Ectopic Pregnancy: Assessing the Incidence, Risk Factors, Clinical Characteristics, Diagnosis, Treatment, and Maternal Outcome in Tertiary Care Hospital
Authors/Creators
- 1. Senior Resident, Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India
- 2. Associate Professor, Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India
Description
Aim: The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India in opd and ipd from April 2019 to February 2022 antinatal check-up. Total 120 cases were diagnosed with ectopic pregnancy. Results: The incidence of ectopic pregnancy (0.029%) or 2.9 per 1000 antinatal up to 20 weeks. The most common site of ectopic pregnancy was fallopian tube 102(89.17%). Ampulla was the commonest site 90 (75%) for ectopic implantation in the fallopian tube. Heterotopic pregnancy is rare where pregnancy is seen in the uterus and tube at the same time. In our study, there were 3 (2.5%) cases of heterotopic pregnancies. The most common risk factor was pelvic inflammatory disease 55(45.83%) followed by H/o previous abortion 25(20.83%) and H/o previous abdominopelvic surgery including tubal ligation, LSCS and appendicectomy 32(26.67%). In our study, 17(14.17 %) patients were using copper IUCD. 67.5% of the patients had bleeding or spotting per vaginum. Urine pregnancy test was positive in 113(94.17%) of patients. Culdocentesis was positive in 53(44.17%) of patients. Ultrasound was able to diagnose 99(82.5 %) of cases. USG findings suggestive of ectopic pregnancy were extra-uterine gestational sac 15(12.5%), haemoperitoneum 71(59.17%) and adnexal mass 91(75.83%). The incidence of ruptured ectopic pregnancy was 88%. 97.5% of the patients received one or more units of blood transfusion intra operatively and/or post operatively. All the patients with ectopic pregnancy were managed surgically. 95% patients underwent laparotomy and 5 % patients had laparoscopic treatment. 95% patients underwent unilateral or bilateral salpingectomy or salpingoophrectomy. Milking of tube was performed in 2.5% of patients. Concurrent dilatation and curettage were performed in the patients who had heterotopic pregnancy 3 (2.5%). There was no maternal mortality in the present study. Conclusion: 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.
Abstract (English)
Aim: The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India in opd and ipd from April 2019 to February 2022 antinatal check-up. Total 120 cases were diagnosed with ectopic pregnancy. Results: The incidence of ectopic pregnancy (0.029%) or 2.9 per 1000 antinatal up to 20 weeks. The most common site of ectopic pregnancy was fallopian tube 102(89.17%). Ampulla was the commonest site 90 (75%) for ectopic implantation in the fallopian tube. Heterotopic pregnancy is rare where pregnancy is seen in the uterus and tube at the same time. In our study, there were 3 (2.5%) cases of heterotopic pregnancies. The most common risk factor was pelvic inflammatory disease 55(45.83%) followed by H/o previous abortion 25(20.83%) and H/o previous abdominopelvic surgery including tubal ligation, LSCS and appendicectomy 32(26.67%). In our study, 17(14.17 %) patients were using copper IUCD. 67.5% of the patients had bleeding or spotting per vaginum. Urine pregnancy test was positive in 113(94.17%) of patients. Culdocentesis was positive in 53(44.17%) of patients. Ultrasound was able to diagnose 99(82.5 %) of cases. USG findings suggestive of ectopic pregnancy were extra-uterine gestational sac 15(12.5%), haemoperitoneum 71(59.17%) and adnexal mass 91(75.83%). The incidence of ruptured ectopic pregnancy was 88%. 97.5% of the patients received one or more units of blood transfusion intra operatively and/or post operatively. All the patients with ectopic pregnancy were managed surgically. 95% patients underwent laparotomy and 5 % patients had laparoscopic treatment. 95% patients underwent unilateral or bilateral salpingectomy or salpingoophrectomy. Milking of tube was performed in 2.5% of patients. Concurrent dilatation and curettage were performed in the patients who had heterotopic pregnancy 3 (2.5%). There was no maternal mortality in the present study. Conclusion: 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.
Files
IJPCR,Vol14,Issue5,Article10.pdf
Files
(164.4 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:f02b4388d23bcd50f28c402e24476956
|
164.4 kB | Preview Download |
Additional details
Dates
- Accepted
-
2022-03-15
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/14/IJPCR,Vol14,Issue5,Article10.pdf
- Development Status
- Active
References
- 1. Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM. Trends in ectopic pregnancy mortality in the United States: 1980– 2007. Obstet Gynecol. 2011; 117:837– 43. 2. Arleo EK, DeFilippis EM. Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging. 2014; 38:763– 70. 3. Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, et al. Chapter 7. Ectopic pregnancy. In: Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, Calver LE, editors. Williams gynecology. 2nd ed. New York: McGraw-Hill; 2012. 4. Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril. 1999; 72:207–15 5. Leke RJ, Goyaux N, Matsuda T, Thonneau PF. Ectopic pregnancy in Africa: a population-based study. Obstet Gynecol. 2004; 103:692-97. 6. Thonneau P, Hijazi Y, Goyaux N, Calvez T, Keita N. Ectopic pregnancy in Conakry, Guinea. Bull World Health Organ. 2002; 80:365-70. 7. Shetty VH, Gowda S, Lakshmidevi M. Role of ultra sonography in Diagnosis of ectopic pregnancy with clinical analysis and management in tertiary care hospital. J Obstet Gynecol Ind. 2014;64(5):354-57. 8. Jophy R, Thomas A, Mhaskar A. Ectopic pregnancy -5 year experience. J Obstet Gynecol Ind. 2002; 52:55-8. 9. Gupta R, Porwal S, Swarnkar M, Sharma N, Maheshwari P. Incidence, trends and risk factors for ectopic pregnancies in a tertiary care hospital of Rajasthan. JPBMS. 2012;16(07):1- 3. 10. Yadav A, Prakash A, Sharma C, Pegu B, Saha MK.Trends of ectopic pregnancies in Andaman and Nicobar Islands.Int JReprod Contracept Obstet Gynecol. 2017;6:15-9 11. Gaddagi RA, Chandrashekhar AP. A Clinical Study of Ectopic Pregnancy. J Clin Diagn Res. 2012;6(5):867-9. 12. Shivakumar HC, Umashankar KM, Ramaraju HE. Analysis of forty cases of ectopic pregnancies in tertiary care hospital in south India. Indian Journal of Basic and Applied Medical Research; 2013: 3(1):235-241. 13. Wakankar R, Kedar K. Ectopic Pregnancy- A rising Trend. Int J Sci Stud. 2015;3(5):18-22. 14. Mufti S, Rather S, Mufti S, Rangrez RA, Wasiqa, Khalida. Ectopic pregnancy: an analysis of 114 cases. JK Practitioner. 2012;17(4):20-3. 15. Shukla DB, Jagtap SV, Kale PP, Thakkar HN.Study of ectopic pregnancy in a tertiary care centre.Int J Reprod Contracept Obstet Gynecol. 2017;6:975-9. 16. Yadav ST, Kaur S, Yadav SS. Ectopic pregnancy an obstetric emergency: retrospective study from medical college Ambala, Haryana, India.Int J Reprod Contracept Obstet Gynecol. 2016;5:2210-4. 17. Bhuria V, Nanda S, Chauhan M, Malhotra V. A retrospective analysis of ectopic pregnancy at a tertiary care centre: one year study. Int J Reprod Contracept Obstet Gynecol. 2016; 5:2224-7. 18. Nair L, Peter N, Rose A. International Journal of Biomedical Research 2015;6(05):331-3. 19. Báez, J. A. A., Vargas, S. V., Cordero, J. F. B., Martínez, L. F. C., Rojas, L. E. P., Restrepo, D. C. S., Romero, J. A. R., & Bejarano, H. E. A. Portable Nasolaryngofi broscopy for Upper Airway Burn Diagnosis. Journal ofMedical Research and Health Sciences, 2021:4(11), 1551–1556. 20. Shobeiri F, Tehranian N, Nazari M. Trend of ectopic pregnancy and its main determinants in Hamadan province, Iran (2000-2010). BMC research notes. 2014;7(1):733. 21. Rakhi, Mital PL, Hooja N, Agarwal A, Makkar P, Andleeb F. Ectopic pregnancy: a devastating catastrophe. Sch J App Med Sci. 2014;2(3A):903-7. 22. Prasanna B, Jhansi CB, Swathi K, Shaik MV. A study on risk factors and clinical presentation of ectopic pregnancy in women attending a tertiary care centre. IAIM. 2016;3(1):90-6. 23. Moini A, Hosseini R, Jahangiri N, Shiva M, Akhoond MR. Risk factors for ectopic pregnancy: A case–control study. J Res Med Sci. 2014; 19:844-9. 24. Parashi S, Moukhah S, Ashrafi M. Main risk factors for ectopic pregnancy: a case–control study in a sample of Iranian women. Int J Fertil Steril. 2014; 8:147-54. 25. Simsek Y, Oguzhan A M. Analysis of ectopic pregnancies admitted to emergency department. Turk J Emerg Med. 2015;15(4):151–154. 26. Ragab A, Mesbah Y, El-Bahlol I, Fawzy M, Alsammani MA. Predictors of ectopic pregnancy in nulliparous women: A case-control study. Middle East Fertility Society Journal.2016;21(1):27-30. 27. Naseem I, Bari V, Nadeem N. Multiple parameters in the diagnosis of ectopic pregnancy. J Pak Med Assoc. 2005;55(2):74-6. 28. Awoleke JO, Adanikin AI, Awoleke AO. Ruptured tubal pregnancy: predictors of delays in seeking and obtaining care in a Nigerian population. Int J Women Health. 2015; 7:141-7