Diagnosis and treatment of tubal pregnancy as related to risk determinants

Symptom-free women at increased risk of ectopic pregnancy: should we screen?

BACKGROUND

Transvaginal sonography, serum human chorionic gonadotrophin (hCG) measurement, and serum progesterone measurement provide the possibility to screen symptom-free women at increased risk of ectopic pregnancy. The objective of the present study was to evaluate the cost-effectiveness of screening for ectopic pregnancy, by addressing the expected benefits and costs of screening for ectopic pregnancy.

METHODS

Screening programs incorporating transvaginal sonography, serum hCG measurement, and serum progesterone measurement were compared with a 'watchful waiting' strategy. Data were extracted from the literature. The strategies were compared on the expected number of prevented tubal ruptures, the expected number of false-positive diagnoses, and expected costs.

RESULTS

The cost-effectiveness of screening appeared to be strongly dependent on the prevalence of ectopic pregnancy. At a prevalence of ectopic pregnancy of 6%, a screening program with transvaginal sonography and serum hCG measurement would reduce the number of patients with ruptured ectopic pregnancy from 2.1 to 0.61 per 100 screened women. Screening was expected to cost approximately Euro 933 per prevented tubal rupture, whereas the number of expected false-positive diagnoses was 0.64 per prevented tubal rupture.

CONCLUSION

We conclude that screening for ectopic pregnancy reduces the number of patients with tubal rupture, but only at the expense of a large false-positive rate. Although sonography in symptom-free women at risk of ectopic pregnancy might be justified for psychological reasons, the medical and economic benefits of such a policy seem to be limited.

Ectopic pregnancy in Korle Bu Teaching Hospital, Ghana: a three-year review

A retrospective study of ectopic pregnancies seen in Korle Bu Teaching Hospital from January 1991 to December 1993 was conducted. The incidence was 39.5/1000 deliveries; patients with ectopic were not of lower parity than those with normal pregnancies. The incidence of historical predisposing factors was 11.08%, although findings at operation indicated a much higher incidence of previous pelvic inflammatory disease (PID). Dizziness/fainting and abdominal distension were more frequent than has been reported elsewhere. This was due to a very high incidence of ruptured ectopic pregnancies (98.1%) with mean volume of haemoperitoneum of 1.37 l. 16.3% of patients were misdiagnosed initially. The second commonest site of tubal pregnancy, after the ampullary region, was cornual. The case fatality rate was 27.9/1000, with more than half of the deaths occurring before or soon after arrival in hospital. In order to reduce the incidence of ruptured ectopic pregnancies we suggest, among other measures, that appropriate diagnostic facilities be provided.