Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study

Background: Ectopic pregnancy is a life-threatening emergency commonly encountered by medical practitioner. Diagnosis is frequently missed and should be considered in any women in the reproductive age group with abdominal pain or vaginal bleeding. The aim of the study is to assess the incidence, clinical presentation, risk factors, methods of diagnosis, treatment, outcome and complications.Methods: This was a prospective study at S.C.B. Medical college from January to December 2017. Parameters like age, parity, gestational period, risk factors, clinical presentations, findings on ultrasonogram and at surgery with morbidities associated with diagnosed cases of ectopic pregnancy (n=93) were noted and analysed with SPSS-19 software.Results: Incidence of ectopic pregnancy was 18/1000 deliveries. Maximum cases were in age group of 21 to 30 years (54.8 %) and parous (76.3%). Common risk factors were having history of abortions (46.2%), previous tubal sterilization (24.7%), having one or more caesarean section (17.2%) and h/o infertility (16.1%). Most common symptom was pain abdomen (96.8%). Commonest site was ampullo-isthmic region of tube and rupture was the commonest mode of presentation. All underwent laparotomy and unilateral salpingectomy was done in 86 % of cases. It contributed to 3.27 % of total maternal deaths.Conclusions: Suspicion in high risk group can direct one to investigate and diagnose early, thereby reducing morbidity, mortality and improving the prospect of future fertility.

Section: Discussionsupporting

confidence: 88%

“…15 The incidence of EP was 0.91% in a study by tahmina. 16 The increase in incidence is associated with rise in the incidence of sexually transmitted infections (STIs) and salpingitis, advances in assisted reproductive technology, tubal surgeries, female contraception and earlier diagnosis with more sensitive methods.…”

Section: Discussionmentioning

confidence: 99%

A clinical study of ectopic pregnancy in a tertiary care hospital

Behera¹,

Ghadei²,

Bal³

2018

“…[5][6][7] The peak age of incidence in this study is 20-25 years (33.84%) which is consistent with the study of Gupta et al (47.5%) and Karmakar et al (44%). 8,9 In this study ectopic pregnancies were found to be present more commonly in third gravidae (46.3%) followed by second gravidae (24.5%) and fourth or more gravidae (18.3%).…”

Section: Discussionsupporting

confidence: 82%

A study of surgically managed ruptured ectopic pregnancies in a rural medical college hospital over a period of 5 years

Patra¹,

Majumder²,

Chattopadhyay³

et al. 2018

Background: Although ectopic pregnancy is of interest to the embryologist, general practitioner, obstetrician, and abdominal surgeon for various reasons, our present study was undertaken to determine the incidence, epidemiological characteristics, clinical features, risk factors, diagnosis, management and operative findings of ectopic pregnancies at our hospital.Methods: This is a retrospective study of ectopic pregnancies that were managed operatively at Bankura Sammilani Medical College and Hospital from April 2013 to April 2018. Unruptured tubal ectopic pregnancy that were managed medically are excluded in this study.Results: The incidence of ectopic pregnancy was 0.59%, and the peak age of incidence was 20-25 years (33.84%) with third gravidas (46.3%) being most commonly affected. The most common symptoms were amenorrhea (96.92%), abdominal pain (90.76%), and vaginal bleeding (11.53%) and the most common signs were pallor (46.30%), shock (38.46%), and cervical motion tenderness (33.84%). Most common risk factors were past history of tubectomy (66.61%). The commonest site for tubal ectopic pregnancy was ampullary in 545 cases (84.89%). Salpingectomy done in 553 cases (85.07%) was the most commonly performed operation for ruptured tubal ectopic pregnancy.Conclusions: In the surgical management of ectopic pregnancy, the benefits of salpingectomy over salpingostomy are uncertain. The early diagnosis of an ectopic pregnancy reduces the presentation to response time, which is crucial in determining the morbidity, mortality and long-term effects for the patient. Although with earlier diagnosis, medical therapy with methotrexate can be offered and surgery avoided in some women, the best regimen remains unclear. There have been advances made in the management of ectopic pregnancy but there are still questions to be answered.

“…Mean gestational age at diagnosis of EP was 7.1 in the study conducted by Tahmina S et al while Khaleeque et al, reported 6 weeks at diagnosis. 24,25 The classical triad of amenorrhoea, pain and vaginal bleeding was seen in 28.57% patients in present study, as compared to Tahima S et al, wherein, this triad was seen in 40.3% cases. Other studies have reported this triad to be present in 28-95% women, clearly indicating that this is not a presenting feature in most cases.…”

Section: Discussionsupporting

confidence: 42%

Ectopic pregnancy: clinical features, management and complications

Palve

Bhattacharya

Magtangi

2018

Background: An ectopic pregnancy (EP) occurs when a fertilized ovum implants outside the normal uterine cavity 1. Ectopic pregnancy (EP) is a condition presenting as a major health problem for women of childbearing age.2 The incidence of EP varies with the population, but it has been accounted for 1-2% of all reported pregnancies. EP is one of the few medical conditions that can be managed expectantly, medically or surgically. Surgical methods are still the mainstay in the management of EP, and in developed societies, laparoscopic surgery is currently the gold standard.Methods: This is a retrospective observational study conducted in a tertiary care centre in Mumbai from November 2016 to November 2017. All patients diagnosed with ectopic pregnancy (by clinical examination, USG and/or B hCG) were included in the study. The aims and objectives of the study were to determine the demographic distribution, risk factors, clinical features, treatment modalities and complications in patients presenting with EP.Results: The incidence of ectopic pregnancies in one year was 1.17%. The commonest age of presentation of EP was between 35-40 years, most of the patients were Gravida 4 (28.57%). Majority of patients presented at a gestational age between 6-8 weeks. Most patients (64.28%) were found to have ruptured ectopic. 28.57% patients had a previous history of abortion. 14.28% of each EP were cornual and heterotopic as found intra-operatively. There was 1 interstitial and 1 scar ectopic pregnancy. The most common associated risk factor in these patients were a history of some form of pelvic surgeries in the past. Most of these patients presented with pain abdomen and were found to be anaemic and with a shock index (SBP/HR) of > 0.8. 64.28% of cases were diagnosed by combination of TVS and serum BhCG levels. Two cases were managed medically, and obstetric hysterectomy was needed in the patient with ruptured scar ectopic gestation.Conclusions: Ectopic pregnancy has a rising incidence in today’s world. With the use of better diagnostic modalities, ectopic pregnancies can be detected early and treated appropriately. However, as a silent disease, it presents with subtle signs and symptoms and hence can be easily misdiagnosed. Also, because of its subtle presentations, patients often present late in the course of the disease, wherein management of the condition can be sometimes life - saving. But once diagnosed accurately, it needs prompt treatment. Treatment however is easy and patients respond wonderfully with both medical and surgical management.