Conservative treatment of unruptured Ectopic pregnancy in Jamaica英文文献资料.docVIP

Open Journal of Obstetrics and Gynecology, 2011, 1, 6-11 OJOG doi:10.4236/ojog.2011.11002 Published Online March 2011 (http://www.SciRP.org/journal/ojog/). Conservative treatment of unruptured ectopic pregnancy in Jamaica H. Fletcher, K. Buchanan, L. Jacob Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston, Jamaica. Email: horace.fletcher@.jm Received 15 February 2011; revised 18 March 2011; accepted 25 March 2011. ABSTRACT changed from the primary surgical to medical treatment which now commonly predominates [5]. In Jamaica the primary mode of treatment still remains surgical as the patients tend to present later when signs and symptoms of rupture are more commonly present. At The Univer- sity Hospital of The West Indies 96.8% and 92% of cases of ectopic pregnancies were treated surgically in 2002 and 2003 respectively. This hospital is also well known for an extremely high ectopic to delivery rate first reported by Douglas in 1963 of 1 ectopic in 29 pregnancies [6]. Surgical treatment is associated with the associated morbidity from both surgical and anaesthetic complications [7] and often results in the loss a fallopian tube which may have a bearing on the patient’s fertility. Surgery may also be done conservatively with linear salpingostomy salvaging the fallopian tube in cases where the ectopic is unruptured and the patient is stable. This method of treatment was more popular at UHWI in the 1990’s before the advent of medical treatment of similar patients. Medical management of ectopic pregnancy is done with the use of methotrexate. This is a folic acid antago- nist that interferes with DNA synthesis and is effective against trophoblastic tissue. It was first used successfully in the treatment of ectopic pregnancy in Japan in 1982 [8]. The use of methotrexate decreases the need for sur- gical intervention and the associa