A 21 year survey of 654 ectopic pregnancies

  • James L. Breen
    From the Department of Obstetrics and Gynecology, Saint Barnabas Medical Center, Livingston, and the Department of Gynecology and Obstetrics, New Jersey College of Medicine and Dentistry, Newark, Livingston, New Jersey
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      Six hundred and fifty-four patients with an ectopic pregnancy seen during a 21 year span were surveyed. The ratio of ectopic pregnancies to deliveries was 1 to 87, the largest number occurring in multiparous patients in the 26 to 30 year age bracket. Abdominal pain (100 per cent), amenorrhea (84 per cent), and irregular vaginal bleeding (80 per cent) were the presenting symptoms, the most significant physical finding being abdominal or rebound tenderness associated with adnexal or cul-de-sac fullness. The diagnosis was initiated by culdocentesis in the majority of patients. Eighty per cent of the tubal pregnancies were ruptured and therapy consisted, primarily, of a total salpingectomy. A small percentage of pregnancies were in rare anatomic sites, i.e., abdominal (1.4 per cent), uterine (0.7 per cent) and ovarian (0.15 per cent). There were three maternal deaths in this series. Etiologically, a histopathologic survey of 320 Fallopian tubes revealed varying degrees of inflammatory change consisting primarily of follicular salpingitis (18 per cent), interstitial salpingitis (16 per cent), and hydrosalpinx (8 per cent). The need for continuing early diagnosis was stressed, for from 1959 to 1963, 505 women in the United States died from an ectopic pregnancy. In the state of New Jersey alone there were, in a 9 year period, 38 maternal deaths due to ectopic pregnancy, 23 patients never receiving therapy.
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