Study of the diagnosis and management of ectopic pregnancy in a rural medical college and hospital

Abstract

Background: Ectopic pregnancy is the implantation of the blastocyst elsewhere except the endometrial lining of the uterus. Ectopic pregnancy is a potentially life-threatening adverse pregnancy outcome and it requires prompt evaluation and treatment. It remains to be one of the leading causes of maternal death in the first trimester. But with better health facilities, early diagnosis and prompt treatment morbidity and mortality can be reduced.

Methods: This retrospective study was conducted over a period of 2 and a half-years from July 2018 to December 2020, in the department of obstetrics and gynaecology at Adichunchanagiri Hospital and Research Centre, B. G. Nagara, Karnataka. A total of 22 cases were admitted at our hospital during this time frame. Four modes of treatment were given according to the patient's condition, ultrasound findings and beta-human chorionic gonadotropin (hCG) levels; these were laparoscopy, laparotomy, methotrexate injection and conservative management. The outcome measures included success of each treatment modality, need for second mode of treatment in each group and duration of hospital stay. Data was collected in a preconceived format from the patient database retrospectively and analyzed.

Results: Total numbers of vaginal deliveries were 4626 during the study period. Of which 0.49% were diagnosed as ectopic pregnancy. The mean age in this study was 26.5 years. Previous history of tubectomy (22.7%), lower segment caesarean section (13.6%), and previous abortion/medical termination of pregnancy (18.1%), pelvic inflammatory disease (9.09%), previous oral contraceptive pills (OCP) use (9.09%), and ovulation induction (4.5%) were major contributing factors responsible for incidence of ectopic pregnancy. The pain was the most consistent presenting symptom in 90.9% of women. A classical triad of ectopic pregnancy (pain, amenorrhea and bleeding per vaginum) seen in 77.2% women. The incidence of tubal ectopic was maximum, i.e. 19 (86.4%) cases out of 22 cases. Among tubal ectopic pregnancies, the most common site was ampulla (68.18%). 14 (63.61%) cases were of ruptured ectopic pregnancies. Complete salpingectomy (50%) was done in maximum women. Salpingo oophorectomy was done in 9.09%. Methotrexate was given to 22.7% of the women. No significant morbidity and mortality was found in our study among 22 patients.

Conclusions: Proper evaluation of pregnancy with associated risk factors and early diagnosis will help to preserve the tube and in turn her fertility and thus helps in decreasing morbidity and mortality.