Epidemiological patterns and clinical presentations of ectopic pregnancy in a tertiary hospital: a prospective observational study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20252311Keywords:
Epidemiological pattern, Ectopic pregnancy, Clinical presentation, Fallopian tubeAbstract
Background: Ectopic pregnancy is a potentially life-threatening condition where a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It poses significant risks to the health and well-being of women of reproductive age. This study aims to explore the epidemiological patterns, clinical presentations, and risk factors associated with ectopic pregnancy in a tertiary hospital setting.
Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital, Rajshahi, from January 2014 to June 2014. A total of 45 patients were selected as study subjects by purposive sampling technique. Statistical analysis was carried out by using the statistical package for social sciences (SPSS) version 16.0 for Windows.
Results: The study found that most ectopic pregnancy patients were aged 21-25 years, with 93.3% having ruptured ectopic pregnancies. A majority (60.0%) had 6-8 weeks of amenorrhea, and 46.7% had one prior pregnancy. Common symptoms included abdominal pain, amenorrhea, shock, and per vaginal bleeding, with abdominal pain present in all cases. Acute presentations, such as massive hemorrhage and cardiovascular collapse, were seen in 57.78%, while 35.56% had acute-on-chronic symptoms. Clinical signs often included abdominal tenderness, distention, and a positive cervical excitation test.
Conclusions: The study highlights the significant burden of ectopic pregnancy among women of reproductive age, particularly those between 21 and 30 years. The majority of cases were ruptured (93.3%), often presenting as acute emergencies with massive intraperitoneal hemorrhage and cardiovascular collapse. Abdominal pain was a universal symptom, while vaginal bleeding was present in most ruptured cases. Clinical findings commonly included abdominal tenderness, cervical excitation, and abdominal distension.
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References
Nieminen K. Operative treatment of genital prolapse. 2004. Available at: https://trepo.tuni.fi/bitstream/ handle/10024/67346/951-44-5858-3.pdf. Accessed on 12 May 2025.
Eisner SM, Ebert AD, David M. Rare Ectopic Pregnancies – A Literature Review for the Period 2007 – 2019 on Locations Outside the Uterus and Fallopian Tubes. Geburtshilfe Frauenheilkd. 2020;80(07):686-701. DOI: https://doi.org/10.1055/a-1181-8641
Glenn J, Irvine LM. Dr Robert Lawson Tait: The forgotten gynaecologist. J Obstet Gynaecol. 2011;31(8):695-6. DOI: https://doi.org/10.3109/01443615.2011.613497
Marion LL, Meeks GR. Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clin Obstet Gynecol. 2012;55(2):376-86. DOI: https://doi.org/10.1097/GRF.0b013e3182516d7b
Shrivastava M, Parashar H, Modi JN. A clinical study of ectopic pregnancy in a tertiary care centre in Central India. Int J Reprod Contracept Obstet Gynecol. 2017;6(6):2485-90. DOI: https://doi.org/10.18203/2320-1770.ijrcog20172336
Gazvani MR, Baruah DN, Alfirevic Z, Emery SJ. Mifepristone in combination with methotrexate for the medical treatment of tubal pregnancy: a randomized, controlled trial. Hum Reprod (Oxford, England). 1998;13(7):1987-90. DOI: https://doi.org/10.1093/humrep/13.7.1987
Kamwendo F, Forslin L, Bodin L, Danielsson D. Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Sexually Transmitted Infect. 2000;76(1):28-32. DOI: https://doi.org/10.1136/sti.76.1.28
Nelson AL, Adams Y, Nelson LE, LaHue AK. Ambulatory diagnosis and medical management of ectopic pregnancy in a public teaching hospital serving indigent women. Am J Obstet Gynecol. 2003;188(6):1541-50. DOI: https://doi.org/10.1067/mob.2003.387
Parazzini F, Tozzi L, Ferraroni M, Bocciolone L, La Vecchia C, Fedele L. Risk factors for ectopic pregnancy: an Italian case-control study. Obstet Gynecol. 1992;80(5):821-6.
Steen R, Shapiro K. Intrauterine Contraceptive Devices and Risk of Pelvic Inflammatory Disease: Standard of Care in High STI Prevalence Settings. Reproductive Health Matters. 2004;12(23):136-43. DOI: https://doi.org/10.1016/S0968-8080(04)23123-8
Job-Spira N, Coste J, Aublet-Cuvelier B, Germain E, Fernandez H, Bouyer J, et al. Incidence of extra-uterine pregnancy and characteristics of treated patients. First results of the auvergne registry. Presse Medicale (Paris, France: 1983). 1995;24(7):351-5.
Moini A, Hosseini R, Jahangiri N, Shiva M, Akhoond MR. Risk factors for ectopic pregnancy: A case–control study. J Res Medical Sci. 2014;19(9):844.
Panchal D, Vaishnav G, Solanki K. Study of management in patient with ectopic pregnancy. Infection. 2011;33:55.
Kumtepe Y, Kadanali S. Medical treatment of ruptured with hemodynamically stable and unruptured ectopic pregnancy patients. Eur J Obstet Gynecol Reprod Biol. 2004;116(2):221-5. DOI: https://doi.org/10.1016/j.ejogrb.2004.03.003
Dialani V, Levine D. Ectopic pregnancy: a review. Ultrasound Quarterly. 2004;20(3):105-17. DOI: https://doi.org/10.1097/00013644-200409000-00005
Aydogmus S. Management and results of ectopic pregnancy adapted by clinical guidelines: Two years experience of University Hospital in Turkey. 2014. Available at: https://philpapers.org/rec/AYDMAR. Accessed on 12 May 2025.
Abbas A, Akram H. Ectopic pregnancy: audit at maula Bakhsh teaching hospital Sargodha. Prof Med J. 2011;18(01):24-7. DOI: https://doi.org/10.29309/TPMJ/2011.18.01.1852
Panchal D, Vaishnav G, Solanki K. Study of management in patient with ectopic pregnancy. Infection. 2011;33:55.
Aziz S, Al Wafi B, Al Swadi H. Frequency of ectopic pregnancy in a medical centre, Kingdom of Saudi Arabia. JPMA J Pak Med Assoc. 2011;61(3):221-4.
Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, et al. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol. 2003;157(3):185-94. DOI: https://doi.org/10.1093/aje/kwf190
Menon S, Sammel MD, Vichnin M, Barnhart KT. Risk factors for ectopic pregnancy: a comparison between adults and adolescent women. J Pediatr Adolescent Gynecol. 2007;20(3):181-5. DOI: https://doi.org/10.1016/j.jpag.2007.01.007
Pradhan B, Duwa S. Annual Analysis of Ectopic Pregnancy in Tertiary Care Hospital. Post-Grad Med J NAMS. 2011;11(01).
Goksedef BPC, Kef S, Akca A, Bayik RNE, Cetin A. Risk factors for rupture in tubal ectopic pregnancy: definition of the clinical findings. Eur J Obstet Gynecol Reprod Biol. 2011;154(1):96-9. DOI: https://doi.org/10.1016/j.ejogrb.2010.08.016
Shrestha J, Saha R. Comparison of laparoscopy and laparotomy in the surgical management of ectopic pregnancy. J Coll Physicians Surg Pak. 2012;22(12):760-4.
Dart RG, Kaplan B, Varaklis K. Predictive value of history and physical examination in patients with suspected ectopic pregnancy. Ann Emerg Med. 1999;33(3):283-90. DOI: https://doi.org/10.1016/S0196-0644(99)70364-1