Published: 2017-10-28

An audit of extra-uterine pregnancy in a tertiary care facility in Northern India

Sheeba Marwah, Kumari Usha Rani, Archana Mishra


Background: Ectopic pregnancy is the most frequent lethal gynaecological predicament, befalling worldwide in all strata of reproductive women. It remains the leading cause of pregnancy-related first trimester deaths. Though prompt diagnosis has furthered a decline in associated morbidity, an upsurge has been seen in its prevalence owing to a rise in predisposing risk factors. The objectives of this study were to identify incidence, risk factors, and outcome in patients presenting with ectopic pregnancy in a tertiary care hospital.

Methods: This two-year retrospective study was conducted in Department of Obstetrics and Gynecology in Vardhaman Mahavir Medical College and Safdarjung hospital, on patients presenting with a diagnosis of ectopic pregnancy (either ruptured or un-ruptured). The primary outcome was incidence of ectopic pregnancy. Secondary outcomes noted were demographic characteristics, predisposing risk factors, clinical presentation and management course in hospital. Data was recorded on a predesigned proforma and deciphered later.

Results: Incidence of ectopic pregnancy was 0.82%. Significant causative factors were previous history of PID (29.28%), TB (21.4%), previous pelvic surgeries (18.57%) and preceding ectopic pregnancy (12.14%).

Conclusions: Increase awareness and knowledge of risk factors amenable to modification and features will aid early diagnosis of extra-uterine pregnancy, besides planning conservative treatment if possible, and devising effective risk-reduction strategies.


Audit, Clinical outcome, Ectopic gestation, Risk factors, Trends, Tertiary hospital

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Takai IU, Yakasai IA, Joy OI, Ugwa EA. An audit of gynaecological procedures performed at Aminu Kano Teaching Hospital. Kano J Basic Clinical Reproductive Sci. 2015;4(2):64-9.

Donald L, Fylstra MD. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. AJOG. 2012;206(4):289-99.

Fernandez H, Capmas P, Lucot JP, Resch B, Panel P, Buouer J. Fertility after ectopic pregnancy: the DEMETER randomized trial. Human Reproduction 2013;28(5):1247-53.

Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates in the Medicaid population. Am J Obset Gynecol. 2013;208:274.e1-7.

Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361:379-87.

Marwah S, Gupta S. Spontaneous Bilateral tubal gestation: a rare case report. Case Reports in Obstet Gynecol. 2016:8526903.

Vaswani P, Vaswani R. Evaluation of risk factors for ectopic pregnancy among women attending a tertiary care hospital in United Arab Emirates: a case control study. Sri Lanka J Obstet Gynaecol. 2013;35(2):53-7.

Aziz S, Al-Wafi B, Swadi HA. Frequency of ectopic pregnancy in a medical centre, Kingdom of Saudi Arabia. J Pak Med Assoc. 2011;61(3):221-4.

Aboyeji AP, Fawole AA, Ijaiya MA. Trends in ectopic pregnancy in Ilorin, Nigeria. Nigerian J Surg Res. 2002;4(1-2):6-10.

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;157:185-94.

Farquhar CM. Ectopic Pregnancy. The Lancet. 2005;366:583-91.

Abasiattai AM, Utuk MN, Ugege W. Spontaneous heterotropic pregnancy with tubal rupture and delivery of a live baby at term: a case report. Nigerian J Med. 2010;19(2):236-8.

Mutihir JT, Nyango DD. Massive Haemoperitoneum from endometriosis masquerading as ruptured ectopic pregnancy: case report. Nigerian J Clin Practice. 2010;13(4):477-9.

Kirk E, Papageorghious AT, Condous G, Tan L. The diagnostic effectiveness of a initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod. 2007;22:2814-28.

Erondu FO, Okoro CR, Aniemeka JI, Ugwu AC, Ohuegbe CI. Atypical clinical sonographic presentation of ectopic pregnancy: a case report. J Med Med Sci. 2010;1(4):5.

Cohen A, Zakar L, Gil Y, Amer-Alshiek J, Bibi G, Almog B, et al. Methotrexate success rates in progressing ectopic pregnancies: A reappraisal. Am J Obstet Gynecol. 2014;211(2):128.e1-5.

Bangsgaard N, Lund CO, Ottesen B, Nilas L. Improved fertility following conservative surgical treatment of ectopic pregnancy. BJOG. 2003;110:765-70.

Musa J, Daru PH, Mutihir JT, Ujah IAO. ectopic pregnancy in Jos Northern Nigeria: prevalence and impact on subsequent fertility. Nigerian J Med. 2009;18:35-8.

Dabota BY. Management and outcome of ectopic pregnancy in developing countries. Ectopic Pregnancy Modern Diagn Manag. Edited by Kamrava M (Ed.); Intech publisher;2011:109-136.

Pathiraja RP, Jayawardane MAMM, Silva KCDP, Srisanjeevan S. An audit on surgical management of Tubal ectopic pregnancies and patients’ preferences survey. Sri Lanka J Obstet Gynecol. 2015;6:19-21.

Mol F, Mello NMV, Strandell A, Strandell K, Jurkovic D, Ross J, et al. Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomized controlled trial. Lancet. 2014;383(9927):1483-9.

Tait RL. Five cases of extrauterine pregnancy operated upon at the time of rupture. BMJ. 1884;1:1250-51.

Wakankar R, Kedar K. Ectopic Pregnancy: a rising Trend. Int J Sci Stud. 2015;3(5):18-22.

Gaddagi RA, Chandrashekhar AP. a clinical study of ectopic pregnancy. J Clin Diagn Res. 2012;6(5):867-9.

Tuli AG, Goyal S, Livingston D, Kurian AS. Ectopic pregnancy: a five-year retrospective study in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2015;4(5):1400-3.

Murugusen A, Prabhu K, Muthulakshmi M. A retrospective study of ectopic pregnancies in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2016;5(8):2537-40.

Singh S, Mahendra G, Vijayalakshmi S, Pukale RS. Clinical study of ectopic pregnancy in a rural setup: a two-year survey. Nat J Med Res. 2014;4(1):37-9.

Prasanna B, Jhansi CB, Swathi K, Shaik MV. A study on risk factors and clinical presentation of ectopic pregnancy in women attending a tertiary care centre. IAIM. 2016;3(1):90-6.

Majhi AK, Roy N, Karmakar KS, Banerjee PK. Ectopic pregnancy: an analysis of 180 cases. J Indian Med Assoc. 2007;105(6):308-12.

Yakasai IA, Abdullahi J, Abubakar IS. Management of ectopic pregnancy in Aminu Kano teaching hospital Kano Nigeria: A 3 year. Global Advanced Res J Med Med Sci. 2012;1(7):181-5.

Igwegbe AO, Eleje GU, Okpola BC. An appraisal of the management of ectopic pregnancy in a Nigerian Tertiary Hospital. Ann Med Health Science Res. 2013;3(2):166-70.

Onwuhafua PI, Onwuhafua A, Adesiyun GA, Adze J. Ectopic pregnancies at Ahmadu Bello University Teaching Hospital, Kaduna Northern Nigeria. Trop J Obstet Gynecol. 2001;18:82-6.

Shetty S, Shetty A. A clinical Study of ectopic pregnancies in a tertiary care hospital of Mangalore, India. Innovative J Med Health Sci. 2014;4(1):305-9.

Mufti S, Rather S, Mufti S, Rangrez RA, Wasiqa, Khalida. Ectopic pregnancy: an analysis of 114 cases. JK Practitioner. 2012;17(4):20-3.

Panchal D, Vaishnav G, Solanki K. Study of management in patient with ectopic pregnancy. NJIRM. 2011;2(3):91-4.

Asuri SS, Kalpana P. A clinical study of ectopic pregnancy. IJRCOG. 2016;5(11):3750-3.

Suseela TL, Gunakala KC. A study on management, morbidity and mortality of ectopic pregnancy attending a tertiary care centre at Rajiv Gandhi Institute of Medical Sciences General Hospital, Kadapa, Andhra Pradesh, India. IJRCOG. 2016;5(11):3736-9.

Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010;115(3):495-502.

Andrea A, Creanga MD, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, et al. Trends in ectopic pregnancy mortality in the United States 1980-2007. Obstet Gynecol. 2011;117(4):837-43.

Yadav DP, Bhati I, Bhati BS. Ectopic pregnancy: a comprehensive analysis of risk factors and management. Int J Reprod Contracept Obstet Gynecol. 2016;5(8):2723-7.