DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174553

Current pattern of presentation and approach to the management of ectopic gestation in the state specialist hospital Ondo: a two-year review

Adedokun I. Adegoke

Abstract


Background: Ectopic gestation is still the leading cause of pregnancy related death in the first trimester. Not much has changed in the area of management in the developing world due to the pattern of patients’ presentation and paucity of laparoscopic facilities. The study aims to assess the current pattern of presentation and approach to the management of ectopic gestation in a secondary health facility in sub-Saharan Africa.

Methods: A retrospective study was carried out to assess the current pattern of patients’ presentation and approach to management of ectopic gestation in State Specialist Hospital, Ondo, Nigeria. All the data were retrieved from the case record of patients and analysed using SPSS version 20.

Result: The commonest symptoms patients presented with were abdominal pain, amenorrhoea and vaginal bleeding with figures 63 (96.92%), 47 (72.31%) and 34 (52.31%) respectively. Tubal ectopic gestation was the commonest type found in 60 (92.31%) patients and was more on the right (56.92%). Fifty-nine (90.77%) of the tubal ectopic gestations were ruptured while only one was unruptured. All the patients had exploratory laparotomy. No mortality was recorded during the period under review.

Conclusion: All the patients reviewed had exploratory laparotomy mainly due to the non-availability of laparoscopy in our centre, the nature of presentation and the financial capability of the patients and their relations. These factors still remain the determinants of clinician’s choice of patients’ management in low resource settings of the world.


Keywords


Ectopic pregnancy, Exploratory laparotomy, Fallopian tubes, Laparoscopy, Ultrasound

Full Text:

PDF

References


Kirk E, Bourne T. Ectopic pregnancy. Obstet Gynecol Reprod Med. 2011;21:207-11

Goel JK, Chandrashekhar M. Pregnancy in a rudimentary horn of bicornuate uterus. MJAAFI 2000;56:351-2.

Varma R, Gupta J. Tubal ectopic pregnancy. Clin Evid. 2009;20:406

Bouyer J, Coste J, Fernandez H. Sites of ectopic pregnancy: a 10-year population-based study of 1800 cases. Hum Reprod. 2002;17:3224-30.

Onwuhafua PI, Onwuhafua A, Adesiyun GA, Adze J. Ectopic pregnancies at Ahmadu Bello University Teaching Hospital, Kaduna Northern Nigeria. Trop J Obstet Gynaecol. 2001:82-6.

Killick SR, Stabile I. Ectopic pregnancy: minimizing the risk, ultrasound diagnosis, and laparoscopic management. Gynecol Forum. 1997;2:3-30

Gamzu R, Almog B, Levin Y, Avni A, Jaffa A, Lessing J. Efficacy of methotrexate treatment in extrauterine pregnancies defined by stable or increasing human chorionic gonadotropin concentrations. Fertil Steril. 2002;77:761-5.

Fylstra DL. Tubal pregnancy: a review of current diagnosis and treatment. Obstetrical Gynaecological Survey. 1998;53(5):320-8.

Centers for Disease Control and Prevention (CDC). Ectopic pregnancy-United States, 1990-1992. MMWR. Morbidity and mortality weekly report. 1995;44(3):46.

Orji EO, Fasubaa OB, Adeyemi B, Dare FO, Onwudiegwu U, Ogunniyi SO. Mortality and morbidity associated with misdiagnosis of ectopic pregnancy in a defined Nigerian population. J Obstet Gynaecol. 2002;22(5):548-50.

Rose IA, Ayodeji O, Olalekan OA, Sylvia A. risk factors for ectopic pregnancy in Lagos, Nigeria. Acta Obstet Gynecol Scand. 2005;84:184-8.

Anorlu RI, Oluwole A, Abudu OO, Adebajo S. Risk factors for ectopic pregnancy in Lagos, Nigeria. Acta Obstet Gynecol Scand. 2005;84:184-8.

Clayton HB, Schieve LA, Peterson HB, Jamieson DJ, Reynolds MA, Wright VC. Ectopic pregnancy risk with assisted reproductive technology procedures. Obstet Gynecol. 2006;107:595-604.

Farquhar CM. Ectopic Pregnancy. The Lancet. 2005;366:583-91.

Katsikis I, Rousso D, Farmakiotis D, Kourtis A, Diamanti KE, Zournatzi KV. Creatine phosphokinase in ectopic pregnancy revisited: significant diagnostic value of its MB and MM isoenzyme fractions. Am J Obstet Gynecol. 2006;194:86-91

Yagami HT, Sato T, Kurisaki T, Kamijo K, Nabeshima Y, Fujisawa SA. A metalloprotease-disintegrin participating in myoblast fusion. Nature. 1995;377:652-6.

Barnhart KT, Fay CA, Suescum M, Sammel MD, Appleby D, Shaunik A, et al. Clinical factors affecting the accuracy of ultrasonography in symptomatic first-trimester pregnancy. Obstet Gynecol. 2011;117:299-306.

American College of Obstetricians and Gynecologists. Medical management of tubal pregnancy. ACOG Practice Bulletin No. 3. Obstet Gynecol. 1998;92:1-7.

Rajesh V, Lawrence M. Evidence-based management of ectopic pregnancy. Curr Obstet Gynaecol. 2002;12:191-9.

Yao M, Tulandi T. Current status of surgical and nonsurgical management of ectopic pregnancy. Fertil Steril. 1997;67:421-33.

Lundorff P, Hahlin M, Kallfelt B, Thorburn J, Lindblom B. Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy. Fertil Steril. 1991;55:911-5.

Awojobi OA and Ogunsina S. Ectopic pregnancy in a rural practice. Nigerian Journal of Medicine. 2001;10(3):139-40.

Van Mello NM, Mol F, Mol BW, Hajenius PJ. Conservative management of tubal ectopic pregnancy. Best Practice and Research Clinical Obstetrics and Gynaecology. 2009;23(4):509-18.

Dickens BM, Faundes A, Cook RJ. Ectopic pregnancy and emergency care: ethical and legal issues. Int J Gynecol Obstet. 2003;82:121-6.

Lewis G. Saving mothers' lives: reviewing maternal deaths to make motherhood safer 2003-2005, the seventh report on confidential enquiries into maternal deaths in the United Kingdom. London: CEMACH; 2007.

Boufous S, Quartararo M, Mohsin M. Trends in the incidence of ectopic pregnancy in New South Wales between 1990-1998. Aus N Z J Obstet Gynaecol. 2001;41:436-8.

Goddijn M, van der Veen F, Schuring Blom GH, Ankum WM, Leschot NJ. Cytogenetic characteristics of ectopic pregnancy. Hum Reprod. 1996;11(12):2769-71.

Walker JJ. Ectopic pregnancy. Clin Obstet Gynecol. 2007;50:89-99.

Weckstein LN, Boucher AR, Tucker H, Gibson DN, Rettenmaier MA. Accurate diagnosis of early ectopic pregnancy. Obstet Gynecol. 1985;65:393-7.

Jehle D, Krause R, Braen GR. Ectopic pregnancy. Emerg Med Clin North Am. 1994;12:55-71.

Yakasai IA, Abdullai J, Abubakar IS. Management of ectopic pregnancy in Aminu Kano teaching hospital Kano Nigeria. Glo Adv Res J Med Med Sci. 2012;1(7):181-5.