Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)

Abstract

Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. When a patient is admitted before rupture, organ-preserving management which keeps a higher fertility rate than ablative surgery can be done. The incidence of Unruptured Ectopic Pregnancy (UTP) on admission is unknown. In the study facilities, methotrexate treatment was given to most of UTP regardless of Fernandez score. The aim of this study was therefore to assess the lessons learnt from that experience. Methods: It was a cross sectional study over a 10 years period, conducted in four university teaching hospitals affiliated to the University of Yaounde I, Cameroon. Included patients were managed either by therapeutic abstention, single or multidose intra muscular MTX. Onset of clinical acute abdomen was the only indication of failure of conservative management and prompted emergency laparotomy. Results: We included 153 UTP cases. The incidence of UTP on admission was 0.46%, the mean age 28.4 ± 4.9, 88.2% were admitted at a gestational age <9 weeks, 19% had no pelvic pain. Medical treatment by MTX success rate was 81.7% but was not related to mono or multiple-dose (p=0.87), the success rate when β-hCG value was ≥ 10000 mIU/ml was 63.3% (p=0.004). When Fernandez score was ≥ 13, 21/25 (84%) were still successful including 3/7 with cardiac activity. (p=0.007). Conclusions: The incidence of UTP on admission is approximately 1/10th of all EP. Some UTP patients should be given MTX treatment opportunity even when Fernandez score recommends surgical management.