Ectopic pregnancy - two years review from BPKIHS, Nepal

Abstract

Ectopic pregnancy remains an important cause of morbidity and mortality in early pregnancy. The incidence has increased worldwide with an increase in pelvic infections and improvements in the diagnostic techniques. The objective of this study was to analyse the various aspects of ectopic pregnancy with a view to suggest interventions which would decrease the incidence.

Material and methods: The study was carried out in the department of Obstetrics and Gynaecology, B.P Koirala Institute of Health Sciences, Dharan (Nepal). Data were analysed retrospectively using the case sheets and operative notes from the past two years (April 02-April 04). The gynaecological admissions and records of the total births within the period of study were also used in the analysis.

Result: The incidence of ectopic pregnancy during this study period was 0.93 of total births and 2.92% of the total gynaecological admissions. The peak age of incidence was in the range of 26-30 years. Majority of patients were in the lower socioeconomic group. Pelvic inflammatory disease and induced abortions were the major risk factors. Their contribution was 61.3% and 38.6% respectively. 70.6% of patients did not use any contraception. 16% used depo provera. Abdominal pain (69.3%), vaginal bleeding (45.3%) and syncopal attacks (21.3%) were the most frequent presenting complaints. 58.6% had amenorrhea of 6-10 weeks. Only 1.3% presented with amenorrhea of greater than 10 weeks. Ampulla (62.6%) followed by isthmus (21.3) were the commonest sites of ectopic implantation. Ovarian and abdominal pregnancies contributed to only 1.3% each. There was no significant difference between the side of the tube involved.82.6% had come with ruptured ectopic but only 12% were in shock. Majority of patients underwent salpingectomy (69.3%) followed by salpingo-oophorectomy (17.3%). Only 2.6% received methotrexate. 70.6% required blood transfusion.

Conclusion: Majority of patients attending BPKIHS for ectopic pregnancy were between 26-30 years and had history of PID & induced abortions. Surgery (salpingectomy/salpingo-oophorectomy) was the main stay of treatment.