Analysis of ectopic pregnancies admitted to emergency department

Background: Ectopic pregnancy is a challenging and life-threatening emergency, which can cause significant maternal morbidity and mortality. The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies in a tertiary care teaching hospital.Methods: This was a prospective study of 50 cases of ectopic pregnancies admitted to the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital from August 2012 to September 2013. Relevant data of the 50 patients was tabulated and descriptive analysis was carried out.Results: The incidence of ectopic pregnancy was 6.3 per 1000 deliveries. Majority of the patients (82%) belonged to 20-30 yrs age group. 70% of the women were multiparous. The commonest site of ectopic pregnancy was fallopian tube (92 %). Past history of pelvic inflammatory disease (40%), abortions (20%), abdominopelvic surgery (14%) and IUCD usage (12%) were among the important risk factors identified. 20% of the patients had no identifiable risk factor. The classical triad of amenorrhea, bleeding per vaginum and abdominal pain was seen in 56 % of the study population. The most important signs which guided the diagnosis of ectopic pregnancy were cervical excitation pain (74%), abdominal tenderness (72%), adnexal mass or fullness (68%) and tenderness in the fornix (68%). Clinical presentation, urinary pregnancy test, culdocentesis and ultrasound were the diagnostic tools used for diagnosis of ectopic pregnancy. The incidence of ruptured ectopic pregnancy was 86%. Majority of the patients underwent salpingectomy (96%). There was no maternal mortality in our study.Conclusions: Early diagnosis, timely referral, improved access to health care, aggressive management and improvement of blood bank facilities can reduce the maternal morbidity and mortality associated with ectopic pregnancy.

Section: Discussionmentioning

confidence: 99%

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

Ganitha

Anuradha

2017

“…The definitive treatment is the interruption of pregnancy by laparoscopy or laparotomy that also allows the realization of the definitive diagnosis of ectopic pregnancy. 4,5 It should be noted that, unlike other cases where the resolution ends with a hysterectomy, in this patient a right salpingo-oophorectomy was performed, preserving the possibility of a new pregnancy.…”

Section: Discussionmentioning

confidence: 88%

“…2 The diagnosis of a tubular ectopic pregnancy is made at an average gestational age of 6 (+1.5) weeks of gestation, varying between 5 and 10 weeks of gestation. 5,6 The size that is known to reach a tubal pregnancy before breaking is about 1.5-3.5 cm, after this size, the growth inside the uterine tubes would cause the rupture of them, due to the absence of elastic muscle fibers in these. 7 Reports have been made of advanced tubal ectopic pregnancies, such as that of Sachan, of a tubal ectopic pregnancy of 14 weeks' gestation, measuring 10 x 12 cm, confirmed by laparotomy and resolved with left salpingooophorectomy.…”

Section: Introductionmentioning

confidence: 99%

Advanced tubal ectopic pregnancy of 19 weeks gestation: case report and review of the literature

Huerta¹,

J²,

Pompa

et al. 2018

Ectopic pregnancy is a condition in which the fertilized ovum is impacted anywhere other than the uterine cavity, these sites may be uterine tubes, cervix, ovary and abdomen. Ectopic implantation in the uterine tubes occurs up to 98%. The distribution according to its location is: 78% ampullary, 12% isthmic, 5% fibrous, 2-3% interstitial, 1% ovarian, 1-2% abdominal, and more rare in cervix with 0.5%. Ectopic pregnancy occurs 1.2 to 2% of pregnancies, with an associated mortality of 0.5 deaths per 1000 pregnancies. There are multiple risk factors for an ectopic pregnancy, among the most frequent are: women with pelvic inflammatory disease (salpingitis) conditioned mainly by Chlamydia trachomatis and Neisseria gonorrhea, anatomical abnormalities of the tubes, previous surgery in them (including sterilization), masses extrinsic tumors that compress them, endometriosis, zygote anomalies, endocrinopathies (corpus luteum deficiency in late ovulation), use of intrauterine devices, previous ectopic pregnancy (as a result of surgical treatment or due to persistence of the original risk factor), contraceptive users with gestagens in low doses, assisted reproduction techniques, smokers, secondary adhesions to surgical interventions on the uterus, ovaries, and other pelvic or abdominal organs, exposure of the uterus to diethylstilbestrol, among others. The objective of this case is to describe an advanced tubal ectopic pregnancy. The following case report is about a 24-year-old patient with a pregnancy of 19 weeks of gestation by first-trimester ultrasound and a history of recent laparoscopic cholecystectomy secondary to biliary lithiasis. He is in the first trimester of normo-evolutive and without symptoms. Authors present to the emergency department with a 24-hour abdominal pain syndrome that requires exploratory laparotomy and right salpingo-oophorectomy due to the presence of ruptured tubal ectopic pregnancy with average fetometry of 19 weeks of gestation. The patient is discharged after an adequate clinical evolution.

“…11 In a prospective study on 35 pregnant women referred to the emergency by Simsec et al in Turkey, they were studied in addition to demographic parameters, β-hCG level, transvaginal ultrasound pathology findings and treatment protocol and results indicated that the level of β-hCG alone was not valuable in the diagnosis of ruptured EP and the final diagnosis should still be with transvaginal ultrasound surgery and ultrasound. 12 Heather Murray et al in a study stated that advances in ultrasound technology and β-hCG measurement methods have complicated the diagnostic workup process in patients with suspected EP because less invasive treatment options are being developed. 13 In a study by Conolly et al by examining symptomatic first trimester pregnant women (abdominal pain and vaginal bleeding) by transvaginal ultrasound and β-hCG measurement they concluded that improved intrauterine pregnancy detection with lower β-hCG could be improved by ultrasound technology however the cut of area is higher than the current guidelines.…”

Section: Discussionmentioning

confidence: 99%

Transvaginal ultrasound compared with serum β-hCG level for diagnosis of ectopic pregnancy in symptomatic patients

Jeddi

Mobaraki

Pirzadeh

2020

Background: Ultrasonography (US) is the most important imaging modality in detecting both intrauterine and ectopic pregnancies. The aim of this study was to comparison transvaginal ultrasound with serum β-hCG level for diagnosis of ectopic pregnancy (Ep) in referred women to Ardabil city hospital.Methods: In this cross-sectional study, a total of 207 women with diagnosis of Ep were enrolled during 2018. All women underwent transvaginal US in the first 24 hours and US done by an expert radiologist. Serum levels of β-hCG at first 24 hours and the time gap between US examination and last menstrual period (LMP) were compared between women with positive and negative US findings. Data collected by a checklist and analyzed by statistical method in SPSS version 21.Results: The primary US were positive in 174 women (84.1%) and negative in 33 women (15.9%). The mean of time gap between US and LMP in women with diagnosed EP was significantly higher than other women (median, 42 days versus 45 days, p=0.042). Also, the mean of serum level of β-hCG had significant difference between two groups. In logistic regression analysis results showed that the time gap between US and LMP hadn’t significant impact on EP diagnosis. The best discriminative zone was set at a serum β-hCG level of 105.65 mIU/ml with a sensitivity and specificity of 82% and 27%, respectively and the under-ROC area was 58%.Conclusions: According to our findings, the median serum level of β-hCG in women with undiagnosed Ep were significantly lower than women with correct diagnosis of Ep but the mean and median of time gap between US and LMP in women with diagnosed EP was more than women without Ep. Also, the proposed discriminative zone for serum level of β-hCG in our study is different from the previous studies.