A retrospective analysis of ectopic pregnancy in a tertiary care centre in South Kerala

Abstract

Introduction: Ectopic pregnancy means the presence of pregnancy outside the normal uterine cavity. Ectopic pregnancy commonly occurs in the fallopian tube (95 %). Diagnosis can be made by USG, serum hCG, although the 'gold standard' is laparoscopy. Management of the cases depends on the clinical presentation, site of the ectopic and need for future reproductive function and can be medical as well as surgical. Objectives: To determine the incidence of ectopic pregnancy, to assess the percentage of ectopic pregnancy diagnosed with each modality, to identify the factors associated with ectopic pregnancy and to calculate the type of management employed whether medical or surgical. Material and methods: This is a retrospective study where all the cases of ectopic pregnancies from 1 st January 2008 to 31 st December 2013 were included. The data on each patient was obtained and was duly entered in M S Excel and descriptive statistical measures were used for analysis Results: The incidence of ectopic pregnancy in the present study was 0.7%. 33.3% patients were primigravida. 5.5% had history of recurrent abortions, 11% of the patients took treatment for infertility, 27.7% had history of previous LSCS, D&C was done in 13% patients and 31.5% had undergone sterilization. In 83.3% ectopic gestation was diagnosed by ultrasound whereas rest 16.7% was diagnosed by serial serum hCG estimation. 22.2% underwent medical management whereas 89% patients underwent surgical management. Failure of medical therapy and subsequent surgical management was seen in 50% patients. Conclusions: Ectopic pregnancy causes significant morbidity to the mother and hence requires a high index of suspicion so that diagnosis can be made early and also to prevent complications and preserve the future reproductive function of the patient.

A study of incidence, risk factors, clinical profile and management of 50 cases of ectopic pregnancy in a tertiary care teaching hospital

“…Similar to our study, most studies reported that majority of women diagnosed with ectopic pregnancy belonged to this age group. 7,[9][10][11][12][13][14][15][16]18,19 This is probably because sexual activity and fertility of women is highest during this period. In the present study, 70% of the women were multiparous which was comparable with studies by Bhuria et al, Rakhi et al, Yadav et al and Prasanna et al 8,15,18,19 In the present study, the commonest site for ectopic pregnancy was tubal (92%).…”

“…[7][8][9][10][11][12][13][14][15][16] This shows that early diagnosis, timely and prompt management of ectopic pregnancy, availability of adequate blood and blood components improves the outcome of ectopic pregnancies. Delay in seeking healthcare, accessibility to expert health facilities, initial misdiagnosis and delayed referral are important deterrents to prompt management of ectopic pregnancy.…”

Clinical Profile of Ectopic Pregnancy at a Tertiary Care Centre in Eastern Nepal- A Retrospective Study

“…In the present study, 75 % of women were in the age group of 20-35 years. Similarly many studies reported that majority of women diagnosed with ectopic pregnancy belonged to this age group (11,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). This is probably because this age group is the period of highest sexual activity and fertility.…”

A clinical study of trends of ectopic pregnancy and its management in a tertiary care hospital

“…Yeasmin S et al 22,26,32 UPT was found to be negative in 6 cases (13.33%) relatable to 6% in studies by Prasanna B et al 31 Culdocentesis was done in 6 cases (13.33%) kindred to studies by Gupta V (16%), Gaddagi R (37.8%), Ganitha (40%) et al 11,13,33 The first successful ultrasound diagnosis of ectopic pregnancy was reported by Kobayashi in 1969. Nearly 86.67% of patients had documented ultrasound findings of echogenic adnexal mass relatable to 83%, and 84% of Nair L and Wakankar et al 19,34 Hemoperitoneum was visualised in 29 patients (64.44%) similar to 62.5%, 66.6% of Debnath J ,Sudha VS et al 17,35 Gestational sac in adnexa was appreciated in 17.78% (n = 8) of individuals akin to 11%, 14% in studies by Mooij, Ganitha G et al 5,13 Ectopic cardiac activity was detected in four patients (8.89%) homologous to 12.5%, 16% in studies by Debnath J, Shetty VH et al 18,35 Pseudo gestational sac was noted in 4.4% patients corresponding to 12%,16% of studies by Debnath J, Shetty VH et al 18,35 Rudimentary horn was seen in 4.4% patients analogous to 9.1% in studies by Gaddagi R et al 11 The classical triad of amenorrhoea, pain abdomen, bleeding per vaginum was discerned in 23 women (51.11%) corresponding to 48%, 53.84%, 54.2%, of Karmakar, Wakankar, Soren M et al 15,19,20 History of amenorrhoea was seen in 88% equivalent to 84%, 86.25%, 88%, 88.09% of Shalini, Mehta A, Shetty VH, Pranathi et al 7,12,16,18 About 86% of ectopic patients presented with pain abdomen kindred to studies by Sudha VS (82.4%), Wakankar (86.53 %), Shetty VH (88%), Most. Sabina Yeasmin (89%) et al [17][18][19]32 Bleeding per vaginum was perceived in 66% of patients homogenous to 63.3%, 63.5%, 65.3%, 68% of studies of Sudha VS, Most.…”