Changing Proportions of Unusual Ectopic Pregnancy Sites: Clinico-Pathological Correlates

Abstract

ABSTRACT

Objective

Ectopic pregnancy is a major cause of maternal morbidity and mortality. Of great concern is the increasing proportion of unusual sites of these pregnancies. This trend poses the problem of delayed diagnosis and failed timely appropriate management of affected patients.

The objective of this study is to review the literature to highlight the challenges inherent in the changing proportions of ectopic pregnancy sites. The review focuses on the pathophysiology and the management strategies of these complicated pregnancies in order to reduce maternal morbidity.

Methodology

Using our hospital records, and online search engines, publications on ectopic gestation were selected and reviewed. In addition, the experiences of some of the authors of this paper form parts of the review. The sum total findings of the various ectopic pregnancy sites were carefully studied in order to identify clinical consequences and challenges encountered with the management of cases.

Result/Conclusion                               

The conclusion was arrived at by careful analysis of the various unusual ectopic sites and patterns of presentation. These sites included abdominal, ovarian, uterine and cervical pregnancies; and the patterns included heterotopic, bilateral tubal, tubal twin ectopic pregnancies, and caesarean scar-site pregnancy. The increasing incidence of ectopic pregnancy in unusual sites is closely linked to pelvic infections, assisted reproductive procedures, increasing caesarean section rates and use of intrauterine devices. The authors conclude on the need for a high index of suspicion of implanted blastocysts in these uncommon sites with potential for delayed appropriate treatment and increased morbidity.