Clinical analysis of ectopic pregnancies in a tertiary care centre

Abstract

Background: An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus.Almost all ectopic pregnancies more than 90% occur in a fallopian tube.As the pregnancy grows, it can cause the tube to rupture. A rupture can cause major internal bleeding. Objectives: to determine the incidence, clinical features, risk factors, treatment and outcomes associated with ectopic pregnancy in a tertiary level teaching hospital. Methods: The data was collected from the medical records section of the hospital. There were 162 cases of ectopic pregnancy diagnosed and treated in the hospital in the study period. Results: 40 patients with history of previous miscarriage had ectopic pregnancies (24.69%). Past history of undergoing lower segment caesarean section was observed in 35 patients (21.60%). Eight (4.9%) out of 162 patients had prior history of ectopic pregnancy. Prior history of tubectomy was seen in 21 (12.9%) patients. The triad of symptoms i.e. amenorrhoea, pain abdomen and per vaginal bleeding was found in only 53 patients (32.7%). The most common site of ectopic pregnancy was ampullary 110 (67.9%) followed by isthmic in 33 (20.3). Other rare sites of ectopic pregnancy noted in our study were 3 (1.8%) cases of caesarean scar pregnancy, one (0.6%) case of cervical pregnancy and 3 (1.8%) cases of ovarian pregnancies. 142 patients (87.65%) were primarily treated with various surgical procedures. Of these, 80 patients (49.38%) were treated with various open procedures, and 62 patients (38.2%) were treated with laparoscopic procedures. Of the 20 patients (12.34%) treated medically, 10 patients (6.17%) failed to respond to the treatment and had to undergo surgical procedure later. Anaemia was the most common complication and was seen in 57 patients (35.1%). Conclusion: Prevention of ectopic pregnancy is difficult because only few of the risk factors are modifiable. Tubal pathology carries the highest risks and pelvic inflammatory diseases plays a major role in tubal adhesions and obstruction. Physicians and patients awareness about the possibility and risk of extra and intra uterine gestation following all methods of sterilization is necessary.