Prospective observational study to assess the incidence, associated risk, management and outcome of ectopic pregnancy
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 9, Pages 3652-3659
AbstractAim: The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies.
Material and Methods: This prospective observational study was carried out in the Department of Obstetrics & Gynaecology, NSMCH, Bihta, Patna, Bihar, India, for 18 months. Total 100 cases were diagnosed with ectopic pregnancy.
Results: During the study period, 9724 deliveries and 100 ectopic pregnancies. Therefore, the incidence of ectopic pregnancy is 1 in 97 pregnancies (1.02%) or 10 per 1000 deliveries. The mean age of the patients was 27.87±4.7 years. Majority of the patients 50 (50%) belonged to 20-25 years. Majority of the patients 76(76%) were multiparous. The most common site of ectopic pregnancy was fallopian tube 92(92%). Ampulla was the commonest site 80(80%) 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 2(2%) cases of heterotopic pregnancies. The most common risk factor was pelvic inflammatory disease 45 (45%) followed by H/o previous abortion 23(23%) and H/o previous abdominopelvic surgery including tubal ligation, LSCS and appendicectomy 27(27%). In our study, 15(15 %) patients were using copper IUCD. H/o infertility due to tubal block or other causes, treatment associated with infertility, endometriosis and H/o previous ectopic pregnancy were other identified risk factors. Almost 97% patients in our study came with H/O variable period of amenorrhoea. 90(90%) cases complained of abdominal pain. 68% of the patients had bleeding or spotting per vaginum. However, the classical triad of amenorrhoea, abdominal pain and vaginal bleeding was seen in 53% cases. The most important signs which guided in the diagnosis of ectopic pregnancy were cervical excitation pain 77(77%), abdominal tenderness 71(71%), adnexal mass or fullness 64(64%) and tenderness in the fornix 66(66%). In the present study, urine pregnancy test was positive in 96(96%) of patients. Culdocentesis was positive in 42(42%) of patients. Ultrasound was able to diagnose 83(83 %) of cases.
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.
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