Title: To Study the Different Clinical Presentations of Ectopic Pregnancy

Authors: Dr Vikram Garasia, Dr Devika Choudhary

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i7.126

Abstract

Background: Ectopic pregnancy has become a commonly seen condition. Its immediate and delayed sequelae must not be under estimated. Although advancement in earlier diagnosis leads to decreased case fatality rate as well as conservative, Laparoscopic treatment have enabled improved outcome, ectopic pregnancy remain a leading cause of maternal mortality and morbidity and accounts for a sizable proportion of infertility and ectopic recurrence. Hence the present study was directed to survey and analyse various clinical aspects of ectopic gestation and to identify various risk factors associated with ectopic pregnancy.

Material & Methods: The present study of different clinical presentations of ectopic pregnancy was conducted on patients who had ectopic pregnancy and were admitted in Dept. of Obst. & Gynae., Rajkiya Mahila Chikitsalaya, J.L.N. Medical College, Ajmer during time period from Oct. 2015 to Dec. 2016. A detailed history of the patients was taken as mentioned in proforma including personal and family history. History of any medical illness and history of any previous surgery was taken. Special attention was paid upon pelvic inflammatory disease, tubal sterilization (either abdominal or Laparoscopic), intrauterine contraceptive devices, hormonal contraception and any history of tubal surgery.

Results: The present study shows the highest incidence of ectopic pregnancy was found in the age group 20-25 years (40%) and minimum incidence was found between 36-40 years of age (3.33%). Amongst the etiological factor in this study highest incidence of ectopic pregnancy was found in previous home delivery (36.66%). In this study incidence of ectopic pregnancy was 11.66% (7 cases) having H/o laparoscopic sterilization (table 3). Pain in lower abdomen was most common finding in this study being present in 99.98%. Clinically pallor was present in 41.66% cases. On per abdominal palpation diffuse tenderness was present in 53.33% cases. In this study group highest incidence of 50% of ectopic pregnancy was found in ampullary portion of fallopian tube and 33.33% in Fimbrial portion of fallopian tube. 1.66% cases of abdominal pregnancy.

Conclusion: It is concluded that most of the cases of ectopic pregnancy can be diagnosed easily by a detailed history and a thorough clinical examination. With the advent of pregnancy test, ultrasonography, and diagnostic laparoscopy diagnosis can be made earlier even before rupture of the tube and management can be done effectively.

Key Words: Ectopic pregnancy, Incidence, Ampulla, risk factors.

References

1.  1.      Dor J, Seidman DS, Levran D, Ben-Rafael Z, Ben-Shlomo I, Mashiach S. The incidence of combined intrauterine and extrauterine pregnancy after in vitro fertilization and embryo transfer. Fertil Steril. Apr 1991;55(4):833-4.

2.      DURUKAN, Tekin et al. Laparoscopic Management of Ectopic Pregnancy Occurring Ten Years after Tubal Sterilization. Gynecology Obstetrics & Reproductive Medicine, [S.l.], v. 15, n. 3, dec. 2009. ISSN 1300-4751.

3.      Jahan Ara Saeed, Idowu Ghani Ogenleye et al. Epidemiology, Risk Factors and Sites of Ectopic Pregnancy in Madina Maternity and Children Hospital, Kingdom of Saudi Arabia. Journal of Islamabad Medical & Dental College (JIMDC); 2013:2(1):26-29.

4.      Saito M, Koyama T, Yaoi Y, Kumasaka T, Yazawa K. Site of ovulation and ectopic pregnancy. Acta Obstet Gynecol Scand. 1975;54(3):227-30.

5.      Joseph RJ, Irvine LM. Ovarian ectopic pregnancy: aetiology, diagnosis, and challenges in surgical management. J Obstet Gynaecol. 2012 Jul;32(5):472-4. doi: 10.3109/01443615.2012. 673039.

6.      Abdullah Karaer et al. Serological investigation of the role of selected sexually transmitted infections in the aetiology of ectopic pregnancy. Pages 68-74 | Published online: 21 Dec 2012.

7.      J.M. Chow, M.L. Yohekura, A. Richwald, S. Greehland, R.L. Sweet and J. Schatchter University of California, Losangeles: 1999.

8.      Curcie – A; Orelj – M; Novakov – A et al : Med – Preg. 1997 May – Jun; 50(5-6) : 212 – 4.

Iavazzo C , Salakos N , Vitoratos N  et al. Intrauterine devices and extrauterine pregnancy. A literature review. Clinical and Experimental Obstetrics & Gynecology 

10.  Franks – AL, Beral – V, Cates – W, Hogure – CJ: Am – J. Obst – Gynecol. 1990 Oct; 169 (4 pt 1) : 1120 – 3.

11.  Ankum – WM, Mol – BW, Van-der-veen-F. Contraception 1995 Dec; 52(6):337 – 41.

12.  Michalas – S; Minaretzis – D et al. Int – J –Gynecol. Obstet. 1992 Jun. 38 (2):101 – 5.

13.  Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. The risk of ectopic pregnancy after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group. N Engl J Med 1997; 336:762-7.

14.  Cartwright – PS: obst – Gynecol – Clin – North – Am. 1991 Mar; 18 (1) : 19-37.

Corresponding Author

Dr Vikram Garasia

PG Resident (3rd), Department of Obstetrics & Gynaecology,

J.L.N Medical College, Ajmer, Rajasthan