A clinical analysis of ectopic pregnancies in a tertiary care centre: A one year retrospective study

Abstract

Following fertilization and fallopian tube transit, the blastocyst normally implants in the endometrial lining of the uterine cavity. An ectopic pregnancy occurs when a fertilized ovum implants outside the normal uterine cavity. Fortunately, beta-human chorionic gonadotropin (β-hCG) assays and transvaginal sonography (TVS) aid earlier diagnosis, maternal survival, and fertility conservation. Ruptured ectopic is a surgical emergency.To study and analyse ectopic pregnancies in a tertiary care centre.To determine the incidence, risk factors, clinical presentation, management, morbidity and mortality of ectopic pregnancy.: A retrospective analysis of ectopic pregnancies was done in Gandhi hospital, Secunderabad from October 2021 to September 2022 (1 year duration) with a sample of 97 cases of suspected ectopic pregnancies observed and treated, out of total 11252 pregnant women admitted.The incidence of ectopic pregnancy was 8 per 1000(0.81%) pregnancies, majority between the age of 20-30yrs (87.5%) and in higher order pregnancies (3or>3 pregnancies) (50.4%). Risk factors were multiparity (50.5%), h/o infertility treatment (12.3%), tubal sterilisation (7.2%). The typical triad of amenorrhoea, pain abdomen and bleeding p/v was observed in 69% of cases. In 16.4% cases the haemoglobin was <7gm% at presentation. Among 97 suspected cases of ectopic pregnancies, 90(92.7%) cases were found to have ectopic pregnancy. 27.8% of cases were presented in class 2 or more haemorrhagic shock. 79% cases were ruptured ectopic pregnancies. Ampullary ectopic pregnancies were predominant(62.9%) followed by corneal (14.6%) > fimbrial(13.4%) > ovarian(4.4%)> isthmus (2.2%). 2 women among 97 cases of suspected ectopic pregnancies were found to have Heterotopic pregnancy {tubal+intrauterine [missed abortion]}. Unilateral salpingectomy was done in 90.5% cases. Medical management was done successfully with single dose of methotrexate in 1 case. Blood transfusions were given in 69.9% cases. Post op wound complications were observed in 3.1% cases. Mortality is zero in present study.Clinicians should be aware of the fact that any women in reproductive age group presenting with pain in lower abdomen or vaginal bleeding, ectopic pregnancy should be suspected irrespective of presence or absence of amenorrhoea, whether or not she has undergone sterilization, because early diagnosis is critical in reducing maternal morbidity and mortality and improving treatment success rates.