Journal of Reproductive Medicine Gynaecology & Obstetrics Category: Medical Type: Research Article
Ectopic Pregnancy at University Hospital Center Point G in Mali: Medical Treatment versus Laporoscopical Surgery
- Keita S1, Thera T2*, Koumare S1, Ongoiba I3, Soumare L1, Sacko O1, Camara M1, Sissoko M3, Sissoko A3, Coulibaly A3, Koita A1, Sanogo ZZ1
- 1 Department Of General And Laparoscopic Surgery, University Hospital Center Of Point G, Bamako, Mali
- 2 Department Of Gynecology And Obstetrics, University Hospital Center Of Point G, 333 Bamako, Mali
- 3 Department Of Gynecology And Obstetrics, University Hospital Center Of Point G, Bamako, Mali
*Corresponding Author:
Thera TDepartment Of Gynecology And Obstetrics, University Hospital Center Of Point G, 333 Bamako, Mali
Tel:+00223 66767252,
Email:tiounkani@gmail.com
Received Date: Nov 27, 2019 Accepted Date: Dec 17, 2019 Published Date: Dec 23, 2019
Abstract
The aim of this work is to compare the results of the management of Ectopic Pregnancies (EP) with methotrexate medical treatment and laparoscopy at the Point G hospital.
Patients and methods
This was a descriptive retrospective study over five years (January 2010 to December 2014) in the General and Laparoscopic Surgery Department and the Obstetrics and Gynecology Department of the Point G (GLCD). Patients treated for tubal location EP were included either by medical treatment with methotrexate or laparoscopy.
Results
The clinical records of 61 patients were collected and divided into two groups: a Medical Treatment group (MT) with 29 patients and a Laparoscopy group (LT) with 32 patients. EP accounted for 1.8% of obstetric emergencies in MT and 2.2% of laparoscopic surgery activities in the LT. The average age of patients in both groups was 32.3 years with extremes of 16 years and 42 years. The amenorrhea triad pelvic pain and metrorrhagia was found in 42% in the LT and 22% in the MT. Uncomplicated haematosalpinx was observed in 82.7% in MTvs 40.6% in LT. Failure of medical treatment was observed in 31%. Salpingectomy for laparoscopic surgery was performed in 6.3%. The return to fertility was observed in 15.4% in MT including 10.4% term pregnancies and 5% recidivism vs 25% in the LT with 15.6% term pregnancies and 9.3% recidivism. Mortality was zero in both groups.
Conclusion
Both methods are feasible and reproducible in the context of working at the Point G Hospital Center at the cost of respect for the indications, each having proved its advantages and its limits.
Keywords
INTRODUCTION
PATIENTS AND METHODS
- D0: MTX 1mg / kg in IM
- D4: assay of ßHCG if 15% decrease in D0, assay at D7
- D7: assay of ßHCG if J7<J4, patient output with outpatient follow-up and weekly determination of until negativation. Failure was observed following rupture of haematosalpinx, persistence and / or increase of ßHCG after administration of the second dose of MTX. The continuation of the care was done by laparotomy or laparoscopy. The surgical method used a laparoscopic column placed at the foot of the table with instrumentation made of mostly reusable devices. All patients were placed supine and operated under general anesthesia with curarization and orotracheal intubation. The introduction of the optical trocar 10 mm in umbilical was performed after open laparoscopy and a trocar of 5 mm in each of the iliac fosses under visual control. The first step consisted of an exploration of the peritoneal cavity and an improved pelvic exposure by the Trendelenburg position. In the case of hemoperitoneum, peritoneal clean was performed using an irrigation-aspiration system connected to a strainer cannula. At the end of this exploration, the diagnosis of the EP was confirmed and the anatomical location specified. The surgical procedure was a function of Pouly's therapeutic score [3]. The rule is at best the conservative treatment of the trunk with salpingotomy, tubo-peritoneal abortion or tubal trans-epileptic expression. Hemostasis was achieved by coagulation with bipolar bistoury. The studied parameters were: the anatomical localization, the evolutionary stage, the feasibility of the method and the factors of the failure, the benefit / risk ratios. The opinion of the ethics committee was taken into account and the anonymity of the patients was respected.
RESULTS
Groups |
|||||
Evolutionary Stages |
GM |
GC |
|
||
Number |
Percentage |
Number |
Percentage |
Total |
|
Hematosalpinx uncomplicated |
24 |
82.7 |
13 |
40.6 |
37 |
Hematosalpinx fissure |
5 |
17.3 |
6 |
18.8 |
11 |
Tubo-peritoneal abortion |
0 |
0 |
2 |
6,3 |
2 |
Tubal rupture |
0 |
0 |
11 |
34.3 |
11 |
Total |
29 |
100% |
32 |
100% |
61 |
Gestures |
Number |
Percentage |
Salpingectomy |
2 |
6.3 |
Salpingotomy |
20 |
62.5 |
Tubo-peritoneal abortion |
2 |
6.3 |
Tubal transplanter expression |
5 |
15.6 |
Suction-washing |
3 |
9.3 |
Total |
32 |
100.0 |
Evolution |
Number |
Percentage |
Increase ßHCG |
3 |
10.3 |
Decrease ßHCG <15% |
4 |
13.8 |
Decrease ßHCG 15-50% |
2 |
6.9 |
Decrease ßHCG 50-80% |
3 |
10.3 |
ßHCG> 80% |
4 |
13.8 |
ßHCG not measured |
9 |
31.1 |
Tubal rupture |
4 |
13.8 |
Total |
29 |
100.0 |
Final Evolution |
Number |
Percentage |
Healing after 1st dose of MTX |
13 |
44.8 |
Healing after 2nd dose of MTX |
7 |
24.2 |
Absence of healing (Breaking) |
9 |
31 |
Total |
29 |
100.0 |
DISCUSSION
CONCLUSION
REFERENCES
- Thera T, Ongoiba I, Sima M (2017) Medical treatment of ectopic pregnancy: Experience of the University Hospital Center of Point G in Bamako AUB Series D, Vol 3.
- Boudhraa K, Bensalah N, Yousfi S, Triki A, Ouerhani R, et al. (2008) Ectopic pregnancy: Diagnosis and therapeutic management of 107 cases. The Letter of the Gynecologist: 5-8.
- Pouly JL, Chapron C, Manhes H, Canis M, Wattiez A, et al. (1991) Multifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients. Fertil Steril. 56: 453-60.
- Nayama M, Gallais A, Ousmane N, Idi N, Tahirou A, et al. (2006) [Management of ectopic pregnancy in developing countries: example of a Nigerian reference maternity]. Gynecol Obstet Fertil 34: 14-18.
- Lokossou A, Denakpo J, Houndeffo T, TonatoBagnan J, Lokossou HS, et al. (2007) Epidemiological, diagnostic and prognostic aspects of ectopic pregnancy in Cotonou HOMEL. Benin Medical 38: 47.
- Randriambololona DMA (2012) Management of ectopic pregnancy at the University Hospital of Gynecology and Obstetrics of Befelatanana Antananarivo Madagascar. Review of Anesthesia-Resuscitation and Emergency Medicine 4: 16-19.
- Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N (2002) Sites of ectopic pregnancy: A 10 year population-based study of 1800 cases. Hum Reprod 17: 3224-3230.
- Hsu JY, Chen L, Gumer AR, Tergas AI, Hou JY, et al. (2017) Disparities in the management of ectopic pregnancy. Am J Obstet Gynecol 217: 49.
- Arrach S (2014) Traitement cœlioscopique de la grossesse extra-utérine (A propos de 18 cas). Gynécologie Obstétrique 2.
- Fernandez H, Pauthier S, Doumerc S, Lelaidier C, Olivennes F, et al. (1995) Ultrasound-guided injection of methotrexate versus laparoscopic salpingotomy in ectopic pregnancy. Fertil Steril 63: 25-29.
- Nieuwkerk PT, Hajenius PJ, Ankum WM, Van der Veen F, Wijker W, et al. (1998) Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients' health-related quality of life. Fertil Steril 70: 511-517.
- Nazac A, Gervaise A, Bouyer J, De Tayrac R, Capella-Allouc S, et al. (2003) Predictors of success in methotrexate treatment of women with unruptured tubal pregnancies. Ultrasound Obstet gynecol 21: 181-185.
- de Bennetot M, Rabischong B, Aublet-Cuvelier B, Belard F, Fernandez H (2012) Fertility after tubal ectopic pregnancy: Results of a population-based study. Fertil Steril 98: 1271-1276.
Citation:Keita S, Thera T, Koumare S, Ongoiba I, Soumare L, et al. (2019) Ectopic Pregnancy at university Hospital Center point G in Mali: Medical Treatment versus Laporoscopical Surgery. J Reprod Med Gynecol Obstet 4: 032.
Copyright: © 2019 Keita S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
