Risk Factors, Clinical Presentation and Management of 62 Cases of Ectopic Pregnancy at Tertiary Care Centre

OBJECTIVE: To observe the risk factors, clinical pattern and management of ectopic pregnancy. DESIGN: Descriptive observational study. PLACE AND DURATION: Gynecological Unit II, Liaquat University of Medical and Health Sciences, Hyderabad from January 1st 2006 to April 1st 2008. PATIENTS & METHODS: All patients with confirmed diagnosis of ectopic pregnancy were included in the study. A pre-formed proforma was used to record the details about the demographic features, pre-existing risk factors for ectopic pregnancy, clinical features at presentation, management and findings at surgery. Data fed to SPSS program version 11 to analyse the results in terms of frequency and percentages. RESULTS: Total maternity admissions were 8016 with 62 cases of ectopic pregnancy giving an incidence of 0.8% or 1: 129. Mean age was 24 years. Majority of the patients were of low parity (n= 34, 54.8%). Pelvic inflammatory disease (n=22,35.4%), previous abdomino pelvic surgery (n=16,26%), previous ectopic (n=4,6.4%) and infertility (n= 22, 35.4%) were seen as the major risk factors. Regarding the clinical pattern; abdominal pain, amenorrhea and collapse appeared as the common clinical presentations. All patients required surgery. Open laparotomy was performed in 56 (90.3%) cases while 6 (9.7%) patients managed laparoscopically. None of the patients found suitable for conservative or medical management. There was no maternal death related to ectopic pregnancy and the postoperative recovery was uneventful. CONCLUSION: The classic clinical pattern of amenorrhea and abdominal pain was lacking in most of the cases with ectopic pregnancy and there were initial diagnostic difficulties. Pelvic inflammatory disease and history of infertility were the main risk factors. Due to the delay in making diagnosis at early stage, open surgery was required in all cases. This emphasizes the importance of a thorough clinical evaluation and appropriate investigations for patients with high suspicious to benefit our poor patients by the use of recent therapeutic modalities