Clinical and Histopathological Findings of Ectopic Pregnancy Cases- A Retrospective Study from a Tertiary Care Hospital, Andhra Pradesh, India

Abstract

Introduction: Ectopic Pregnancy (EP) is defined as a pregnancy that occurs in ectopic location, that is, outside the cavity of uterus. It is one of the leading causes of mortality in the first trimester of pregnancy and one of indication for emergency laparotomy. Timely diagnosis is extremely crucial as delay in diagnosis can lead to mortality. Diagnosing ectopic pregnancy is quiet challenging as there are many conditions which have similar presentation and may not require surgical management. Histopathology is required for confirmation of ectopic pregnancy by identifying trophoblastic tissue in ectopic location since there are other conditions like haematosalpinx, ruptured hemorrhagic corpus luteum which can have similar presentation clinically. Aim: To analyse the clinicopathological features of cases clinically diagnosed as ectopic pregnancy and estimate the percentage of cases which were confirmed on histopathology and assess the percentage of cases which were negative on histopathology. Materials and Methods: This was a retrospective observational study conducted on three years data collected retrospectively between July 2017 and June 2020. Clinical details like age of the patient, parity, gestational age, previous history of any associated risk factors for ectopic pregnancy, were obtained from patient requisition forms and pathology records. Hematoxylin and Eosin (H & E) stained sections were reviewed. Descriptive analysis was done. Data entry was made in Microsoft (MS) excel sheet. Frequencies and percentages were calculated. Results: Total of 128 cases (mean age 25.8±4.87 years) data was analysed in this study, most women were between 21 to 30 years (97 out of 128 (75.7%), with mean age of 25.8 years and presented in 2nd pregnancy (40 out of 86 cases where details were known (46.5%) and in 6th week of gestation (28 out of 78 cases where details were known) (35.8%)) with mean gestational age of 7.2 weeks. Most common risk factors were previous abortions and previous caesarean section (36 out of 82 cases where details were known (43.9% each)). Fallopian tube was the most common site (112 out of 113 cases, 99.1%). On histopathological examination, trophoblastic tissue was identified in 116 cases out of 128 cases. (90.6%). Twelve cases showed no evidence of trophoblastic tissues (11.7%), of these, three cases (25%) showed ruptured corpus luteum, seven cases (40%) showed hematosalpinx, and two cases (13.3%) showed chronic salpingitis changes. Conclusion: Ectopic pregnancy was most frequent in women between 21 to 30 years, in 2nd pregnancy and in 6th week of gestation. Most common risk factors were previous abortions and previous caesarean section. Fallopian tube was the most common site. Ectopic pregnancy was confirmed on histopathological examination, 90.6% cases. A total of 11.7% cases which showed no evidence of trophoblastic tissues, were cases of Haematosalpinx, ruptured hemorrhagic corpus luteum and chronic salpingitis and they presented clinically as ectopic pregnancy.