VP59.16: Management of non‐tubal ectopic pregnancy: a 10‐year case series

Non-tubal ectopic pregnancy (NTEP) presents significant diagnostic and management challenges owing to its rare and unique sites of implantation. Unfortunately, there is still limited data to guide NTEP management. The aim of this study was to evaluate the outcomes for women receiving medical, surgical or expectant management for NTEP at our institution. Retrospective case note review of all women treated for NTEP (excluding Caesarean scar) at an Australian tertiary centre from 2010 to 2020. 15 women with NTEP were identified in total. There were 14 interstitial and 1 ovarian ectopic pregnancies (EP), which accounted for 4% and 0.27% of all EP at our centre over the past 10 years. The mean gestational age was 54 days (range: 22–70) and mean serum hCG was 175,96IU/mL (12-85327) with fetal heart activity present in 2 cases. 3 cases were diagnosed intraoperatively after presenting with clinical evidence of ruptured ectopic, while the remaining 12 cases were diagnosed on early pregnancy ultrasound. Of the 15 cases, 6 cases received primary medical management with systemic methotrexate (MTX) and 1 received ultrasound-guided injection (USGI) with MTX and potassium chloride (KCl), 7 received primary surgical management and 1 received expectant management. Overall, primary management was successful in 12 cases (80%; 4 medical [66.7%], 7 surgical [100%], and 1 expectant [100%]). Among the 3 cases that failed medical management, 1 required surgery following a ruptured ectopic with hemorrhagic complication, and 2 were excluded from further analysis after being lost to follow up on transfer of care to another external health provider. No hysterectomy, unplanned return to OR or ICU, or mortality was observed for all cases. Primary medical, surgical and even expectant management of NTEP can be effective, but such decisions must take into account the clinical presentation, patient's preference, available resources, and surgeon's skills, in order to avoid associated treatment morbidity.