Epidemiology of ectopic pregnancy at the University Teaching Hosipital Lusaka

Abstract

Background: Ectopic pregnancy is defined as a pregnancy outside the uterine cavity and is a life-threatening emergency in the field of obstetrics and gynaecology. It is a most common cause of maternal morbidity and mortality in the first trimester of pregnancy. In resource-constrained settings, where trained specialists are limited in number and geographic location, outcomes are worse. Diagnosis is frequently missed, partly because the patient may not be aware that she is pregnant. However, timely diagnosis accompanied by appropriate management of ectopic pregnancy can alter the clinical course from death to life. The study aims to determine the epidemiology of ectopic pregnancies at University Teaching Hospital (UTH). Methods: A cross sectional study conducted between May, 2014 to November, 2014 in the Department of Obstetrics and Gynaecology at the University Teaching Hospital, Lusaka, Zambia. Women treated for ectopic pregnancies were recruited from the gynaecology ward, interviewed by research assistants and data abstracted from their medical files. Results: A total of 90 women with ectopic pregnancies were enrolled representing 0.5% of early and late pregnancy admissions (total 19,600 pregnant women reviewed between May 2014 –November, 2014). Over 70% were from high residential areas, 52% had at least secondary education, and 81.1% were married or co-habiting. Although 27.8% were HIV positive, 37.8% did not have a known status. Almost half (46.6%) were in their first or second pregnancy. Though 10% were in the second trimester (13-19weeks) gestation, most (67.8%) were below 12 weeks and in 22% the gestation was not known. The commonest risk factors were: more than one sexual partner ever (55.6%) with 10% ever treated for a sexually transmitted disease. The commonest symptoms were lower abdominal pain (97.8%) and amaenorrhea (83.3%). Dizziness was reported in 48.9%. About a quarter (24.4%) were considered in shock on admission and most had abdominal tenderness (86.7%). Where an ultrasound was done (n=57, 63.3%) this was helpful in 86% of cases (n=49). Haemoperitnem was reported in 59.6%. In 65 cases (72.2%) either paracentesis or culdocentesis was done and was positive for blood in 49 (75.4%) of cases. Apart from only one case treated with methotrexate, all other had a laparotomy and 70% were found ruptured. The commonest sites for the ectopic were infundibulum (33.3%) and ampulla (28.9%). Salpingectomy was the commonest procedure (84.4%). Over half (54.3%) had blood loss greater than 500mls. And 44 (48.9%) were transfused. In 34 cases of those transfused, one or two units were transfused. Four patients (4.4%) were recovered in a high dependency unit – the rest in an ordinary ward. One patient died (case fatality of 1.1%). Conclusion: The series at UTH showed that ectopic pregnancy had a low prevalence and had a risk factor profile and clinical presentation like that described elsewhere in the region. Most cases presented with a ruptured ectopic requiring blood transfusion. Earlier presentation can provide an opportunity for more conservative treatment with less morbidity.