Epidemiology of ectopic pregnancy at the University Teaching Hosipital Lusaka
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Date
2016
Authors
Chisha, Sume Percival
Journal Title
Journal ISSN
Volume Title
Publisher
University of Zambia
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.
Description
MASTER OF MEDICINE IN OBSTETRICS AND GYNAECOLOGY
Keywords
Ectopic pregnancy-Zambia