Ectopic pregnancy in African developing countries

Abstract

Objective. We have reviewed the scientific literature on ectopic pregnancy (EP) in African countries published over the past 20 years and available from several databases (MED-LINE, EMBASE, POPLINE, and Cochrane Fertility Regulation Group), with the aim of painting a complete picture of the situation (incidence, risk factors, diagnosis, treatment, and complications). Results. Although hospital-based African studies indicate EP incidence has probably increased in Africa in recent decades, major methodological limitations in the published literature make it impossible to draw formal conclusions concerning the incidence of EP in Africa in recent years. As in industrialized countries, pelvic inflammatory disease (PID) associated with sexually transmitted diseases (STDs) must be considered as the most important risk factor for EP in developing countries. In African developing countries, a majority of hospital-based studies have reported EP case fatality rates of around 1-3%, 10 times higher than that reported in industrialized countries. Late diagnosis, leading in almost all cases to major complications, and emergency surgical treatments are key elements accounting for such high fatality rates in women suffering from EP in Africa. Conclusion. EP should be considered a relevant public health indicator in developing countries, providing an overall picture of the capacity of a health system to deal with the diagnosis and treatment of emergency situations, especially in the field of obstetrics and gynecology.

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

“…Further, case fatality rates from ectopic pregnancy are 10-fold higher in developing African countries as compared to high-income countries, in large part due to a delayed or erroneous diagnosis. 11 A high proportion of ectopic pregnancies require blood transfusion. In a retrospective review of cases of ectopic pregnancy in a hospital in Western Tanzania, 33 of 88 (37.5%) cases required blood transfusion.…”

Ruptured extrauterine pregnancy

“…Of all the reported pregnancies, 0.4 to 2% are extrauterine [1,2]. The improved accuracy of transvaginal ultrasonography, early in pregnancy, and the quantitative measurement of the β-unit of human chorionic gonadotropin (β-hCG) allow early detection of ectopic pregnancies [3,4].…”

“…Maternal morbidity and mortality associated with ectopic pregnancy are still much more of a scourge in the developing world due to the lack of adequate health care and shortage of resources such as laboratory facilities and ultrasound [1]. In South Africa, in 1999-2001, 27 of the 1462 deaths attributed to direct causes were associated with ectopic pregnancy [7].…”