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Multicenter Study
. 2024 Oct 14;14(10):e086723.
doi: 10.1136/bmjopen-2024-086723.

Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion

Camila Ayume Amano Cavalari  1 , Hedieh Mehrtash  2 , Vanessa Brizuela  2 , Adama Baguiya  3 , Kwame Adu-Bonsaffoh  4 , Jose Guilherme Cecatti  1 , Luis Bahamondes  1 , Charles M'poca Charles  1 , Philip Govule  5   6 , Jean-Paul Dossou  7   8 , Renato T Souza  1 , Luis Henrique Leão  1 , Veronique Filippi  9 , Özge Tunçalp  2 , Luiz Francisco Baccaro  10
Affiliations
Multicenter Study

Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion

Camila Ayume Amano Cavalari et al. BMJ Open. .

Abstract

Introduction: There are limited global data on ectopic pregnancy (EP) and molar pregnancy (MP), making it important to understand their epidemiology and management across different regions. Our study aimed to describe their prevalence for both conditions, severity of their complications and management among women in selected health facilities across 17 countries in Africa and Latin America and the Caribbean (LAC).

Methods: This is a secondary analysis of the WHO multi-country survey on abortion. Data were collected from 280 healthcare facilities across 11 countries in Africa and 6 in LAC. Sociodemographic information, signs and symptoms, management and clinical outcomes were extracted from medical records. Facility-level data on post-abortion care (PAC) capabilities were also collected, and facilities were classified accordingly. χ2 or Fisher's exact tests were used to compare categorical data.

Results: The total number of women with EP and MP across both regions was 9.9% (2 415/24 424) where EP accounted for 7.8% (1 904/24 424) and MP for 2.1% (511/24 424). EP presented a higher severity of complications than MP. At admission, 49.8% of EP had signs of peritoneal irritation. The most common surgical management for EP was laparotomy (87.2%) and for MP, uterine evacuation (89.8%). Facilities with higher scores in infrastructure and capability to provide PAC more frequently provided minimal invasive management using methotrexate/other medical treatment (34.9%) and laparoscopy (5.1%).

Conclusion: In Africa and LAC, EP and MP cause significant maternal morbidity and mortality. The disparity in the provision of good quality care highlights the need to strengthen the implementation of evidence-based recommendations in the clinical and surgical management of EP and MP.

Keywords: GYNAECOLOGY; Hospitals, Public; OBSTETRICS.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. Severity of complications in ectopic pregnancy (n=1904) and molar pregnancy (n=511). PLTC, potentially life-threatening complications; SMO, severe maternal outcome.
Figure 2
Figure 2. Types of management. Ectopic pregnancy (n=1904) and molar pregnancy (n=511).
See this image and copyright information in PMC

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