A retrospective study of ectopic pregnancy at a tertiary care centre

Abstract

Background: Ectopic pregnancy is a global problem and is the most common life-threatening emergency in early pregnancy leading to significant morbidity and fetal loss. It occurs in variable presentations. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The aim of this study was to determine the incidence, clinical presentation, risk factors, treatment, and morbidity and mortality associated with ectopic pregnancy.Methods: The present retrospective study was conducted over a period of three years in the department of obstetrics and gynecology at SMS and R, Greater Noida, UP from Feb 2014 to Jan 2017.A total of 80 patients with ectopic pregnancy were analyzed regarding clinical presentation, risk factors, operative findings and treatment modality.Results: Total number of 80 cases of ectopic pregnancies were admitted during this period against 2645 deliveries representing frequency of 3%. Majority of cases (43.75%) were in the age group of 25-29 years and 41.25% were gravida 4 and above. Risk factors were identifiable in 66.25% of cases. Previous abortion was the most common risk factor (31.25%). The classical triad of amenorrhea, pain abdomen and vaginal bleeding was present in 71.25% of cases. More than half of case (55%) had ruptured tubal pregnancy on admission. Unruptured tubal pregnancy was seen in 10% case. Interestingly we found one rare case of bilateral ectopic pregnancy. Salpingectomy by open method was the mainstay of treatment (86.25%).Conclusions: Ectopic pregnancy is still a major challenge in gynecological practice. In our country most of the cases present late after tubal rupture requiring radical surgical treatment. Early diagnosis and timely intervention in the form of medical treatment or conservative surgery not only reduces maternal morbidity but also preserves future fertility.

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

“…In postpartum period, edematous, congested and friable tube increases the chance of incomplete tubal occlusion resulting in ectopic implantation. A history of infertility preceded 8.88% of the cases synchronous with 6.25%, 7%, 8% of Mehta A, Sudha VS, Ganitha et al 13,16,17 Ovulation induction history was found in 6.6% of the study subjects comparable to 1.25%, 4% of Mehta A, Shetty VH et al respectively. 16,18 Hormonal alterations caused by clomiphene and other ovulation induction agents may predispose to tubal implantation.…”

“…Prior ectopic history was elicited in 4.44% of cases analogous to 3.75%, 4%, 4.2% of Mehta A, Shalini Kumari, S Tahmina et al 12,16,27 Tubal corrective surgery was documented in 4.44% of the study subjects which corresponds to 3.29%, 4%, 5.7% of Li, Karmakar, Assouni Mindjah YA et al respectively. 15,23,28 Use of medical abortifacients was documented in 4.44% of our patients parallel to 9.7% of Shetty KS et al 22 The overall risk of rupture of EP by OTC abortifacient is as high as 1.9% to 6.5% as demonstrated in studies by Sarojini and Kavina S et al 29,30 There is a dire need to institute an ultrasound mandatory before medical abortion, and bring in legislation seeking a protocol on the sale of MTP pills over the counter.…”

“…Methotrexate was successful in 4.44% of cases akin to 5.5%, 6.14% of Dasari and Sudha VS et al respectively. 14,17 The first successful surgical intervention to treat an ectopic pregnancy was by John Bard, a surgeon in New 5,24 General anaesthesia was administered to 48.88 % corresponding to 38%, 51.92% of Shetty VH, Wakankar et al Nearly 51% of patients were operated under spinal anaesthesia parallel to 46.15%, 62% of Wakankar, Shetty VH et al 18,19 Preponderance of the implantations were in the fallopian tube (95.55%) akin to 94.4%, 94.71%, 96%, 96.2% of S Tahmina, Sudha VS, Singh S, Wakankar et al Ampullary ectopics amounted to 41.86% similar to Porwal S (40%), Mehta A (42.5%), Singh S (44%) et al 9,16,38 Ectopic in isthmus was documented in 9.3% of the patients analogous to 8%, 9.52%, 10.76% of Ganitha, N. Spandana, Chate MT et al 10,13,26 Interstitial ectopic accounted for 9.3% of cases corresponding to 4% each of Mooij and Shetty VH, 6.25% in Kaur N et al 5,18,39 Cornual ectopic (4.65%) was the least common site equivalent to 4.65%, 4.76% of studies by Choudhary, N.Spandana et al 26,40 Non tubal ectopic was seen in two cases (4.65%).Both were pregnancies in rudimentary horn akin to studies by Gaddagi R (9.1%), 4% each of Shalini Kumari and Prasanna B et al 11,12,31 Right sided ectopic cases were paramount accounting to more than 50% of the cases homogenous to studies of Kaveri Patel (50%), Wakankar (55.76%), Sabina Yeasmin (57.44%) et al 19,32,36 About 21 women (46.66%) had left sided lesions comparable to 40%, 42.5% of Shetty VH, Sabina Yeasmin et al 18,32 Nearly 62.79% had hemoperitoneum analogous to 65.3%, 70% of studies by S.Tahmina, Sabina Yeasmin et al…”

“…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.…”

“…Only two women were above 35 years of age (4.44%)parallel to 3.75%, 4%, 4% of studies of Mehta A, Trina Karmakar, Singh S et al respectively. 9,15,16 Second gravidas comprised of 42.22% of study subjects corresponding to studies of Sudha VS (32.45%), Shetty VH (38%) et al 17,18 The higher incidence in multigravida is probably due to previous miscarriages and infection resulting in tubal damage. Primi gravidas amounted to 26.6% of ectopic cases analogous to 23.07%, 24% of Wakankar, Shetty VH et al 18,19 Third gravida comprised of 24.44 % of the patients similar to 28% of Shetty VH et al 18 Fourth gravida accounted for 4.44%, akin to 10% of Shetty VH et al The lowest incidence of 2.22% was discerned in 5th gravida homogenous to 5.7% in studies of Wakankar R et al 19 Gestational age ranged between 4 and 15 weeks.…”