Introduction: Ectopic pregnancy is an emergency and a life-threatening condition which is an important cause of major maternal morbidity and mortality. This study was designed to determine incidence, common identified risk factors, clinical presentations, management, morbidity and mortality due to ectopic pregnancy at the national referral hospital in Thimphu, Bhutan. Methods: This was a retrospective study of all cases of ectopic pregnancies for a period of two years from 1st January 2018 to 31st December 2019. Socio-demographic characteristics, risk factors, clinical presentations, investigations and mode of treatments were extracted. Simple descriptive statistics such as frequencies, percentages, mean and range were utilised. Results: There were 9603 pregnant women admitted for delivery, out of which 122 were ectopic pregnancies. The incidence of ectopic pregnancy was 12.7/1000 pregnancies. Majority of them were in the age group of 21-30 years and 32.69% of the affected were nulliparous. While Pelvic inflammatory disease was seen in 41.35%, 20.19% were unmarried. Abdominal pain, amenorrhea, and vaginal bleeding were the most common symptoms. Among the ectopic pregnancies, 99.5% were diagnosed with ultrasound. A total of 94.23% had undergone surgical intervention, of which only 1% had laparoscopic surgery. No maternal mortality had occurred. Conclusions: Women with past history of pelvic inflammatory disease, previous miscarriage, unmarried, and nulliparous presenting with history of amenorrhea, abdominal pain, vaginal bleeding should be a high index of suspicion for ectopic pregnancy. Timely diagnosis and intervention in the form of surgical or medical management will reduced the morbidity and mortality due to ectopic pregnancy.

Enhanced recovery after surgery (ERAS) has proven benefits to the patients and the health system at large. Implementing ERAS in obstetrics has the potential to decongest the maternity ward by reducing postoperative hospital stay with safe maternal and neonatal outcomes. Extrapolating outcomes from studies in a similar setting and from our experience, we hereby discuss the possibility of implementing modified ERAS in obstetrics adapted to our resource-limited setting. Contextual-based consensus on modifications and implementation has to come from all stakeholders for a successful program.