The impact of tubal ectopic pregnancy in Papua New Guinea – a retrospective case review

Abstract

BackgroundEctopic pregnancy (EP) is an important cause of morbidity and mortality amongst women of reproductive age. Tubal EP is well described in industrialised countries, but less is known about its impact in low-resource countries, in particular in the South Pacific Region.MethodsWe undertook a retrospective review of women with tubal EP treated at a provincial referral hospital in coastal Papua New Guinea over a period of 56 months. Demographic and clinical variables were obtained from patients’ medical records and analysed. The institutional rate of tubal EP was calculated, and diagnosis and management reviewed. Potential risk factors for tubal EP were identified, and delays contributing to increased morbidity described.ResultsA total of 73 women had tubal EP. The institutional rate of tubal EP over the study period was 6.3 per 1,000 deliveries. There were no maternal deaths due to EP. The mean age of women was 31.5+/−5.7 years, 85% were parous, 67% were rural dwellers and 62% had a history of sub-fertility. The most commonly used diagnostic aid was culdocentesis. One third of women had clinical evidence of shock on arrival. All women with tubal EP were managed by open salpingectomy. Tubal rupture was confirmed for 48% of patients and was more common amongst rural dwellers. Forty-three percent of women had macroscopic evidence of pelvic infection. Two-thirds of patients received blood transfusions, and post-operative recovery lasted six days on average. Late presentation, lack of clinical suspicion, and delays with receiving appropriate treatments were observed.ConclusionsTubal EP is a common gynaecological emergency in a referral hospital in coastal PNG, and causes significant morbidity, in particular amongst women residing in rural areas. Sexually transmitted infections are likely to represent the most important risk factor for tubal EP in PNG. Interventions to reduce the morbidity due to tubal EP include the prevention, detection and treatment of sexually transmitted infections, identification and reduction of barriers to prompt presentation, increasing health workers’ awareness of ectopic pregnancy, providing pregnancy test kits to rural health centres, and strengthening hospital blood transfusion services, including facilities for autotransfusion.

A Retrospective Study on Risk Factors and Clinical Presentation of Ectopic Pregnancy

“…Most of the women were married (97.5%). A study by Hamura et al [6] also showed an almost similar figure (93%). Risk factors were found in only 35% cases.…”

“…A study by Gaddagi et al [7] had almost similar result in which 8.1% cases of ectopic pregnancy were due to PID. Our findings were different from the findings of Hamura et al [6] in which 43% cases had macroscopic evidence of PID at the time of surgery. The importance of infectious factors in ectopic pregnancy is well documented.…”

“…The prevalence of ectopic pregnancy is mostly related to nulli parity [1] . A study by Gaddagi et al [7] concluded that 27% cases were nulliparous, 10.8% were primiparous and 62.2% were multiparous .Hamura et al [6] found that 15% women were nulliparous, 56% were Para one or para two. In a study by Igwegbe et al [2] multiparous patients were the largest (54.8%).…”

“…Al-Turki et al [5] also showed that majority of the patients (61.1%) were below the age of 30 yrs. Hamura et al [6] showed a majority of the cases (95%) were aged >25 yrs. 60% cases in our study are either nulliparous or Primi parous.…”

Rate of ectopic pregnancy in Madinah Maternity and Children Hospital, Madinah, Saudi Arabia

“…Post conservative management of ectopic pregnancy adhesions develops in the pelvic area and in turn, presence of pelvic adhesions increase the rate of ectopic pregnancy [9,10].…”