An audit of extra-uterine pregnancy in a tertiary care facility in Northern India

Abstract

Background: Ectopic pregnancy is the most frequent lethal gynaecological predicament, befalling worldwide in all strata of reproductive women. It remains the leading cause of pregnancy-related first trimester deaths. Though prompt diagnosis has furthered a decline in associated morbidity, an upsurge has been seen in its prevalence owing to a rise in predisposing risk factors. The objectives of this study were to identify incidence, risk factors, and outcome in patients presenting with ectopic pregnancy in a tertiary care hospital.Methods: This two-year retrospective study was conducted in Department of Obstetrics and Gynecology in Vardhaman Mahavir Medical College and Safdarjung hospital, on patients presenting with a diagnosis of ectopic pregnancy (either ruptured or un-ruptured). The primary outcome was incidence of ectopic pregnancy. Secondary outcomes noted were demographic characteristics, predisposing risk factors, clinical presentation and management course in hospital. Data was recorded on a predesigned proforma and deciphered later.Results: Incidence of ectopic pregnancy was 0.82%. Significant causative factors were previous history of PID (29.28%), TB (21.4%), previous pelvic surgeries (18.57%) and preceding ectopic pregnancy (12.14%).Conclusions: Increase awareness and knowledge of risk factors amenable to modification and features will aid early diagnosis of extra-uterine pregnancy, besides planning conservative treatment if possible, and devising effective risk-reduction strategies.

Ectopic Pregnancy in Tigray, Ethiopia: A Cross-Sectional Survey of Prevalence, Management Outcomes, and Associated Factors

“…The present study determined the prevalence, key management outcomes, and factors associated with the management outcomes of EPs treated in Central Tigray region of Ethiopia. We found that the prevalence of EP was recorded in 5 : 1000 deliveries (0.5%), a finding consistent with studies in Guinea (0.41%) [9], and Papua New Guinea (0.6%) [16]; although different globally, EP accounts for almost 2% [8,9], South Africa (2.2%) [12], and Nigeria (1.1%) [13]. These variations could be linked to differences in environmental conditions (e.g., exposure to toxic materials), the prevalence of related infections (e.g., sexually transmitted infections), and social lifestyle (e.g., smoking).…”

“…Journal of Pregnancy areas is far better than their rural counterparts, and this may influence the early presentation to EP care and treatment, which is supported by research in Ethiopia and India [8,18]. Consistent with other findings [1,22], women diagnosed with EP and anemia were also at higher risk of unfavorable EP outcome management.…”

“…However, only 50% of patients present with typical symptomatology [10]. The exact etiology of EP is elusive but the factors which predispose women to EP include age, abortion status, ovulation stimulation, pelvic infection, tubal surgeries, and use of modern contraceptives [8,11]. For example, a ten-year cross-sectional study in Nigeria (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) showed that the majority of cases were between 26 and 30 years, were married, multiparous, and had a previous history of induced abortions [11].…”

“…In Ethiopia, the magnitude of EP among total deliveries was 0.82% [ 7 ]. Globally, EP accounts for almost 2% of all pregnancies, 0.25-2% of all pregnancy-related complications, and 9% of all pregnancy-related deaths [ 8 , 9 ].…”

“…The clinical presentation of EP varies from asymptomatic to acute abdominal pain and may present with hypovolemia and shock [ 8 , 11 ]. A four-year cross-sectional study conducted in South Africa showed abdominal pain was the main complaint of patients, accounting for 81.1% of the recorded symptoms, and more than one-third of patients had signs of shock when they presented to the hospital [ 12 ].…”