Published: 2018-05-26

Analysis of various types of ectopic pregnancies: a five-year review

Maheswari S., Poornima C., Lalitha N., Seetha Panicker


Background: Ectopic pregnancy (EP) is a common, life threatening emergency during the first trimester and a significant cause for maternal morbidity and mortality. In any woman of reproductive age presenting with abdominal pain and vaginal bleeding, ectopic pregnancy should be considered. The objectives of the present study is to determine the incidence, risk factors, clinical presentation, type of ectopic pregnancy, treatment, morbidity and mortality.

Methods: Retrospective analysis of case sheets of patients admitted with ectopic pregnancy at PSGIMSR, Coimbatore during the period July 2011 to June 2016 was done. The details noted were age, parity, risk factors {previous abortion, previous EP, previous pelvic surgery, intrauterine contraceptive device, tubectomy, history of pelvic inflammatory disease}, treatment for infertility, clinical presentation, ultrasound findings, investigations including beta HCG value and hemoglobin level, treatment offered, need for blood transfusion, operative findings and morbidity.

Results: During the five year, there were 12,407 deliveries at our hospitals and 88 cases of ectopic pregnancies were managed. The incidence is 6.6/1000 deliveries. Among them 44% belonged to the age group of 25-30 years and multi gravida were 73.8%. Most common risk factors were previous abortion (23.8%) and previous surgeries including caesarean section, tubectomy, appendicectomy, tubal microsurgery (23.8%). Most common presentation was pain abdomen (85.2%). Out of the 88 cases, 73 patients were managed surgically (82.9%) and 11 cases were managed successfully with methotrexate (12.5%). Three of them underwent conservative management and one had Uterine Artery Embolization.

Conclusions: Early diagnosis based on risk factors and timely intervention plays a main role in reducing morbidity and mortality associated with ectopic pregnancy.


Beta HCG, Ectopic pregnancy, Methotrexate, Risk factors, Salphingectomy Transvaginal USG

Full Text:



Walker JJ. Ectopic pregnancy. Clin Obstet Gynecol. 2007;50:89-99.

Mahboob U, Mazhar SB. Management of ectopic pregnancy: a two-year study. J Ayub Med Coll Abbottabad. 2006;18:34-7

Chow WH, Daling JR, Cates WJ, Greenberg RS. Epidemiology of ectopic pregnancy. Epidemiol Rev. 1987;9:70-94.

Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol. 2006;46:521-7.

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

Akande V, Turner C, Horner P, Horne A, Pacey A, British Fertility Society. Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice. Human Fertil. 2010;13:115-25.

Job-Spira N, Collet P, Coste J, Bremond A, Laumon B. Risk factors for ectopic pregnancy. Results of a case control study in the Rhone-Alpes region. Contracept Fertil Sex. 1993;21:307-12.

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.

Parashi S, Moukhah S, Ashrafi M. Main risk factors for ectopic pregnancy: a case-control study in a sample of Iranian women. Int J Fertil Steril. 2014; 8:147-54.

Moini A, Hosseini R, Jahangiri N, Shiva M, Akhoond MR. Risk factors for ectopic pregnancy: a case-control study. J Res Med Sci. 2014; 19:844-9.

Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65:1093-9.

Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel AC, Shaunik A. Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies. Fertil Steril. 2006;86:36-43.

Timmerman D. Predictive models for the early diagnosis of ectopic pregnancy.Verh K Acad Geneeskd Belg. 2004;66:155-71.

Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005;173:905.

Shetty KS, Shetty KA. A clinical study of ectopic pregnancies in atertiary care hospital of Mangalore, India. Innovat J Med H Sci. 2014;4:305-9.

Khaleeque F, Siddiqui RI, Jafarey SN. Ectopic pregnancies: A Three-year study. J Pak Med Assoc 2001;51:240-3.

Karki RCL, Pradhan B, Duwa S. Annual Analysis of Ectopic Pregnancy in Tertiary Care Hospital. PMJN. 2011;11:5-8

Gupta R, Porwal S, Swarnkar M, Sharma N, Maheshwari P. Incidence, trends and risk factors for Ectopic Pregnancies in a tertiary care hospital of Rajasthan. JPBMS. 2012;16:1-3.

Maheswari S, Panicker S. Triplet heterotopic pregnancy following ovulation induction with clomiphene citrate: a case report and review of literature Int J Rerod Contracept Obstet Gynecol. 2013;2:743-5.

Latchaw G, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. GynecolObstet Invest. 2005;60:177-80.

Jurkovie D. Ectopic pregnancy. In: Edmonds DK, editor. Dew Hurst’s textbook of Obstetrics and Gynecology. 7 ed. USA; Blackwell Publishers;2007

Shah N, Khan NH. Ectopic pregnancy: Presentation and risk factors. J Coll Physicians Surg Pak. 2005;15:535-8.

Abbas A, Akram H. Ectopic Pregnancy; Audit at Maula Bakhsh Teaching Hospital Sargodha.Prof Med J. 2011;18:24-7.

Lozeau AM, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2005; 72:1707-14.

Majhi AK, Roy N, Karmakar KS, Banerjee PK. Ectopic pregnancy--an analysis of 180 cases. J Indian Med Assoc. 2007;105:308-10.