DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20220154

A decade study of the incidence and clinical analysis of ectopic pregnancy at a tertiary hospital in Eastern Nigeria

Jemima A. Chukwu, Ambrose E. Agulanna, Izuchukwu A. Okafor, Agnes A. Nwakanma, Blessing C. O. Osuji

Abstract


Background: Ectopic pregnancy (EP), a condition where a fertilized egg grows outside a woman’s uterus, is a fertility- and life-threatening gynecological condition. This study aimed at determining the incidence of EP, clinical presentation, gestational age at presentation, risk factors and treatment modalities.

Methods: This study was conducted at St. Charles Borromeo specialist hospital, Onitsha, Nigeria (January 2009 to December 2018). Information were obtained from the hospital’s medical records as retrieved from various wards. Data were analyzed using IBM SPSS, version 23, then presented as percentage in tables and figure.

Results: Out of 13,402 pregnancies recorded in this study, 119 were EPs giving an incidence of 0.89%. 105 case notes were included in this study since they met the inclusion criteria. Majority of the women belonged to the age group of 26-30 years. Patients with EP presented more between 7-8 weeks of gestational age (40%), though 7.6% were unsure of their last menstrual period. 80 EP cases (76.2%) were ruptured while 25 (23.8%) were unruptured. The ectopic gestation occurred most at the ampulla (51.4%) and more at the right side (66.6%) than the left (33.4%). Pelvic inflammatory disease (30.4%) followed by prior abortion (20.0%) were major predisposing risk factors. The most common clinical presentations were abdominal pain (92.38%), amenorrhea (57.14%) and vaginal bleeding (51.42%). 85.7% had salpingectomy, 9.5% were medically managed.

Conclusions: EP remains a major gynecological emergency. Diagnosis before rupture could offer an opportunity for a successful medical management, thereby; minimizing morbidity and mortality.


Keywords


Ectopic pregnancy, Amenorrhea, Salpingectomy, Gestational age

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References


Udigwe GO, Umeononihu OS, Mbachu II. Ectopic pregnancy: A 5 year review of cases at Nnamdi Azikiwe university teaching hospital (NAUTH) Nnewi. Niger Med J. 2010;51(4):160-3.

Zhang J, Zhang Y, Gan L, Liu X, Du S. Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy. BMC Pregnancy Childbirth. 2020;20(1):654.

Patel M, Chavda D, Prajapati S. A retrospective study of 100 cases of ectopic pregnancy: clinical presentation, site of ectopic and diagnosis evaluation. Int J Reprod Contracept Obstet Gynecol. 2016;5(12):4313-6.

Bhuria V, Nanda S, Chauhan M, Malhotra V. A retrospective analysis of ectopic pregnancy at a tertiary centre; one year study. Int J Reprod Contracept Obstet Gynecol. 2016;5(7):2224-7.

Barnhart KT. Clinical practice. ectopic pregnancy. N Engl J Med. 2009;361(4):379-87.

Liskin LS. Maternal morbidity in developing countries: a review and comments. Int J Gynecol Obstet. 1992;37(2):77-87.

Celestine OJ, Justina OA. Ectopic pregnancy experience in a tertiary health facility in South-South Nigeria. Niger Health J. 2016;16(1).

Akaba GO, Agida TE, Onafowokan O. Ectopic pregnancy in Nigeria’s federal capital territory: a six year review. Niger J Med. 2012;21(2):241-5.

Oguejiofor CB, Ezugwu CJ, Eleje GU, Emeka EA. Ruptured ectopic pregnancy in a nigerian tertiary hosiptal: what has changed? Int J Gynecol Obstetric Res. 2020;8:14-9.

Rajkhowa M, Glass MR, Rutherford AJ, Balen AH, Sharma V, Cuckle HS. Trends in the incidence of ectopic pregnancy in England and Wales from 1966-1996. BJOG. 2002;107(3):369-74.

Anorlu RI, Oluwole A, Abudu OO, Adebajo S. Risk factors for ectopic pregnancy in Lagos, Niger. Acta Obstet Gynecol Scand. 2005;84(2):184-8.

Igwegbe AO, Eleje GU, Okpala BC. An appraisal of the management of ectopic pregnancy in a Nigerian tertiary hospital. Ann Med Health Sci Res. 2013;3(2):166-70.

Sorbi F, Sisti G, Pieralli A, Di TM, Livi L, Buccoliero AM, et al. Cervicoisthmic choriocarcinoma mimicking cesarean section scar ectopic pregnancy. J Res Med Sci. 2013;18(10):914-7.

Orazulike NC, Konje JC. Diagnosis and management of ectopic pregnancy. Women Health. 2013;9(4):373-85.

Panti A, Ikechukwu NE, Lukman OO, Yakubu A, Egondu SC, Tanko BA. Ectopic pregnancy at Usmanu Danfodiyo university teaching hospital Sokoto; a ten year review. Ann Niger Med. 2012;6(2):87-91.

Okoror CEM, Uhunmwangho BO, Idemudia O. Ectopic pregnancy at a teaching hospital, Nigeria: an analysis of presentation and risk factors. Menoufia Med J. 2020;33(2):415-8.

Lawani OL, Anozie OB, Ezeonu PO. Ectopic pregnancy: a life-threatening gynecological emergency. Int J Women’s Health. 2013;19(5):515- 21.

Onwuhafua PI, Onwuhafua A, Adesiyun GA, Adze J. Ectopic pregnancies at the Ahmadu Bello university teaching hospital, Kaduna Northern Nigeria. Trop J Obstet Gynaecol. 2001;18(2):82-6.

Meena N, Bairwa R, Sharma S. Study of ectopic pregnancy in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2019;9(1):212-5.

Atlas. Fact sheet: Girls not brides. Available at: https://www.girlsnotbrides.org/child-marriage/india/. Accessed on 17 December 2021.

Abdulkareem TA, Eldan SM. Ectopic pregnancy: diagnosis, prevention and management. Intech. 2017:49-65.

Gharoro EP, Igbafe AA. Ectopic pregnancy revisited in Benin City, Nigeria: analysis of 152 cases. Acta Obstet Gynecol Scand. 2002;81(12):1139-43.

Kamwendo F, Forslin L, Bodin L, Danielson D. Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Sex Transm Infect. 2000;76(1):28-32.

Horne AW, Brown JK, Nio-Kobayashi J. The association between smoking and ectopic pregnancy: Why nicotine is BAD for your fallopian tube. Plos One. 2014;9(2):89400.

Lynos RA, Saridogan E, Djahanbakhch O. The reproductive significance of human fallopian tube cilia. Hum Reprod Update. 2006;12(4):363-72.

Igberase GO, Ebeigbe PN, Igbekoyi OF, Ajufoh BI. Ectopic pregnancy: an 11-year review in tertiary center in the Niger Delta. Trop Doctor. 2005;35:175-7.

Orji EO, Fasubaa OB, Adeyemi B, Dare FO, Onwudiegwu U, Ogunniyi SO. Motality and morbidity associated with misdiagnosis of ectopic pregnancy in defined Nigerian population. J Obstet Gynaecol. 2002;22:548-50.

Goyaux N, Leke R, Keita N, Thonneau P. Ectopic pregnancy in African developing countries. Acta Obstetricia et Gynecologica Scandinavica. 2003;82:305-12.

Paluku JL, Kalole BK, Furaha CM. Late abdominal pregnancy in a post-conflict context:case of a mistaken acute abdomen-a case report. BMC Pregnancy Childbirth. 2020;20(1):238.

Awojobi OA, Ogunsina S. Ectopic pregnancy in rural practice. Niger J Med. 2001;10:139-40.