A clinical study of ectopic pregnancy at a tertiary care centre in Telangana, India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20200358Keywords:
Amenorrhoea, Ectopic pregnancy, Maternal mortality, Risk factors, SalpingectomyAbstract
Background: Ectopic pregnancy (EP) is a life-threatening obstetrics emergency in early trimester, associated with a high morbidity and mortality if not timely intervened. High index of clinical suspicion is required for early diagnosis, specifically in women presenting with amenorrhoea, pain abdomen and vaginal bleeding. Aim of this study is to determine the incidence, risk factors, clinical presentation, management and outcome of ectopic pregnancy.
Methods: This retrospective observational study was conducted in the department of obstetrics and gynaecology, at Prathima institute of medical sciences, Telangana from July 2012 to June 2019, for a period of 7 years. A total of 53 cases of ectopic pregnancy were analyzed for parameters like age, gravidity, gestational age, risk factors, clinical presentation, management and morbidity.
Results: Incidence of ectopic pregnancy was 5.3 per thousand deliveries. Majority of cases were in age group of 20 to 25 years (52.8%) and were gravida 3 and above (68%). The commonest risk factors identified were history of previous pelvic surgeries (37.7%) followed by history of abortion (18.8%). Commonest symptoms were abdominal pain (90.6%), amenorrhoea (75.5%) and vaginal bleeding (47.2%). Only 41.5 % of cases had triad of symptoms. Fallopian tube (92.4%), specifically ampulla (62.3%) was the most frequent site affected. About 73.6% cases presented with ruptured tube. Surgery (94.3%) was the mainstay of therapy.
Conclusions: ectopic pregnancy is a life-threatening emergency, early diagnosis and treatment will improve the prognosis.
References
Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Cashey BM et al. Williams obstetrics. 25th ed. United States of America. Mc Graw Hill Education; 2018;19:371-87.
Hoover RN, Hyer M, Pfeiffer RM, Adam E, Bond B, Cheville AL, et al. Adverse health outcomes in women exposed in utero to diethylstilbestrol. N Engl J Med. 2011;365(14):1304-14.
Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates and racial disparities in the Medicaid population, 2004-2008. Fertil Steril. 2014;102(6):1671-6.
Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol. 2017;130(2):366-73.
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.
Sudha VS, Delphine RT. A retrospective study on ectopic pregnancy: a two-year study. Int J Reprod Contracept Obstet Gynecol. 2016;5:4365-8.
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;6:2485-90.
Crochet JR, Bastian LA, Chireau MV. "Does this woman have an ectopic pregnancy? the rational clinical examination systematic review". JAMA. 2013;309(16):1722-9.
Timmerman D. Predictive model for early diagnosis of ectopic pregnancy. Verh K Acad Geneeskd Belg. 2004;66(2):155-71.
Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361(4):379-87.
Shetty S, Shetty A. A clinical study of Ectopic pregnancies in a Tertiary care hospital of Mangalore, India. Inn J Med Health Sci. 2014;4(1):305-9.
Islam A, Fawad A, Shah AA, Jadoon H, Sarwar I, Abbasi A. Analysis of two years cases of ectopic pregnancy. J Ayub Med Coll Abbottabad. 2017;29(1):65-7.
Yeasmin M, Uddin M, Hassan E. A clinical study of ectopic pregnancies in a tertiary care hospital of chittagong, Bangladesh. Chattagram Maa-O-Sishu Hospital Medical College J. 2014;13(30):1-4.
Chate MT, Chate B, Chate K. Clinical study of ectopic pregnancy. Int J Reprod Contracept Obstet Gynecol. 2017;6:3498-501.
Panda SR, Rani A, Meena M. Clinico sociodemographic profile of ruptured ectopic pregnancies at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2017;6:1885-9.
Gaddagi RA, Chandrashekhar AP. A clinical study of ectopic pregnancy. J Clin Diag Res. 2012;6(5):867-9.
Tahmina S, Daniel M, Solomon P. Clinical analysis of ectopic pregnancy in tertiary care centre in south India: a six-year retrospective study. J Clin Diag Res. 2016;10(10):13-6.
Singh S, Mahendra G, Vijaylaxmi S, Pukale RS. Clinical study of ectopic pregnancy in a rural setup: a two year survey. Natl J Med Res. 2014;4(1):37-9.
Kokate PH, Kurude V, Ahire B. Clinical study of ectopic pregnancy at tertiary care centre in Mumbai. IJRAMR. 2017;4(1):2163-5.
Ramana SV, Padmaja G. Clinical study of ectopic pregnancy. Indian J Applied Res. 2015;5(4):494-6.
Kirk E, Papageorghiou AT, Condous G, Tan L, Bora S, Bourne T. The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod. 2007;22:2824-8.
Van Mello NM, Mol F, Opmeer BC, Ankum WM, Barnhar K, Coomarasamy A, et al. Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. Hum Reprod Update. 2012;18:603-17.
Tubal ectopic pregnancy. ACOG Practice Bulletin NO. 191. American College of Obstetrician and Gynaecologist. Obstet Gynecol. 2018;131:e65-77.
Murrey H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005;173(8):905.
Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Site of ectopic pregnancy: a 10-year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224-30.
Igwegbe AO, Eleje GU, Okpala BC. An appraisal of management of ectopic pregnancy in a Nigerian Tertiary hospital. Ann Med Health Sci Res. 2013;3(2):166-70.
Jurkovie D. Ectopic pregnancy. In: Edmonds DK, editor. Dew Hurst’s textbook of Obstetrics and Gynecology. 7th ed. USA: Blackwell Publishers; 2007.
Shah N, Khan NH. Ectopic pregnancy: presentation and risk factors. J Coll Physicians Surg Pak. 2005;15:535-8.
Chatterjee S, Dey S, Chowdhury RG, Ganguli D. Ectopic pregnancy in previously infertile women subsequent pregnancy outcome after laparoscopic management. Al Ameen J Med Sci. 2009;2(1):67-72.
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.
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.
