Outpatient non -surgical management of unruptured ectopic pregnancy in a specialist hospital in Nigeria: a report of three cases

Abstract

Background: Ectopic pregnancy is a major contributor to maternal morbidity and mortality in the first trimester of pregnancy especially when ruptured. Most patients with this condition present to the health facility with features of rupture, warranting the traditional approach of an emergency exploratory laparotomy which puts a burden on available infrastructure, causes distortion of family dynamics and reduces reproductive potentials.
Aim: To report the successful outpatient medical management of three cases of unruptured ectopic pregnancy using multidose intramuscular methotrexate in a specialist health facility in Port Harcourt.
Case report: We present three cases of unruptured ectopic pregnancy diagnosed early using serum β HCG and ultrasound scan managed successfully with multidose intramuscular methotrexate on an outpatient basis.
Conclusion: Early confirmation of pregnancy immediately after a missed period and localization of gestation site will facilitate identification of patients suitable for medical management of extrauterine pregnancy using a readily available anti-folate, methotrexate, which can be performed as an office procedure. This modality of treatment will reduce surgical risk, reduce demand on the already stretched health system and improve reproductive outcome.

Keywords: Unruptured ectopic, Methotrexate, Ultrasound scan, Serum β human chorionic gonadotrophin hormones