A 10 Year Review of 255 cases of Ectopic Pregnancy

Objective: The study was conducted to determine the frequency, risk factors, clinical features and diagnostic modalities of Ectopic Pregnancy in a tertiary care hospital. Study design: Retrospective, Analytic study. Place and duration of study: Gynae B ward, Ayub Teaching hospital, Abbottabad, from Jan 2003 to Dec 2012. Methodology: The patients included in this study were admitted from outpatient department and emergency department to gynaecological unit. A detailed history was taken and examination was done. Variables like age of the patient, parity, past history, symptoms, signs, and operative procedure were all recorded for evaluation. Various predisposing factors like previous abortion, contraception, recurrent ectopic, previous pelvic surgery, infertility treatment and pelvic inflammatory disease were analyzed. Results: There were 255 cases of Ectopic pregnancy out of 25010 deliveries during the study period and the frequency was 1.01%. The main predisposing factor to ectopic pregnancy was pelvic inflammatory disease (43.13%) while 37.64% had previous abortions. Recurrent ectopic pregnancy was observed in 9.01% of patients while 27.05% had history of previous pelvic surgeries. Conclusion: The most common risk factor for ectopic pregnancy is pelvic inflammatory disease. If it is timely diagnosed and properly treated, ectopic pregnancy with its grave consequences can be avoided. Methodology The study was conducted in Ayub Teaching Hospital, Abbottabad in the department of Gynae & obstetrics from January 2003 to December 2012. The patients included in this study were from outpatient department and emergency department. Patients who had any four of the following features are included in the study, i.e history of amenorrhea not more than 12 weeks, positive pregnancy test, abdominal pain ,empty uterus on scan, adenexal mass, positive culdocentesis. A detailed history regarding age of the patient, parity, symptoms like amenorrhoea, per vaginal bleeding, abdominal pains, dizziness and vomiting was taken. Past history of repeated abortions, surgical interventions, infertility, pelvic inflammatory disease, history of contraception and ovulation induction was also taken. Pelvic inflammatory disease was diagnosed on the basis of history of repeated foul smelling vaginal discharge, fever and repeated antibiotic cover. Patients were particulary asked about previous record of ultrasound to see whether they had intrauterine or extrauterine pregnancy. Patients were examined and signs like shock, features of peritonism, abdominal tenderness, cervical excitation and adnexal tenderness were noted. Paracentesis and culdocentesis were also performed in some cases. Provisional diagnosis of ectopic pregnancy was made either by history and clinical examination alone or was supplemented by investigations like trans abdominal scan, trans vaginal scan, urinary beta HCG and serum beta HCG. Diagnostic laparoscopy was not considered in any case. Patients who came in shock were examined in detail and based on history and examination, diagnosis of rupture ectopic was made. After initial stabilization and arrangement of blood laparotomy was carried out preceded by informed consent. In some cases surgical opinion was also taken as the symptoms mimicked acute appendicitis. Most of the patients with ruptured ectopic pregnancy had free fluid in the pouch of Douglas on ultrasonography. Some of our patients who were diagnosed as cases of chronic ectopic and unruptured ectopic gestations by ultrasound scan done in private hospitals were included in the study and investigations like urinary beta HCG, serum beta HCG and trans vaginal scan were carried out to confirm diagnosis. Bushra Khan1*, Farhat Deeba2 and Wajiha Khan3 1Gynae B unit, Ayub Teaching hospital, Abbottabad, Pakistan 2Women Medical College, Abbottabad, Pakistan 3COMSATS institute of Information technology, Department of Enviromental Sciences, Abbottabad, Pakistan Address for Correspondence Bushra Khan, Senior Registrar, Gynae B unit, Ayub Teaching hospital, Abbottabad Pakistan, E-mail: [email protected] Submission: 26 September 2013 Accepted: 25 November 2013 Published: 27 November 2013 Review Article Open Access