Abstract
Background: Ectopic pregnancy is defined as any intra or extra uterine pregnancy in which the fertilized ovum implants at an aberrant site which is unfavorable to its growth and development. It is the most important cause of maternal mortality and morbidity in the first trimester. It occurs when the developing blastocyst implants either outside the uterus or in an abnormal position within the uterus corneal.
Objective: To find out the incidence of ectopic pregnancy and to determine the clinical features, risk factors, treatment and assessment of risk of maternal mortality and morbidity in a tertiary care hospital.
Material and Methods: This was a retrospective observational study conducted over a period of two years. A total of 17560 deliveries occur during this period and 78 cases were diagnosed as ectopic pregnancy. Data were collected from labor ward and operation theatre registers. All these cases were analyzed with respect to the history, clinical presentation, investigations and treatment.
Results: Out of 17560 deliveries 78 cases were diagnosed as ectopic pregnancy giving the incidence of 0.44%. A majority of the patients (70.51%) belonged to the age group of 20-30 yrs. Among that 71.8% were multigravida and 28.2% were primi gravid. Cervical motion tenderness was found to be a significant finding in 64 (82.05%) cases followed by adenaxal mass in 61 (78.20%) cases. The commonest site for ectopic pregnancy was tubal (93.58%) followed by ovarian (3.84%). Ruptured ectopic was present in 79.48% cases on laparotomy while 11.53% were unruptured.
Conclusion: Ectopic pregnancy is a leading cause in young reproductive woman. High degree of suspicion and early diagnosis is the key to successful management.
Keywords: Amenorrhea, Ectopic pregnancy, Maternal mortality, Ruptured ectopic, Tubectomy.
References
- Mahhoob U, Masher SH. Management of ectopic pregnancy, a two-year study. I Ayub Meb Coll Abbotthad. 2006; 18 (4):34-7.
- Odendaal HJ, Schaetzing AE, Kruger TK. Textbook of Clinical Gynecology. 2nd Ed. Juta Academic publisher. Cape Town, South Africa;2001.
- Cumminghum FG, Leveno, Bloon St, Hauth JC, Rouse DJ, Spong CY. Ectopic pregnancy; In Williams obstetrics, 23rd United States of America MC Graw Hills Publishing. 2010:238-54.
- Singh S, Mahendra G, Vijayalakshmi S, Pukale RS. Clinical study of ectopic pregnancy in a rural setup: A two year survey. Natl J Med Res. 2014;4(1):37–9.
- Khaleeque F, Siddiqui RI, Jafarey SN. Ectopic pregnancies: A three year study. [2] J-Pak Med Assoc. 2001;51(7):240–2.
- Udigwe GO, Umeononihu OS, Mbachu II. Ectopic pregnancy: a 5 year review of cases at nnamdiazikiwe university teaching hospital (NAUTH) Nnewi. Niger Med J. 2010;51(4):160
- Walker JJ. Ectopic pregnancy. ClinObstet Gynecol. 2007;50:89–99
- Berek JS, Berek DL. Berek and Novak’s Gynecology. 15th edition. USA: Lippincott, Williams & Wilkins, A Wolters Kluwer Business; 2012, p. 627.
- Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009; 361:379–87.
- Sultana CJ, Easley K, Collins RL. Outcome of laparoscopic vs traditional surgeries for ectopic pregnancies. Fertil Steril 1992; 57:285.
- Delacruz A, Cumming DC. The factors which determine the fertility after a conservative or radical surgical treatment for ectopic pregnancy. Fertil Steril 1997; 68:871.
- Ory SJ, Villaneva AL, Sand PK. Conservative treatment of ectopic pregnancy with methotrexate. AM J, obstet, Gynecol. 1986;154:1299-306.
- Shah P, Shah S, Kutty RV, Modi D. Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG-5. Trop Med Int Health. 2014;19(5):568–75.
- Yadav K, Namdeo A, Bhargava M. A retrospective and prospective study [8]of maternal mortality in a rural tertiary care hospital of Central India. Indian J Community Health. 2013;25(1):16–21
- Panti A, Tanko B, Yakubu A, Egondu S, Ikechukwu N, lukman O. Ectopic pregnancy at UsmanuDanfodiyo University Teaching Hospital Sokoto: A ten year review. Ann Niger Med. 2012;6(2):87
- Igwegbe A, Eleje G, Okpala B. An appraisal of the management of ectopic pregnancy in a nigerian tertiary hospital. Ann Med Health Sci Res.2013;3(2):166–70
- Panchal D, Vasihanav G, Solanki K. Study of Management inpatient with Ectopic pregnancy. National journal of Integrated Research in Medicine. 2011;2(3):91-4
- Gaddagi RA, Chandrashekbar AP. A Clinical Study of Ectopic pregnancy, Journal of clinical and Diagnostis Research. 2012;6:867-9
- Gupta R, Porwal S, Swarnkar M, Sharma N, Maheshwari P. Incidence, trends and risk factors for Ectopic Pregnancies in a tertiary care hospital of Rajasthan. J Pharm Biomed Sci. 2012;16(07):1-3
- Shetty S, Shetty A. A clinical study of ectopic pregnancies in a tertiary care hospital of mangalore, India. Innov J Med Health Sci. 2014;4(1)305-9
- Sudha VS, Delphine RT. A retrospective study on ectopic pregnancy: a two year study. Int J Reprod Contracept Obstet Gynecol 2016;5:4365-8
- B. Swami, Parul Sharma, Manvi Tyagi, Rinku Kuswaha, Juhee Harit. “Clinical Study of Ectopic Pregnancy”. Journal of Evolution of Medical and Dental Sciences 2015;4(86):15057-62
- Fageeh WM. Diagnosis and Management of Ecotopicpregancyin king Abdul Aziz University Hosptial, a Four year Experience, Medical science. 2008:15(2).
- Chate MT, Chate B, Chate. Clinical study of ectopic pregnancy. Int J Reprod Contracept Obstet Gynecol 2017;6:3498-3501.
- Gupta BK, Pathania BK, Jindal M, Vohra R, Ahmed M. Risk Factors For Ectopic Pregnancy; A case Control study in Tertiary care Centre, Journal of Dental and Medical Sciences. 2014;13(3):23-7.
- Smita Kumari, Dipali Prasad, Archana Sinha, Sadia Parween. Retrospective study of ectopic pregnancy in tertiary care centre. IAIM, 2018;5(1):95-9
- Yakasai IA, Abdullahi J, Abubakar IS. Management of ectopic pregnancy in Aminu Kano teaching hospital Kano Nigeria: Glob Adv Res J Med Med Sci., 2012;1:181-5
- S Tahmina, Mary Daniel, Preethy Solomon. Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study. Journal of Clinical and Diagnostic Research. 2016;10(10):13-6
- Chatterjee S, Dey S, Chowdhury RG, Ganguli D. Ectopic pregnancy in previously infertile women pregnancy in previously outcome after laparaoscoptic Management Al amen J Med Sck. 2009;2(1):67-72.
- Jurkovie D, Ectopic pregnancy, IN: Edmonds DK, Editor, Dew Hurst textbook of obstetrics and Gynecology 7ed, USA: Blackwell Publishers. 2007.
- Latchaw G, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. GynecolObstet Invest. 2005;60(3):177-80.
Corresponding Author
Prem Singh Tak
Dr S N Medical College, Jodhpur, Rajasthan