Ectopic Pregnancy Ectopic pregnancy may present with a wide clinical spectrum ranging from a total lack of symptoms and signs to a shocked and moribund condition resulting from major intra-peritoneal haemorrhage

INTRODUCTION Gynaecological disorders are a common cause of morbidity among women of reproductive age worldwide. In developing countries, gynaecological emergencies present enormous challenges given the weak health infrastructure in these settings. Whereas reports indicate that approximately 1.4 million gynaecological emergency visits to emergency department are recorded in the USA accounting for 24.3 visits per 1000 women of reproductive age (15 44 years)[ 1 ], equivalent data for developing countries are not readily available. However acute gynaecological conditions are important causes of morbidity and mortality in these countries and constitute significant public health problems. This review will highlight common gynaecological emergencies in the tropics and discuss current evidencebased approaches to their management. The most common gynaecological emergencies are ectopic pregnancy, acute pelvic inflammatory disease, miscarriages and complicated ovarian cysts [2]. Other gynaecological conditions which may present as emergencies are menstrual disorders, bleeding gynaecological malignancies, coital laceration and sexual assault. In the tropics, ectopic pregnancy and complications of unsafe abortion are the most common life threatening gynaecological emergencies. In developing countries, ectopic pregnancy is the most common surgical gynaecological emergency3 while in the USA, acute pelvic inflammatory disease is the most common gynaecological emergency1. Gynaecological emergencies can be classified into two broad categories based on whether they are pregnancy related or non-pregnancy related4. Pregnancy related gynaecological emergencies are mainly complications of early pregnancy namely ectopic pregnancy, miscarriage and complications of unsafe abortion. Non-pregnancy related gynaecological emergencies include acute pelvic inflammatory disease, menstrual disorders, bleeding from gynaecological malignancies, coital laceration and sexual assault. Common gynaecological emergencies typically present as an acute abdomen, abnormal vaginal bleeding or a combination of both [2]. Recent advances in sonography, biochemical pregnancy testing, minimal access surgery and newer antibiotics have led to early diagnosis[2] and expanded the frontiers of more conservative treatment options.