Delayed management of ruptured ectopic pregnancy: an observation of concern

Abstract

There were 82 cases of ruptured ectopic pregnancies during a 6-year period, (2049- 2054) April 1992-1998. Associated high risk factors were proven PID (3), infertility (10), sterilization (4), previous ectopic (6), IUCD (1). One of the cases had clomiphen citrate and the other was an OCP for cystic ovary. Atypical presentations were malaena (2) and intestinal obstruction (1). Symptoms and admission interval varied from 1 hour to more than a month in 8 cases. Surgical intervention was undertaken at an earliest in 2
hours and delayed beyond 1-2 weeks in 7 cases. Surgical management was delayed beyond 6 hours (69.5%) and 12 hours (56%) respectively. This delay was mainly due to misdiagnosis (45%) as the symptoms of PID (3), DUB (1), and pelvic abscess (1) overlapped with ectopic. Improper and inadequate referral due to inexpert opinion at admission was another cause for delay.

Forty-two point six percent had significant haemoperitoneum, of which 39.4 needed blood transfusion. Two cases had tubal reconstruction and two underwent hysterectomy.
We emphasize to overcome the diagnostic dilemma by adopting sensitive BhCG using monoclonal antibodies, TVS and laparoscopy whenever necessary along with active surgical team to cut short the delay in operative management of ruptured ectopic.