Author(s): Anupama Suresh1, Jaice Mary Devasia2, Bhavya Adla3 Amrita Balachandran4, Suresh Y. V5
BACKGROUND Ectopic pregnancy is among the leading causes of mortality among pregnant women in the first trimester. Ectopic pregnancy occurs at a rate of 1-2% of all the pregnancies and can occur in any sexually active woman of reproductive age. We wanted to analyse the various risk factors associated with ectopic pregnancy, assess the morbidity and outcome associated with the risk factors and assess the results of management of ectopic pregnancy. METHODS A five-year retrospective cohort study was conducted from July 2011 to June 2016 at a hospital in Southern India. RESULTS 199 out of 29,548 pregnancies were diagnosed with ectopic pregnancy, leading to an incidence of 6.73 per 1000 deliveries. Majority of the ectopic pregnancies were seen in the age group of 26-30 years and among multigravidas. Missed menstrual cycle (62%) and bleeding per vagina (45.7%) were the most common presenting symptoms. The most common risk factor was history of a previous abdominal surgery (26%), followed by pelvic inflammatory disease (17%) and previous abortion (14.5%). The most common site of ectopic gestation was tubal ectopic (96.4%), of which 65% was ruptured at the time of diagnosis. 97.9% patients were surgically managed, 2.5% patients were successfully treated medically with methotrexate. Five patients were shifted to ICU in view of severe shock. There was no mortality. CONCLUSIONS Early diagnosis with clinical examination, use of ultrasonography, beta HCG levels, and immediate intervention is crucial in the management of ectopic pregnancy to reduce the mortality. Surgical morbidity can be avoided with conservative surgeries. Literacy, health education, good ambulance services plays vital role in reducing the morbidity in rural areas.