Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)

Mve Koh Valere; Essiben Felix; Essome Henri; Dang Atanga Danielle; Mbu Enow Robinson

doi:doi:10.11648/j.jgo.20190703.11

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Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)

Mve Koh Valere, Essiben Felix, Essome Henri, Dang Atanga Danielle, Mbu Enow Robinson

Published in Journal of Gynecology and Obstetrics (Volume 7, Issue 3)

Received: 17 March 2019 Accepted: 25 April 2019 Published: 23 May 2019

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Abstract

Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. When a patient is admitted before rupture, organ-preserving management which keeps a higher fertility rate than ablative surgery can be done. The incidence of Unruptured Ectopic Pregnancy (UTP) on admission is unknown. In the study facilities, methotrexate treatment was given to most of UTP regardless of Fernandez score. The aim of this study was therefore to assess the lessons learnt from that experience. Methods: It was a cross sectional study over a 10 years period, conducted in four university teaching hospitals affiliated to the University of Yaoundé I, Cameroon. Included patients were managed either by therapeutic abstention, single or multidose intra muscular MTX. Onset of clinical acute abdomen was the only indication of failure of conservative management and prompted emergency laparotomy. Results: We included 153 UTP cases. The incidence of UTP on admission was 0.46%, the mean age 28.4 ± 4.9, 88.2% were admitted at a gestational age <9 weeks, 19% had no pelvic pain. Medical treatment by MTX success rate was 81.7% but was not related to mono or multiple-dose (p=0.87), the success rate when β-hCG value was ≥ 10000 mIU/ml was 63.3% (p=0.004). When Fernandez score was ≥ 13, 21/25 (84%) were still successful including 3/7 with cardiac activity. (p=0.007). Conclusions: The incidence of UTP on admission is approximately 1/10th of all EP. Some UTP patients should be given MTX treatment opportunity even when Fernandez score recommends surgical management.

Published in	Journal of Gynecology and Obstetrics (Volume 7, Issue 3)
DOI	10.11648/j.jgo.20190703.11
Page(s)	60-67
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Unruptured Ectopic Pregnancy, Widen Indication, Acute Abdomen

References

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APA Style

Mve Koh Valere, Essiben Felix, Essome Henri, Dang Atanga Danielle, Mbu Enow Robinson. (2019). Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon). Journal of Gynecology and Obstetrics, 7(3), 60-67. https://doi.org/10.11648/j.jgo.20190703.11

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ACS Style

Mve Koh Valere; Essiben Felix; Essome Henri; Dang Atanga Danielle; Mbu Enow Robinson. Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon). J. Gynecol. Obstet. 2019, 7(3), 60-67. doi: 10.11648/j.jgo.20190703.11

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AMA Style

Mve Koh Valere, Essiben Felix, Essome Henri, Dang Atanga Danielle, Mbu Enow Robinson. Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon). J Gynecol Obstet. 2019;7(3):60-67. doi: 10.11648/j.jgo.20190703.11

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@article{10.11648/j.jgo.20190703.11,
  author = {Mve Koh Valere and Essiben Felix and Essome Henri and Dang Atanga Danielle and Mbu Enow Robinson},
  title = {Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {7},
  number = {3},
  pages = {60-67},
  doi = {10.11648/j.jgo.20190703.11},
  url = {https://doi.org/10.11648/j.jgo.20190703.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20190703.11},
  abstract = {Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. When a patient is admitted before rupture, organ-preserving management which keeps a higher fertility rate than ablative surgery can be done. The incidence of Unruptured Ectopic Pregnancy (UTP) on admission is unknown. In the study facilities, methotrexate treatment was given to most of UTP regardless of Fernandez score. The aim of this study was therefore to assess the lessons learnt from that experience. Methods: It was a cross sectional study over a 10 years period, conducted in four university teaching hospitals affiliated to the University of Yaoundé I, Cameroon. Included patients were managed either by therapeutic abstention, single or multidose intra muscular MTX. Onset of clinical acute abdomen was the only indication of failure of conservative management and prompted emergency laparotomy. Results: We included 153 UTP cases. The incidence of UTP on admission was 0.46%, the mean age 28.4 ± 4.9, 88.2% were admitted at a gestational age <9 weeks, 19% had no pelvic pain. Medical treatment by MTX success rate was 81.7% but was not related to mono or multiple-dose (p=0.87), the success rate when β-hCG value was ≥ 10000 mIU/ml was 63.3% (p=0.004). When Fernandez score was ≥ 13, 21/25 (84%) were still successful including 3/7 with cardiac activity. (p=0.007). Conclusions: The incidence of UTP on admission is approximately 1/10th of all EP. Some UTP patients should be given MTX treatment opportunity even when Fernandez score recommends surgical management.},
 year = {2019}
}

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TY - JOUR
T1 - Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)
AU - Mve Koh Valere
AU - Essiben Felix
AU - Essome Henri
AU - Dang Atanga Danielle
AU - Mbu Enow Robinson
Y1 - 2019/05/23
PY - 2019
N1 - https://doi.org/10.11648/j.jgo.20190703.11
DO - 10.11648/j.jgo.20190703.11
T2 - Journal of Gynecology and Obstetrics
JF - Journal of Gynecology and Obstetrics
JO - Journal of Gynecology and Obstetrics
SP - 60
EP - 67
PB - Science Publishing Group
SN - 2376-7820
UR - https://doi.org/10.11648/j.jgo.20190703.11
AB - Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. When a patient is admitted before rupture, organ-preserving management which keeps a higher fertility rate than ablative surgery can be done. The incidence of Unruptured Ectopic Pregnancy (UTP) on admission is unknown. In the study facilities, methotrexate treatment was given to most of UTP regardless of Fernandez score. The aim of this study was therefore to assess the lessons learnt from that experience. Methods: It was a cross sectional study over a 10 years period, conducted in four university teaching hospitals affiliated to the University of Yaoundé I, Cameroon. Included patients were managed either by therapeutic abstention, single or multidose intra muscular MTX. Onset of clinical acute abdomen was the only indication of failure of conservative management and prompted emergency laparotomy. Results: We included 153 UTP cases. The incidence of UTP on admission was 0.46%, the mean age 28.4 ± 4.9, 88.2% were admitted at a gestational age <9 weeks, 19% had no pelvic pain. Medical treatment by MTX success rate was 81.7% but was not related to mono or multiple-dose (p=0.87), the success rate when β-hCG value was ≥ 10000 mIU/ml was 63.3% (p=0.004). When Fernandez score was ≥ 13, 21/25 (84%) were still successful including 3/7 with cardiac activity. (p=0.007). Conclusions: The incidence of UTP on admission is approximately 1/10th of all EP. Some UTP patients should be given MTX treatment opportunity even when Fernandez score recommends surgical management.
VL - 7
IS - 3
ER -

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Author Information

Mve Koh Valere

Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
Essiben Felix

Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
Essome Henri

Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
Dang Atanga Danielle

Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
Mbu Enow Robinson

Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon

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Mve Koh Valere, Essiben Felix, Essome Henri, Dang Atanga Danielle, Mbu Enow Robinson. (2019). Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon). Journal of Gynecology and Obstetrics, 7(3), 60-67. https://doi.org/10.11648/j.jgo.20190703.11

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ACS Style

Mve Koh Valere; Essiben Felix; Essome Henri; Dang Atanga Danielle; Mbu Enow Robinson. Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon). J. Gynecol. Obstet. 2019, 7(3), 60-67. doi: 10.11648/j.jgo.20190703.11

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AMA Style

Mve Koh Valere, Essiben Felix, Essome Henri, Dang Atanga Danielle, Mbu Enow Robinson. Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon). J Gynecol Obstet. 2019;7(3):60-67. doi: 10.11648/j.jgo.20190703.11

Copy | Download

@article{10.11648/j.jgo.20190703.11,
  author = {Mve Koh Valere and Essiben Felix and Essome Henri and Dang Atanga Danielle and Mbu Enow Robinson},
  title = {Widening the Field of Indication of Conservative Management of Unruptured Tubal Pregnancy in Low Resources Settings: Lessons Learnt from 10-year Experience in Three University Teaching Hospitals in Yaoundé (Cameroon)},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {7},
  number = {3},
  pages = {60-67},
  doi = {10.11648/j.jgo.20190703.11},
  url = {https://doi.org/10.11648/j.jgo.20190703.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20190703.11},
  abstract = {Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. When a patient is admitted before rupture, organ-preserving management which keeps a higher fertility rate than ablative surgery can be done. The incidence of Unruptured Ectopic Pregnancy (UTP) on admission is unknown. In the study facilities, methotrexate treatment was given to most of UTP regardless of Fernandez score. The aim of this study was therefore to assess the lessons learnt from that experience. Methods: It was a cross sectional study over a 10 years period, conducted in four university teaching hospitals affiliated to the University of Yaoundé I, Cameroon. Included patients were managed either by therapeutic abstention, single or multidose intra muscular MTX. Onset of clinical acute abdomen was the only indication of failure of conservative management and prompted emergency laparotomy. Results: We included 153 UTP cases. The incidence of UTP on admission was 0.46%, the mean age 28.4 ± 4.9, 88.2% were admitted at a gestational age <9 weeks, 19% had no pelvic pain. Medical treatment by MTX success rate was 81.7% but was not related to mono or multiple-dose (p=0.87), the success rate when β-hCG value was ≥ 10000 mIU/ml was 63.3% (p=0.004). When Fernandez score was ≥ 13, 21/25 (84%) were still successful including 3/7 with cardiac activity. (p=0.007). Conclusions: The incidence of UTP on admission is approximately 1/10th of all EP. Some UTP patients should be given MTX treatment opportunity even when Fernandez score recommends surgical management.},
 year = {2019}
}

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