CHRONIC ECTOPIC PREGNANCY - A CLINICAL ANALYSIS OF 62 CASES

Chronic ectopic pregnancy is a form of tubal pregnancy in which salien t minor ruptures or abortions of an ectopic pregnancy, instead of a si ngle episode of bleeding, incites an inflammatory response often leadi ng to the formation of-a pelvic mass. Its clinical features are often confusing, and laboratory evaluations are often misleading. Surgery fo r chronic ectopic pregnancy is frequently difficult since chronic infl ammatory changes and adhesions distort the normal anatomy. In the pres ent retrospective study, its incidence was found to be 20.3% (n=62) in a series of 305 ectopic pregnancies. A pelvic mass of varying sonogra phic appearance, mostly with a nonhomogenous echo pattern, was demonst rated in all 55 patients in whom transvaginal sonographic evaluation w as performed preoperatively. Although most of the patients [91.9% (n=5 7)] had a positive serum beta HCG value, 5 patients had a negative tes t value. Laparotomy resulted in 40 salpingectomies, 19 salpingo-oophor ectomies, and 3 total abdominal hysterectomies with salpingo-oophorect omies. One patient had an incidental cystotomy and 2 an incidental col otomy. We conclude that chronic ectopic pregnancy is not rare, althoug h little is mentioned about it as a clinical entity in the gynaecologi cal literature. With increased awareness of its mildly symptomatic and protracted clinical course, and with proper interpretation of laborat ory evaluations, a preoperative diagnosis can be made in the majority of the cases.