A twelve year analysis of non-tubal ectopic pregnancies: Do the clinical manifestations and risk factor for these rare pregnancies differ from those of tubal pregnancies?

Abstract

The aim of this study was to analyze the characteristics and peculiarity of non-tubal ectopic (NTE) pregnancy presenting to a major district hospital in London, UK. Data were collected between January 2003 and July 2014. There were 850 cases of ectopic pregnancies (798 tubal pregnancies and 53 NTE pregnancies). Forty-seven of the NTE were included in the study. Data were analyzed using IBM SPSS Statistics 20. Pearson’s chi-squared analysis was used to compare statistical significance of the data collected; the level of statistical significance at which the null hypothesis was rejected was chosen as 0.05. The 31–40 year age group had the highest incidence (55 % of the cohort). Thirty-seven percent of NTE were primigravida. Most of the women presented at 6–10 weeks gestation (63 %) with abdominal and vaginal bleeding being the most common presentation in 55 % of cases. When compared with tubal ectopic pregnancy, NTE was more likely to present at later gestation of presentation (p = 0.000), have history of assisted reproduction (p = 0.041) and more likely to present with diarrhoea, shoulder-tip pain and syncopal attack as well having a significant amount of haemoperitoneum at surgery compared with tubal ectopic pregnancy. NTE pregnancies are likely to present most commonly at 6–10 weeks and therefore clinicians should have a high index of suspicion when treating any pregnant woman at this gestation. The later presentation of NTE pregnancies may relate to the delay in diagnosis of these rarer ectopic pregnancies; this may be attributed to the clinician having a level of suspicion that is too low, as the incidence of NTE pregnancies is becoming increasingly common. A combination of a thorough history with the presence of specific risk factors such as a history of assisted conception, pelvic surgery and pelvic inflammatory disease and symptoms such as syncope and an abnormal amount of free fluid behind the empty uterus at ultrasound should make the clinician highly suspicious of a NTE or heterotopic pregnancy.