Ectopic pregnancy is rearly an urgent and dangerous one; Diagnosis of the certain cases are still remain difficult such as unruptiured one,. associated witl-´ pelvic inflammatory disease, chronic ectopic pregnancy ´or´ sort of one refered from other clinic after D & C done under the impression of incomplete or complete abortion.
We would like to emphasize that every minor vaginal surgery or curettage should be aseptic and active prevention on the tubal infection never be ignored in order to minimize the high incidence of ectopic pregnancy.
The data to be presented are based on 313 cases of ectopic pregnancy operated on at the Ewha Woman´s University Hospital, Seoul Korea for past 7 years (1963-1969).
The results were obtained as follows;
1. The incidence of ectopic pregnancies were 1 : 41 or 2.43/0 of deliveries.
2. Approximately- one-third (34.8%x) cases of ectopic gestation have occurred at middle age group ranging from 31 to 36 year of age. 36.2/ of the total subject were found to be multiparous women 1 or 2 parities.
3. It is important to notice that one-half (50.4%) cases of ectopic gestation were one who had at least one episode of curettage or induced abortion. 1301o cases of all subject were one with past history of laparotomy for some lesion.
These factors were strongly suggestive of a causative factors followed by relatively silent pelvic infection, which an not be ignored.
4. Most frequent symptoms of ectopic pregnancy were lower abdominal pain (9?.o of the cases) and vaginal spotting (68.6%°!). Skipped menstruation were about one-half (53 J) of the cases and it was generally (87.3/) delayed 4 to IL weeks. The means of culdecentesis is considered a safe and useful measures, but it´s diagnostic accuracy or positive findings were slightly more than 1/2 or 66 jo of the cases although the most (85%) cases of ectopic pregnancy were encountered as known ruptured type.
5. Misdiagnosed case for ectopic gestation were only 5 cases (1.60%) in which considered significantly lower in comparison with some other report of 15 to 30%.
6. We believe that times required from admission to surgery were very adequate. Most of the cases (80%) were operated on within 2 hours, especially patients with severe shock or 40% of over all cases with shock were undergone surgery in 30 minutes.
7. The incidence of tubal pregnancy were 90% of the total subjects. It´s most frequent site were ampullar portion (44%), then often isthmic portion (15.3/). Less common varities were 8 cases of cornual pregnancy and 2 cases of cervical pregnancy encountered.
8. Approximately one-quater (27.8%) cases of ectopic pregnancy were in critical shock -state on; the admission. Most cases (85/) -were ruptured ore on the admission except rare incidence (15%) of unruptured lucky one.
9. The treatment of choice in tubal-pregnancy is removal of the-affected tube except extensively x upturecl angular pregnancy which should need prompt total hysterectomy and other additional surgery for concomitant lesions. We carried out incidental appendectomy on 80% cases of the ectopic gestation without any postoperative complications or any increased incidence of recurrent ectopic geatation.
Fast pressure blood transfusion through multiple route is mandatory in emergancy or operating room.
There was no mortality except 1 case of D. 0. A..
|