included: 1 abdominal, 33 caesarean scar, 13 cervical, 42 cornual/interstitial, 2 heterotopic, and 14 ovarian.

Treatment regimens were: 4 expectant, 77 methotrexate, 10 surgical, and 11 combination regimens. 

Primary management plan was successful in 75 pregnancies (74%): 65 had no complications and required no further intervention, 4 required additional systemic methotrexate doses or KCl injection, and 6 had unexpected complications arising from the planned treatment. 

Eighteen cases (18%) required a different, unplanned management approach and the primary management plan was considered unsuccessful.

Nine cases were transferred to other hospitals prior to resolution of their βHCG and thus the success of their management remains inconclusive.

Conclusion:

This study illustrates the common clinical scenarios and summarises the treatment options for non-tubal ectopic pregnancies. Critical appraisal of the described outcomes will guide an evidence-based clinical approach to the management of this condition.

  1. Hajenius PJ, Mol F, Mol BWJ, Bossuyt PMM, Ankum WM, Van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD000324. DOI: 10.1002/14651858.CD000324.pub2.
  2. Shen L, Fu J, Huang W, Zhu H, Wang Q, Yang S, Wu T. Interventions for non-tubal ectopic pregnancy (Protocol). Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD011174. DOI: 10.1002/14651858.CD011174.