title: Management of non-tubal ectopic pregnancies at a large tertiary hospital.
abstract: There are limited data on the management of non-tubal ectopic pregnancies (NTEP). We reviewed the management of these cases at a tertiary centre with a dedicated institutional protocol. All cases of confirmed NTEP were retrospectively identified from 2006 to 2014. Records were reviewed for presenting features, mode and success of initial management, preservation of fertility and length of hospital stay. The main outcome measure was the success rate of medical management with methotrexate. The 60 cases identified included 34 cornual, 14 Caesarean section scar, nine cervical and three cervical involving previous Caesarean scar. Primary surgical management was performed in 22 patients. Thirty-eight patients received medical therapy with single or multidose methotrexate. Successful medical management was observed in 33 (87%); however, length of stay was significantly longer compared with surgical patients (mean 14 ± 12 days versus 5 ± 2 days, P < 0.01). Hysterectomy was performed in three patients (one surgical group, two medical group). There was one case of methotrexate toxicity with no long-term adverse outcome. Medical management of NTEP is a safe first-line therapy for clinically stable patients desiring preservation of fertility despite a longer period of inpatient monitoring and follow-up.
authors.affiliation: Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Women's Program, Monash Health, Clayton, Australia. Electronic address: sarah_prema@hotmail.com.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Hunt
authors.affiliation: Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Women's Program, Monash Health, Clayton, Australia; Monash IVF, Clayton, Australia.
authors.forename: Alon
authors.initials: A
authors.lastname: Talmor
authors.affiliation: Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Women's Program, Monash Health, Clayton, Australia; Monash IVF, Clayton, Australia.
authors.forename: Beverley
authors.initials: B
authors.lastname: Vollenhoven
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000328:Adult; D000465:Algorithms; D002585:Cesarean Section / Q000009:adverse effects; D002921:Cicatrix / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007044:Hysterectomy; D020407:Internet; D007902:Length of Stay; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
keywords: Cervical ectopic; Cornual ectopic; Ectopic pregnancy; Fertility; Non-tubal ectopic pregnancy; Scar ectopic