A retrospective analysis of ectopic pregnancies in tertiary care hospital of Western India: two year study

Authors

  • Tanmay J. Chudasama Department of Obstetrics and Gynecology, SVP Hospital, NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Sapana R. Shah Department of Obstetrics and Gynecology, SVP Hospital, NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Rupa C. Vyas Department of Obstetrics and Gynecology, SVP Hospital, NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Purvi M. Parikh Department of Obstetrics and Gynecology, SVP Hospital, NHL Municipal Medical College, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20203319

Keywords:

Bleeding per vagina, Ectopic pregnancy, Pelvic inflammatory disease, Urine pregnancy test

Abstract

Background: Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester and major cause of reduced reproductive potential. Early detection of EP by improved ultrasonography modalities has decreased the rate of rupture and consequent maternal morbidity. Aim was to study the predisposing risk factors in modern scenario and choose the appropriate management available.

Methods: A retrospective study on clinical diagnosis and management of EP of patients was carried out between January 2018 to February 2020. Investigations included CBC, UPT, serum β-hCG and TVS. Management was decided after thorough evaluation.

Results: Out of 7,780 deliveries, 70 were EP (0.9%). Women with age 21-30 year had highest incidence (85.7%). Common symptoms were abdominal pain (94%), amenorrhea (87%), bleeding per vagina (48%). Most common risk factor associated with EP was PID (28.5%). Tubal EP was most common (84.2%) involving ampulla (66%), isthmus (15%), fimbria (12%), interstitial (7%). Scar ectopic was reported in 10% of cases and ovarian, rudimentary horn and abdominal pregnancy in 1.4% each. About 52.8% of ectopic was ruptured and salpingectomy was done in 74.3% and salpingo-oophorectomy in 2.8%. Five cases of scar EP required hysterotomy and 1 case was managed by methotrexate (MTX).

Conclusions: EP remains a major challenge to the obstetrician worldwide. A high index of suspicion is required for early diagnosis and timely intervention in the form of medical or surgical treatment will definitely help in reducing the morbidity and mortality.

References

Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates in the medicaid population. Am J Obstet Gynecol. 2013;208(4):274.e1-7.

Department of Health. In: Drife J, Lewis G, editors. Why Mothers Die: A Confidential Enquiry into the Maternal Deaths in the United Kingdom. Norwich, UK: HMSO; 2001:282.

Cumminghum FG, Leveno, Bloon St, Hauth JC, Rouse DJ, Spong CY. Ectopic pregnancy; In Williams obstetrics, 23rd United States of America MC Graw Hills Publishing; 2010:238-254.

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

Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S. Dtsch Arztebl Int. 2015;112(41):693-703.

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

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.

Gaddagi RA, Chandrashekbar AP. A clinical study of ectopic pregnancy. J Clin Diagnos Res. 2012;6:867-9.

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

Yakasai IA, Abdullahi J, Abubakar IS. Management of ectopic pregnancy in Aminu Kano teaching hospital Kano Nigeria: a 3-year. Glob Adv Res J Med Med Sci. 2012;1:181-5.

Li C, Meng CX, Zhao WH, Lu HQ, Shi W, Zhang J. Risk factors for ectopic pregnancy in women with planned pregnancy: a case–control study. Eur J Obstet Gynecol Reprod Biol. 2014;181:176-82.

Barnhart K. Ectopic pregnancy. N Engl J Med. 2009;361:379-87.

Wakankar R, Kedar K. Ectopic pregnancy-rising trend at Indira Gandhi Government Medical College, Nagpur. Int J Sci Stud. 2015;3(5):18-22.

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. 2016;10(10):QC13-QC16.

Avcioğlu SN, Altinkaya SÖ, Küçük M, Demircan Sezer S, Yüksel H. Predictors of success of different treatment modalities for management of ectopic pregnancy. Obstet Gynecsol Int. 2014;2014:423708.

Seow KM, Hwang JL, Tsai YL, Huang LW, Lin YH, Hsieh BC. Subsequent pregnancy outcome after conservative treatment of a previous caesarean scar pregnancy. Acta Obstet Gynecol Scand. 2004;83(12):1167-72.

Kuscu NK, Lacin S, Kartal O, Koyuncu F. Rupture of rudimentary horn pregnancy at the 15th week of gestation: a case report. Eur J Obstet Gynecol Reprod Biol. 2002;102(2):209-10.

Takacs P, Latchaw G, Gaitan L, Chakhtoura N, De Santis T. Risk factors for conversion to laparotomy during laparoscopic management of an ectopic pregnancy. Arch Gynecol Obstet. 2005;273(1):32-4.

Howard W. Jones III, John A. Rock, TeLinde’s Operative Gynecology, 11th ed. 771-98

Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207:44.e1-13.

Majhi AK, Roy N, Karmakar KS, Banerjee PK. Ectopic pregnancy - an analysis of 180 cases J, Indian Med Assoc. 2007;105(6):310-2.

Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol. 2012;206:289-99.

Downloads

Published

2020-07-23

Issue

Section

Original Research Articles