scholarly journals Clinical presentation and outcome of ectopic pregnancies in a tertiary care rural hospital

Author(s):  
Indu Verma ◽  
Punya Priya ◽  
Charvi Chugh ◽  
Harsharan Kaur ◽  
Dinesh Sood

Background: Ectopic pregnancy is the commonest cause of the maternal morbidity and mortality in the first trimester of the pregnancy. The aim of this study was to see the clinical presentation, associated risk factors, mode of treatment and outcome.Methods: Retrospective study conducted in a tertiary care rural hospital. Women with diagnosis of ectopic pregnancy admitted between August 2016 to September 2018 were studied. Medical record files were scrutinized to get the details. Data was analyzed using Microsoft Office Excel (version 2007). Numerical data were subjected to descriptive analysis, with mean±standard deviation (SD) and categorical data as frequency and percentage.Results: Forty cases of ectopic pregnancy were included who were unbooked, non-smokers, married and belonged to rural areas. Eighty percent were in the age group of 20 to 30 years.  Maximum were gravida 3 or 4 with commonest presentation was pain, site was tubal. Laparotomy was done in 95% of women salpingectomy was the commonest surgical procedure done in 32 (80%) women. Salpingoophrectomy was done in one woman and lifesaving hysterectomy in 2 (5%) women for cervical and ruptured interstitial ectopic pregnancy one each. Blood transfusion was required in 28 (70%) women. No mortality was seen.Conclusions: Women of reproductive age group with pain abdomen and menstrual complaints, even without amenorrhoea, ectopic pregnancy should be ruled out. Treating reproductive tract infections / PID and offering contraceptives will decrease the incidence of ectopic pregnancy. Medical and paramedical staff should do the timely referral to higher centres.

Author(s):  
Naorem Sunanda Chanu ◽  
Vinodkumar Suresh Basavaradder ◽  
Cibi Darsani ◽  
Ahanthembi Sanaton

Background: Ectopic pregnancy is one of the most common life-threatening emergencies in early trimester of pregnancy. The aim of this study was to determine the incidence, age group, gravidity, parity, risk factors, clinical presentation, treatment modalities associated with ectopic pregnancy in the current scenario.Methods: We conducted a prospective study for the period of two years starting from Aug 2017 to Aug 2019 at JNIMS OBG Department.Results: A total of 94 patients who were diagnosed as ectopic pregnancy and they were analysed for clinical presentation, risk factors, operative findings and treatment modality. Majority of patients were in the age group of 25 to 30 years. Ectopic pregnancy was more commonly associated with history of prior abortions, prior LSCS and PID. Commonly presented with amenorrhea of 6-8 weeks with abdominal pain and bleeding PV, most common site being ampulla followed by isthmus. Most of the patients had ruptured pregnancy at presentation. Majority of the patients underwent salpingectomy and salpingectomy with contralateral tubectomy.Conclusions: Ectopic pregnancy diagnosis is a grey zone and challenging. Early diagnosis by keeping suspicion in first trimester with PV bleeding and pain abdomen with history of amenorrhea about ectopic pregnancy, which helps in management to reduce maternal morbidity and even mortality.


2018 ◽  
Vol 8 (1) ◽  
pp. 2-6
Author(s):  
Sangeeta Devi Gurung ◽  
Prakash Sharma

Introduction: Ectopic pregnancy (EP) is one of the major complications in first trimester pregnancy, resulting in increased maternal morbidity and mortality. It accounts for 1.3-2.4% of all pregnancies. Previously, though laparoscopy was considered as the gold standard for diagnosis of ectopic pregnancy, due to availability of high resolution ultrasound, it has become the first line investigation for the diagnosis of ectopic pregnancy.Methods: It is a prospective study conducted in Manipal Teaching Hospital, Pokhara, from January 2015 till December 2017. All the cases diagnosed with ectopic pregnancy were included in the study.  Ultrasonological and intraoperative findings were recorded. Data was analyzed using SPSS (VERSION 16).Results: Twenty six patients were diagnosed with ectopic pregnancies. The incidence was 0.35%. It was most common among the reproductive age group between 20-40 years with mean age of 30.50 years. Pelvic inflammatory disease (n=10, 38.5%) was considered as risk factor. Radiological finding of Type III ectopic pregnancy (n=21, 80.8%) was the most common type.Conclusion: Ectopic pregnancy is common among reproductive age group with previous history of pelvic inflammatory disease. Type III is the most common type.


Author(s):  
Arati Behera ◽  
Ranjita Ghadei ◽  
Rudra Narayan Bal

Background: Ectopic pregnancy is a life-threatening emergency commonly encountered by medical practitioner. Diagnosis is frequently missed and should be considered in any women in the reproductive age group with abdominal pain or vaginal bleeding. The aim of the study is to assess the incidence, clinical presentation, risk factors, methods of diagnosis, treatment, outcome and complications.Methods: This was a prospective study at S.C.B. Medical college from January to December 2017. Parameters like age, parity, gestational period, risk factors, clinical presentations, findings on ultrasonogram and at surgery with morbidities associated with diagnosed cases of ectopic pregnancy (n=93) were noted and analysed with SPSS-19 software.Results: Incidence of ectopic pregnancy was 18/1000 deliveries. Maximum cases were in age group of 21 to 30 years (54.8 %) and parous (76.3%). Common risk factors were having history of abortions (46.2%), previous tubal sterilization (24.7%), having one or more caesarean section (17.2%) and h/o infertility (16.1%). Most common symptom was pain abdomen (96.8%). Commonest site was ampullo-isthmic region of tube and rupture was the commonest mode of presentation. All underwent laparotomy and unilateral salpingectomy was done in 86 % of cases. It contributed to 3.27 % of total maternal deaths.Conclusions: Suspicion in high risk group can direct one to investigate and diagnose early, thereby reducing morbidity, mortality and improving the prospect of future fertility.


Author(s):  
Ishrat Zuber ◽  
Vaishali Chaurasia

Background: Ectopic pregnancy is a catastrophic and life-threatening condition and one of the commonest acute abdominal emergency in day-to-day practice. Objectives of present study were to know the incidence of Ectopic pregnancy at Tertiary care centre, the age group, parity and risk factor of ectopic pregnancy, the clinical presentation of ectopic pregnancy and the outcome and management of ectopic pregnancy.Methods: It was a retrospective study conducted at Chirayu Medical College and Hospital, Bhopal from 1st June 2009 to 31st May 2014. A total of 42 patients with ectopic pregnancy were analyzed on clinical presentation, clinical findings, investigations, operative findings and outcome.Results: A majority of women (64.29%) were in the age group of 21-30 years and 78.57% were multigravida. Commonest risk factors were previous history of abortion (23.80%) and pelvic inflammatory disease (14.28%) Amenorrhea (92.85%) and pain abdomen (89.22%) were the most common presenting symptoms. Ampulla of fallopian tube was the commonest site (45.23%). Unilateral salpingectomy was performed in 40.47% patients. There were no maternal deaths and majority (80.96%) were discharged within seven days.Conclusions: Ectopic pregnancy still remains one of the major causes of maternal morbidity and mortality. Early diagnosis and referral in hemodynamically stable state along with use of minimal access surgery or medical management can change the scenario of ectopic pregnancy in the developing world.


Author(s):  
Maheswari S. ◽  
Poornima C. ◽  
Lalitha N. ◽  
Seetha Panicker

Background: Ectopic pregnancy (EP) is a common, life threatening emergency during the first trimester and a significant cause for maternal morbidity and mortality. In any woman of reproductive age presenting with abdominal pain and vaginal bleeding, ectopic pregnancy should be considered. The objectives of the present study is to determine the incidence, risk factors, clinical presentation, type of ectopic pregnancy, treatment, morbidity and mortality.Methods: Retrospective analysis of case sheets of patients admitted with ectopic pregnancy at PSGIMSR, Coimbatore during the period July 2011 to June 2016 was done. The details noted were age, parity, risk factors {previous abortion, previous EP, previous pelvic surgery, intrauterine contraceptive device, tubectomy, history of pelvic inflammatory disease}, treatment for infertility, clinical presentation, ultrasound findings, investigations including beta HCG value and hemoglobin level, treatment offered, need for blood transfusion, operative findings and morbidity.Results: During the five year, there were 12,407 deliveries at our hospitals and 88 cases of ectopic pregnancies were managed. The incidence is 6.6/1000 deliveries. Among them 44% belonged to the age group of 25-30 years and multi gravida were 73.8%. Most common risk factors were previous abortion (23.8%) and previous surgeries including caesarean section, tubectomy, appendicectomy, tubal microsurgery (23.8%). Most common presentation was pain abdomen (85.2%). Out of the 88 cases, 73 patients were managed surgically (82.9%) and 11 cases were managed successfully with methotrexate (12.5%). Three of them underwent conservative management and one had Uterine Artery Embolization.Conclusions: Early diagnosis based on risk factors and timely intervention plays a main role in reducing morbidity and mortality associated with ectopic pregnancy.


2018 ◽  
Vol 27 (2) ◽  
pp. 22-26
Author(s):  
NA Parveen ◽  
MM Sarker ◽  
MK Sarker

Ectopic pregnancy is a common life-threating condition. Diagnosis is frequently missed and should be considered in any women in the reproductive age group presenting with abdominal pain or vaginal bleeding. This prospective observational study was conducted in RMCH to determine the incidence, risk factors, clinical presentation, treatment, morbidity and mortality associated with ectopic pregnancy. A total of 50 cases of ectopic pregnancy were operated during the study period giving the incidence of ectopic pregnancy of 8.02/1000 pregnancies. The age of the patient ranged from 18-37 years, with maximum (40%) between 26-30 years age group. 36% patients had delivered one child and 24% were nulliparous. 30% patients had pelvic inflammatory disease and 22% had history of previous abortion/ MR. All patients presented with lower abdominal pain, 68% presented with abnormal vaginal bleeding and 60% had amenorrhoea. Most of the patients were diagnosed by high clinical suspicion and confirmed by USG. 96% cases ectopic pregnancy occurred in the fallopian tube and ampullary part was mainly affected. Laparotomy followed by unilateral salphingectomy was performed in majority (60%) of cases. 22% cases ipsilateral salpingectomy with tubectomy other side and 12% cases salpingostomy were performed. The recovery of majority of patients was smooth and uneventful. There was no death in this study.TAJ 2014; 27(2): 22-26


Author(s):  
Beera Neelima ◽  
V. G. Vanamala

Background: Over the years, there has been a considerable rise in the incidence of ectopic pregnancy. This study was undertaken to identify the risk factors that contribute to this condition, so that immediate action can be taken so as to save the mother.Methods: 62 women, in their first trimester of pregnancy who were diagnosed with ectopic pregnancy were included in the study. Demographic details, clinical and obstetric details were taken from all the patients. Ultrasound was performed to confirm the ectopic pregnancy.Results: Out of the 62 patients, most of them with ectopic pregnancy were found to be in the 26-30 (40.3%) year’s age group. Smoking, whether active or passive was observed in nearly 42% of the cases. The mean gravid status among the women was 3, with 34 live births. 21 of them had induced abortions and 4 were spontaneous. PID was observed in 12 patients (19.4%), 17.7% were IUD users.Conclusions: Risk factors such as previous ectopic pregnancy, use of contraceptives, infertility, PID, abortion as well as increased maternal age aid in the early detection of ectopic pregnancy in women resulting in proper and timely treatment.


Author(s):  
Sreelatha C. Y. ◽  
Sumana M. ◽  
Sundar M. ◽  
Anjan Sreeranga ◽  
Pavithra P.

Background: STI/RTIs have been recognized as major public and reproductive health challenges worldwide. In developing countries, RTI/STIs are the second or third most common public health problem of young people. A variety of factors that put women at risk of reproductive tract infection, such as socio- economic, demographic, sexual, medical, behavioral practices, personal hygiene behavior  have not been adequately explored in India. An objective of the study was to estimate prevalence of STI/RTI among married reproductive age group women in selected CHCs/PHCs of Hassan District and to understand the influence of various factors on STI/RTI among women.Methods: A community based cross sectional study undertaken over a period of 3 months from May 2016 to July 2016, in rural areas of Hassan. Total of 400 married women in the age group 15-49 years were included in the study. Household survey was done in the selected clusters till 20 women per cluster were identified. Married women of reproductive age group of 15 to 49 years, residing in the study area for past 6 months were included in the study.  Results: The prevalence of STI/RTI among married reproductive women was 32%. Prevalence of vaginal discharge decreased with an increase in age, level of education and income. RTI/STI was observed to be higher in scheduled castes and tribes (35.8% and 33.3%) respectively.  Conclusions: Health education regarding the risk factors of unhygienic menstrual practices, non-institutional deliveries and illegal abortions must be imparted to the women in the study area in order to bring about a behavioral change to protect them from RTI/STI. 


Author(s):  
Kamini B. ◽  
Srisanthanakrishnan V.

Background: Reproductive tract infections, adding burden to the morbidities in women especially in developing countries. Women, who are in reproductive age group, are at higher risk of contracting RTIs easily. Bacterial vaginosis, candidiasis and trichomoniasis are the commonly reported RTIs in India. Hence this study was planned to find the prevalence of self reported symptoms of RTIs and the prevalence of RTIs of public health importance in women of reproductive age group 15-49 years in a rural area.Methods: A community based, cross sectional study was conducted among 461 women, who gave written consent. Participants were interviewed and if they have more than two symptoms of RTIs, they were included for gynecological examination and laboratory investigations at the rural health center.Results: The prevalence of self reported RTIs was found to be 55.5% and 27.55% of participants had two or more symptoms of RTIs. Based on examination, Prevalence of cervisitis, vaginitis and pelvic inflammatory diseases were reported as 9.54%, 12.15% and 3.25% respectively. Based on laboratory investigation, candidiasis, bacterial vaginosis and trichomoniasis were reported as 6.075, 5.86% and 2.6% respectively.Conclusions: With the prevailing burden of RTIs, it is important to create awareness and to health educate all women to reduce increasing trend of RTIs. This is possible with proper planning and implementation of health programmes in such a way that it should reach every women residing in the rural areas also. 


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