Changing Paradigms in the Initial Treatment of Ectopic Pregnancy at a University Hospital in Brazil

Abstract Objective To evaluate the use of different treatment options for ectopic pregnancy and the frequency of severe complications in a university hospital. Methods Observational study with women with ectopic pregnancy admitted at UNICAMP Womeńs Hospital, Brazil, between 01/01/2000 and 12/31/2017. The outcome variables were the type of treatment (first choice) and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran–Armitage test, chi-square test, Mann–Whitney test and multiple Cox regression. Results In total 673 women were included in the study. The mean age was 29.0 years (± 6.1) and the mean gestational age was 7.7 (± 2.5). The frequency of surgical treatment decreased significantly over time (z = -4.69; p < 0.001). Conversely, there was a significant increase in the frequency of methotrexate treatment (z = 4.73; p < 0.001). Seventy-one women (10.5%) developed some type of severe complication. In the final statistical model, the prevalence of severe complications was higher in women who were diagnosed with a ruptured ectopic pregnancy at admission (PR = 2.97; 95%CI: 1.61–5.46), did not present with vaginal bleeding (PR = 2.45; 95%CI: 1.41–4.25), had never undergone laparotomy/laparoscopy (PR = 6.69; 95%CI: 1.62–27.53), had a non-tubal ectopic pregnancy (PR = 4.61; 95%CI: 1.98–10.74), and do not smoke (PR = 2.41; 95%CI: 1.08–5.36). Conclusion there was a change in the first treatment option for cases of ectopic pregnancy in the hospital during the period of analysis. Factors inherent to a disease that is more difficult to treat are related to a higher frequency of severe complications.

摘要：研究目的：评估巴西坎皮纳斯州立大学（UNICAMP）附属妇女医院内异位妊娠（ectopic pregnancy）的不同治疗方案应用情况，以及严重并发症的发生频率。
方法：本研究为观察性研究，纳入2000年1月1日至2017年12月31日期间，该院收治的异位妊娠女性患者。结局变量为首选治疗方案类型与严重并发症发生情况；自变量为临床与社会人口学资料。统计分析采用Cochran-Armitage趋势检验、卡方检验、曼-惠特尼检验及多重Cox回归分析。
结果：本研究共纳入673例女性患者，平均年龄29.0岁（±6.1），平均孕周7.7（±2.5）。随着时间推移，手术治疗的应用频率显著降低（z=-4.69；p<0.001）；反之，甲氨蝶呤（methotrexate）治疗的应用频率显著升高（z=4.73；p<0.001）。共有71例患者（10.5%）发生了某种类型的严重并发症。最终统计模型显示，以下情况的患者严重并发症发生率更高：入院时诊断为异位妊娠破裂者（PR=2.97；95%置信区间CI：1.61~5.46）、无阴道出血症状者（PR=2.45；95%CI：1.41~4.25）、既往未接受过剖腹手术/腹腔镜手术者（PR=6.69；95%CI：1.62~27.53）、为非输卵管异位妊娠者（PR=4.61；95%CI：1.98~10.74）以及非吸烟者（PR=2.41；95%CI：1.08~5.36）。
结论：本研究分析期间，该医院异位妊娠患者的首选治疗方案发生了变化。疾病本身的难治性相关因素与更高的严重并发症发生频率相关。