Management of tubal ectopic pregnancy in a large maternity unit; a six-year review

Objective(s): Ectopic pregnancy is where a pregnancy develops in an abnormal location. The incidence of ectopic pregnancy in Ireland is approximately 14.8 per 1,000 maternities. Most occur within the fallopian tube and untreated may result in serious morbidity with complications including blood transfusion, visceral injury at surgery and death. Ectopic pregnancy remains the leading cause of death worldwide in the first trimester of pregnancy. We aimed to examine the diagnosis and management of tubal ectopic pregnancy in a large tertiary maternity hospital. Study Design: This was a retrospective review of individuals treated for tubal ectopic pregnancy from 2017 to 2022. Records were identified from local databases. Anonymised data on risk-factors, symptoms and management was collected. Data were transcribed from electronic healthcare records and descriptive analyses performed. Results: Of the 471 records identified; 20 were excluded as they were non-tubal ectopic pregnancies. Primary management employed was conservative (99/451, 22 %), medical (113/451, 25 %) and surgical (239/451, 53 %). Surgery was performed in 62.7 % (283/451) cases, including those who started in one treatment pathway but changed to surgical management. Most surgeries were performed in a co-located general hospital theatre (89.3 %), with 54.4 % undertaken out-of-hours. Laparoscopy was the commonest surgical approach (96.4 %) and salpingectomy the most prevalent procedure (99.3 %). Emergency surgical intervention, due to haemodynamic instability and/or suspected rupture, was required in 21.9% (62/283). Only 11.7% (33/283) of those managed surgically experienced adverse outcomes, with blood transfusion and high dependency unit admission the most common. A small proportion (10%) of individuals were provided with pregnancy loss information (including resources and support services available), highlighting the importance of recognising ectopic pregnancy as a pregnancy loss and not just a gynaecological emergency. Conclusion(s): In this large series, most tubal ectopic pregnancies had surgical laparoscopic management, but this was outside normal working hours and in a co-located general hospital. Management of tubal ectopic pregnancy was safe with minimal adverse outcomes.