A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource Setting
Background: Guidelines recommend the prompt surgical removal of any ectopic pregnancy (EP) in the presence of a vital embryo. This treatment impacts future fertility, particularly in low-resource settings where access to assisted reproductive techniques is limited. In addition, growing evidence is r...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/17/5642 |
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| author | Michele Orsi Foday Musa Janneh Amadu Sesay Abdul Karim Bah Nitsuh Addis Tiru |
| author_facet | Michele Orsi Foday Musa Janneh Amadu Sesay Abdul Karim Bah Nitsuh Addis Tiru |
| author_sort | Michele Orsi |
| collection | DOAJ |
| description | Background: Guidelines recommend the prompt surgical removal of any ectopic pregnancy (EP) in the presence of a vital embryo. This treatment impacts future fertility, particularly in low-resource settings where access to assisted reproductive techniques is limited. In addition, growing evidence is reporting live births after conservative management of initially undiagnosed abdominal pregnancies. Therefore, the discussion on the acceptability of expectant management in selected cases has been recently raised. Case: We present and discuss the case of a woman with vital first trimester EP who refused surgical treatment at Princess Christian Maternity Hospital, Freetown, Sierra Leone. She was initially diagnosed with a 12 week pregnancy located in the left adnexal region without hemoperitoneum. She refused both surgical treatment and hospital admission and did not come back to the hospital for antenatal care until 26 weeks of gestational age. Therefore, she was admitted and finally delivered, at 34 weeks of gestation, a 1.9 kg healthy baby which was alive. To disentangle the potential conflict between the ethical principles of medical treatment’s beneficence and the patient’s autonomy, we provide an update on counselling for a patient with early vital EP in a resource-limited setting and discuss the knowledge gap in this area. Conclusions: Limited access to fertility treatment in low- and middle-income countries may justify the discussion of expectant management as an option in selected cases of uncomplicated vital EP. |
| first_indexed | 2024-03-10T23:19:41Z |
| format | Article |
| id | doaj.art-a12831a056ce4da8940ef67f8d87d5d7 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T23:19:41Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-a12831a056ce4da8940ef67f8d87d5d72023-11-19T08:23:24ZengMDPI AGJournal of Clinical Medicine2077-03832023-08-011217564210.3390/jcm12175642A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource SettingMichele Orsi0Foday Musa Janneh1Amadu Sesay2Abdul Karim Bah3Nitsuh Addis Tiru4Unit of Obstetrics, Department of Woman Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 12, 20122 Milan, ItalyPrincess Christian Maternity Hospital, University of Sierra Leone Teaching Hospital Complex, Fourah Bay Road, Freetown 00232, Sierra LeonePrincess Christian Maternity Hospital, University of Sierra Leone Teaching Hospital Complex, Fourah Bay Road, Freetown 00232, Sierra LeonePrincess Christian Maternity Hospital, University of Sierra Leone Teaching Hospital Complex, Fourah Bay Road, Freetown 00232, Sierra LeonePrincess Christian Maternity Hospital, University of Sierra Leone Teaching Hospital Complex, Fourah Bay Road, Freetown 00232, Sierra LeoneBackground: Guidelines recommend the prompt surgical removal of any ectopic pregnancy (EP) in the presence of a vital embryo. This treatment impacts future fertility, particularly in low-resource settings where access to assisted reproductive techniques is limited. In addition, growing evidence is reporting live births after conservative management of initially undiagnosed abdominal pregnancies. Therefore, the discussion on the acceptability of expectant management in selected cases has been recently raised. Case: We present and discuss the case of a woman with vital first trimester EP who refused surgical treatment at Princess Christian Maternity Hospital, Freetown, Sierra Leone. She was initially diagnosed with a 12 week pregnancy located in the left adnexal region without hemoperitoneum. She refused both surgical treatment and hospital admission and did not come back to the hospital for antenatal care until 26 weeks of gestational age. Therefore, she was admitted and finally delivered, at 34 weeks of gestation, a 1.9 kg healthy baby which was alive. To disentangle the potential conflict between the ethical principles of medical treatment’s beneficence and the patient’s autonomy, we provide an update on counselling for a patient with early vital EP in a resource-limited setting and discuss the knowledge gap in this area. Conclusions: Limited access to fertility treatment in low- and middle-income countries may justify the discussion of expectant management as an option in selected cases of uncomplicated vital EP.https://www.mdpi.com/2077-0383/12/17/5642ectopic pregnancyexpectant managementfemale infertilitymedical ethicsassisted reproductionlow-resource setting |
| spellingShingle | Michele Orsi Foday Musa Janneh Amadu Sesay Abdul Karim Bah Nitsuh Addis Tiru A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource Setting Journal of Clinical Medicine ectopic pregnancy expectant management female infertility medical ethics assisted reproduction low-resource setting |
| title | A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource Setting |
| title_full | A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource Setting |
| title_fullStr | A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource Setting |
| title_full_unstemmed | A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource Setting |
| title_short | A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource Setting |
| title_sort | clinical and ethical dilemma expectant management for ectopic pregnancy with a vital fetus in a low resource setting |
| topic | ectopic pregnancy expectant management female infertility medical ethics assisted reproduction low-resource setting |
| url | https://www.mdpi.com/2077-0383/12/17/5642 |
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