Ruptured Ectopic Pregnancy in a Nigerian Tertiary Hospital: What has Changed?

Abstract

s: Background : Ruptured ectopic pregnancy continues to be a major surgical emergency in gynecology. Due to the contribution of ectopic pregnancy in maternal mortality indices in Nigeria, an intervallic review of it has become very necessary. Objectives : This is to determine the prevalence, clinical presentation, risk factors, and the management outcomes of ectopic pregnancies. Methods : This is a retrospective study of cases of ectopic gestations managed in the gynecological unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-east Nigeria from January 1st 2013 to December 31st, 2017. Information was obtained from the case files, theatre and labor ward registers. We only included women with ruptured ectopic pregnancy that were managed surgically. Cases that were managed medically or conservatively were excluded. The proforma was initially used for retrieving data from case files obtained from the Medical Record department of the hospital. The data was later transferred to SPSS version 23 for analysis. Results : During the period, there were a total of 5301 deliveries, 901 gynecological admissions and 67 ectopic pregnancies recorded. This gives a prevalence of 1.3% of total deliveries and 6.7 of gynecological admissions. However, only 56 case files were available with complete information for the study, and could be used for further analysis. The majority were in the age group of 25-29 years. The prevalence was highest among the secundigravida 17, (30.4%) followed by and primigravidas, 13(23.2%). Previous pelvic inflammatory disease 30(53.6%), previous induced abortion 16(35.7%), and previous abdominopelvic surgery 10(26.8%) were the most common associated risk factors. Lower abdominal pain 54(96.4%), amenorrhea 50(89.3%), vaginal bleeding 40(71.4%) and syncope/shock attack 38(67.9%) were the predominant symptoms at presentation. Majority 34(60.7%) of the tubal rupture occurred at gestational age of 8-10weeks. Thirty (53.6%) cases occurred at the right tubes. Most, 71.4% (40) of the tubal ectopic gestations were ampullary. Majority of the patients 51(91.1%) had unilateral salpingectomy, 14(25.0%) had total salpingectomy while 5(8.9%) had cornual repair. Forty six (85.7%) women received blood transfusion. The case fatality rate was 1.8% which was exclusively due to anesthetic complication. Conclusion : The prevalence of ruptured ectopic pregnancy is still high in Nigeria with pelvic infection being the most common associated risk factor. Only tubal ectopic pregnancy was reported. There are no reported cases for abdominal pregnancies, ovarian pregnancies and heterotopic pregnancies within the last half decade, although with first mortality from ectopic pregnancy being recorded, which appears to signify a changing pattern.