A CLINICAL STUDY OF ECTOPIC PREGNANCIES IN A TERTIARY CARE HOSPITAL OF MANGALORE, INDIA

  • Shraddha Shetty
  • Anil Shetty
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S. Shetty and A. Shetty, “A CLINICAL STUDY OF ECTOPIC PREGNANCIES IN A TERTIARY CARE HOSPITAL OF MANGALORE, INDIA”, ijmhs, vol. 4, no. 1, Jan. 2014.
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Abstract

Background: Ectopic pregnancy is a common life-threatening condition. Diagnosis is frequently missed and should be considered in any woman in the reproductive age group presenting with abdominal pain or vaginal bleeding. Aims: To determine the incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy. Material and Methods: Retrospective analysis of case histories of patients admitted with ectopic pregnancy at Government Lady Goshen Hospital, Mangalore was done. The following parameters: age, parity, gestational age, risk factors, clinical presentation, need for blood transfusion and findings on ultra-sonogram and at surgery and morbidity associated with ectopic pregnancy were noted. Results: A total of 31 cases of ectopic pregnancy were operated giving the incidence of ectopic pregnancy of 5.6/1000 deliveries. The commonest risk factors present were history of abortion (29 %), history of tubal surgery (9.6%), infertility (3.2%) and pelvic inflammatory diseases (3.2%).The commonest symptoms were  abdominal pain (80.6%), amenorrhea (77.4%) and abnormal vaginal bleeding (61.3%); and commonest signs were abdominal tenderness (64.5%), cervical excitation (51.6%)  and adnexal tenderness (48.4%). Surgery by open method in the form of salpingectomy (90.3%), salpingo-oophorectomy (6.5%) and salpingostomy (3.2%) were the mainstay of management. Morbidity included anemia (41.9%), blood transfusion (54.8%) and wound infection (32.2%). No maternal mortality noted. Conclusion: Early diagnosis, identifying of underlying risk factors and timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy.

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References

1. Walker JJ. Ectopic pregnancy. Clin Obstet Gynecol. 2007; 50: 89–99. 2. Mahboob U, Mazhar SB. Management of ectopic pregnancy: a two-year study. J Ayub Med Coll Abbottabad.2006 Oct-Dec; 18(4):34-7 3. Goyaux N, Leke R, Keita N, Thonneau P. Ectopic pregnancy in African developing countries. Acta Obstet Gynecol Scand 2003; 82:305-12. 4. Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol. 2006; 46:521–527. 5. Turner C, Horner P, et al. British Fertility Society Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice. Hum Fertil (Camb) 2010; 13:115–125. 6. Timmerman D. Predictive models for the early diagnosis of ectopic pregnancy. Verh K Acad Geneeskd Belg. 2004; 66 (2):155-71. 7. Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009; 361:379–387. 8. Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy . CMAJ. 2005; 173(8):905. 9. Rashmi A Gaddagi, AP Chandrashekhar. A Clinical Study of Ectopic Pregnancy. JCDR 2012;6:867-869 10. Gupta R, Porwal S, Swarnkar M, Sharma N, Maheshwari P. Incidence, trends and risk factors for Ectopic Pregnancies in a tertiary care hospital of Rajasthan. JPBMS 2012; 16 (07):1-3. 11. Khaleeque F, Siddiqui RI, Jafarey SN. Ectopic pregnancies: A Three year study. J Pak Med Assoc 2001; 51:240–243. 12. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010 Mar;115(3):495-502 13. R. C (Karki) L, Pradhan B, Duwa S. Annual Analysis of Ectopic Pregnancy in Tertiary Care Hospital. PMJN 2011;11 :5-8 14. Roussos D, Panidis D, Matalliotakis I, Mavromatidis G, Neonaki M, Mamopoulos M, Koumantakis E. Factors that may predispose to rupture of tubal ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2000 Mar;89(1):15-7 15. Murray H, Baakdah H, Bardell T, Tulandi T.Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005 Oct 11;173(8):905-12 16. Eskandar M, Archibong EI, Sadek AA, Sobande AA. Bahrain Med Bull 2002; 24 (2):63-65. 17. Warren CW, Gwinn ML, Rubin GL. Seasonal variation in conception and various pregnancy outcomes. Soc Biol 1986; 33:116-26. 18. Swende TZ. Jogo AA. Ruptured tubal pregnancy in Makurdi, North Central Nigeria. Niger J Med 2008; 17(1): 75-7 19. Ludwig M, Kaisi M, Bauer O, Diedrich K .Heterotopic pregnancy in a spontaneous cycle: do not forget about it! Eur J Obstet Gynecol Reprod Biol. 1999 Nov; 87(1):91-3. 20. Espinosa PM, Alcantar Mendoza MA. Heterotopic pregnancy: Report of a case and review of literature. Ginecol Obstet Mex. 1997; 65:482–6. 21. GO Udigwe, OS Umeononihu, I.I Mbachu. Ectopic pregnancy: A 5 year review of cases at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. NMJ 2010 ;51: 160-163 22. Latchaw G, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. Gynecol Obstet Invest. 2005; 60 (3):177-80. 23. Knafel A, Basta P, Skotniczny K, Paweł M, Krzysztof B, Rokita W, Obrzut B, Wicherek Ł. Ectopic pregnancy rupture--can it be prevented? Ginekol Pol. 2009 Oct;80(10):734-9 24. Bangsgaard N, Lund CO, Ottesen B, Nilas L. Improved fertility following conservative surgical treatment of ectopic pregnancy. BJOG 2003 Aug; 110 (8):765-70. 25. Canis M, Savary D, Pouly JL, Wattiez A, Mage G. Ectopic pregnancy: criteria to decide between medical and conservative surgical treatment? J Gynecol Obstet Biol Reprod (Paris). 2003 Nov; 32 (7 Suppl):S54-63. 26. Chatterjee S, Dey S, Chowdhury R G, Ganguli D. Ectopic Pregnancy In Previously Infertile Women Subsequent Pregnancy Outcome After Laparoscopic Management. Al Ameen J Med Sci 2009;2(1):67-72 27. Jurkovie D. Ectopic pregnancy. In: Edmonds DK, editor. Dew Hurst’s textbook of Obstetrics & Gynecology. 7 ed. USA:; Blackwell Publishers;2007 28. Shah N, Khan NH. Ectopic pregnancy: Presentation and risk factors. J Coll Physicians Surg Pak. 2005;15:535–8. 29. Majhi AK, Roy N, Karmakar KS, Banerjee PK. Ectopic pregnancy--an analysis of 180 cases. J Indian Med Assoc. 2007 Jun;105(6):308,310,312 30. Abbas A, Akram H. Ectopic Pregnancy; Audit at Maula Bakhsh Teaching Hospital Sargodha.Prof Med J 2011;18 (1): 24-27. 31. Lozeau AM, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2005;72:1707–14

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References

1. Walker JJ. Ectopic pregnancy. Clin Obstet Gynecol. 2007; 50: 89–99.
2. Mahboob U, Mazhar SB. Management of ectopic pregnancy: a two-year study. J Ayub Med Coll Abbottabad.2006 Oct-Dec; 18(4):34-7
3. Goyaux N, Leke R, Keita N, Thonneau P. Ectopic pregnancy in African developing countries. Acta Obstet Gynecol Scand 2003; 82:305-12.
4. Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol. 2006; 46:521–527.
5. Turner C, Horner P, et al. British Fertility Society Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice. Hum Fertil (Camb) 2010; 13:115–125.
6. Timmerman D. Predictive models for the early diagnosis of ectopic pregnancy. Verh K Acad Geneeskd Belg. 2004; 66 (2):155-71.
7. Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009; 361:379–387.
8. Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy . CMAJ. 2005; 173(8):905.
9. Rashmi A Gaddagi, AP Chandrashekhar. A Clinical Study of Ectopic Pregnancy. JCDR 2012;6:867-869
10. Gupta R, Porwal S, Swarnkar M, Sharma N, Maheshwari P. Incidence, trends and risk factors for Ectopic Pregnancies in a tertiary care hospital of Rajasthan. JPBMS 2012; 16 (07):1-3.
11. Khaleeque F, Siddiqui RI, Jafarey SN. Ectopic pregnancies: A Three year study. J Pak Med Assoc 2001; 51:240–243.
12. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010 Mar;115(3):495-502
13. R. C (Karki) L, Pradhan B, Duwa S. Annual Analysis of Ectopic Pregnancy in Tertiary Care Hospital. PMJN 2011;11 :5-8
14. Roussos D, Panidis D, Matalliotakis I, Mavromatidis G, Neonaki M, Mamopoulos M, Koumantakis E. Factors that may predispose to rupture of tubal ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2000 Mar;89(1):15-7
15. Murray H, Baakdah H, Bardell T, Tulandi T.Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005 Oct 11;173(8):905-12
16. Eskandar M, Archibong EI, Sadek AA, Sobande AA. Bahrain Med Bull 2002; 24 (2):63-65.
17. Warren CW, Gwinn ML, Rubin GL. Seasonal variation in conception and various pregnancy outcomes. Soc Biol 1986; 33:116-26.
18. Swende TZ. Jogo AA. Ruptured tubal pregnancy in Makurdi, North Central Nigeria. Niger J Med 2008; 17(1): 75-7
19. Ludwig M, Kaisi M, Bauer O, Diedrich K .Heterotopic pregnancy in a spontaneous cycle: do not forget about it! Eur J Obstet Gynecol Reprod Biol. 1999 Nov; 87(1):91-3.
20. Espinosa PM, Alcantar Mendoza MA. Heterotopic pregnancy: Report of a case and review of literature. Ginecol Obstet Mex. 1997; 65:482–6.
21. GO Udigwe, OS Umeononihu, I.I Mbachu. Ectopic pregnancy: A 5 year review of cases at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. NMJ 2010 ;51: 160-163
22. Latchaw G, Takacs P, Gaitan L, Geren S, Burzawa J. Risk factors associated with the rupture of tubal ectopic pregnancy. Gynecol Obstet Invest. 2005; 60 (3):177-80.
23. Knafel A, Basta P, Skotniczny K, Paweł M, Krzysztof B, Rokita W, Obrzut B, Wicherek Ł. Ectopic pregnancy rupture--can it be prevented? Ginekol Pol. 2009 Oct;80(10):734-9
24. Bangsgaard N, Lund CO, Ottesen B, Nilas L. Improved fertility following conservative surgical treatment of ectopic pregnancy. BJOG 2003 Aug; 110 (8):765-70.
25. Canis M, Savary D, Pouly JL, Wattiez A, Mage G. Ectopic pregnancy: criteria to decide between medical and conservative surgical treatment? J Gynecol Obstet Biol Reprod (Paris). 2003 Nov; 32 (7 Suppl):S54-63.
26. Chatterjee S, Dey S, Chowdhury R G, Ganguli D. Ectopic Pregnancy In Previously Infertile Women Subsequent Pregnancy Outcome After Laparoscopic Management. Al Ameen J Med Sci 2009;2(1):67-72
27. Jurkovie D. Ectopic pregnancy. In: Edmonds DK, editor. Dew Hurst’s textbook of Obstetrics & Gynecology. 7 ed. USA:; Blackwell Publishers;2007
28. Shah N, Khan NH. Ectopic pregnancy: Presentation and risk factors. J Coll Physicians Surg Pak. 2005;15:535–8.
29. Majhi AK, Roy N, Karmakar KS, Banerjee PK. Ectopic pregnancy--an analysis of 180 cases. J Indian Med Assoc. 2007 Jun;105(6):308,310,312
30. Abbas A, Akram H. Ectopic Pregnancy; Audit at Maula Bakhsh Teaching Hospital Sargodha.Prof Med J 2011;18 (1): 24-27.
31. Lozeau AM, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2005;72:1707–14

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