Published: 2019-08-26

An analysis of tubal ectopic pregnancy in a rural tertiary care hospital in India: a retrospective study

Chandana Galidevara, Swaramya C.


Background: The objective of this study was to analyse distribution of predisposing risk factors for ectopic pregnancy and to study the various modalities of management instituted along with surgical characteristics.

Methods: This is a retrospective data analysis of tubal ectopic pregnancies (EP) managed in a tertiary rural referral centre over three years.

Results: A total of 160 women were managed for tubal EP. Majority of the women belonged to the age group of 21-30 years (73%). Multigravidae constituted 71.3% of the women and overall, 90.6% women conceived spontaneously. History of ovulation induction was present in 3.7% of women, IUI in 1.2% and IVF in 4.4%. Risk factors encountered in the study include previous EP (9.4%), history of tubal sterilisation (6.9%), caesarean section (13.1%), PID (7.5%), miscarriage (25%), tubal recanalization (3.7%). Conservative management was instituted in 16.8%. Amongst the women managed surgically, 67.5% underwent laparotomy with the remaining being managed laparoscopically. Of the surgically managed patients 72.9% had ruptured EP. There was a predominance of right sided ectopic in our study (79%) and ampullary region of the fallopian tube was the most common site of tubal EP (81.2%). The most common procedure performed was total salpingectomy (56.4%). Supportive treatment with blood transfusion was required amongst 18.8% of the women who had EP. In the postoperative period, fever was noted in 13.5% of women and 2.5% needed intensive care unit admission for hemodynamic stabilisation. The incidence of wound discharge was 12% of women who underwent surgery.

Conclusions: This study underpins the importance of early diagnosis, appropriate clinical managementwith timely intervention to improve outcomes associated with EP and to prevent severe morbidity and mortality.


Conservative management, Laparoscopy, Laparotomy, Risk factors, Ruptured ectopic, Surgical management, Tubal ectopic

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Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG Int J Obst Gynaecol. 2011;118:1-203.

Falcone T, Mascha EJ, Goldberg JM, Falconi LL, Mohla G, Attaran M. A study of risk factors for ruptured tubal ectopic pregnancy. J Women's Heal. 1998;7(4):459-63.

Pranathi P, Madhavi Y. A clinical analysis of ectopic pregnancies in a tertiary care hospital in Hyderabad. Asian Pac J Heal Sci. 2018;5(1):14-24.

Sindos M, Togia A, Sergentanis TN, Kabagiannis A, Malamas F, Farfaras A, et al. Ruptured ectopic pregnancy: risk factors for a life-threatening condition. Arch Gynecol Obstet. 2009;279(5):621.

Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093-9.

Zwart JJ, Jonkers MD, Richters A, Öry F, Bloemenkamp KW, Duvekot JJ, et al. Ethnic disparity in severe acute maternal morbidity: a nationwide cohort study in the Netherlands. Euro J Pub Heal. 2010;21(2):229-34.

Elson CJ, Salim R, Potdar N, Chetty M, Ross JA, Kirk EJ. Diagnosis and management of ectopic pregnancy. BJOG. 2016;.123:e15-e55.

Mol F, Mol BW, Ankum WM, Van der Veen F, Hajenius PJ. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Human Reproduction Update. 2008;14(4):309-19.

Kumar V, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid. 2015 Nov 16;2015:1406.

Shetty S. A clinical study of ectopic pregnancies in atertiary care hospital of Mangalore, India. Innov J Med Health Sci. 2014;4(1).

Tahmina S, Daniel M, Solomon P. Clinical analysis of ectopic pregnancies in a tertiary care centre in Southern India: a six-year retrospective study. J Clin Diagn Res: JCDR. 2016;10(10):QC13.

Ranji GG, Usha Rani G, Varshini S. Ectopic Pregnancy: Risk Factors, Clinical Presentation and Management. J Obstet Gynaecol Ind. 2018;68(6):487–92.

Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Prac. 2015;1(1):15.

Li C, Zhao W-H, Zhu Q, Cao S-J, Ping H, Xi X, et al. Risk factors for ectopic pregnancy: a multi-center case-control study. BMC Pregnancy Childbirth. 2015:15.

Santos-Ribeiro S, Tournaye H, Polyzos NP. Trends in ectopic pregnancy rates following assisted reproductive technologies in the UK: a 12-year nationwide analysis including 160 000 pregnancies. Human Reprod. 2016;31(2):393-402.

Rodrigues SP, de Burlet KJ, Hiemstra E, Twijnstra AR, van Zwet EW, Trimbos-Kemper TC, et al. Ectopic pregnancy: when is expectant management safe?. Gynecol Surg. 2012;9(4):421-6.

Practice Committee of the American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil steril. 2013;100(3):638-44.

Duggal BS, Tarneja P, Sharma RK, Rath SK, Wadhwa RD. Laparoscopic management of ectopic pregnancies. Med J Arm Forces Ind. 2004;60(3):220-3.