The prevalence of ectopic pregnancy in Jos, North Central Nigeria: a reproductive health challenge

Abstract

Background: Ectopic pregnancy is a life threatening gynecological emergency with a rising incidence of maternal morbidity especially in resource poor settings. Most cases present in the emergency unit when ruptured.

Objective: The objective of this study was to determine the prevalence, identifiable risk factors, clinical presentation and management outcome of ectopic pregnancy.

Method: This was a retrospective review of cases of ectopic pregnancies seen and managed in the gynecological unit of Plateau State Specialist Hospital (PSSH) Jos from 1st September 2012 to 31st August, 2017. The medical records of the patients managed for ectopic pregnancy as well as the delivery register from the labor room, theater register and gynecological admissions during the study period were retrieved. The data were collected with the aid of data entry form designed for this purpose. The relevant data collected were analyzed using epi info 16 version and presented in tables.

Results: During the period, a total number of 13,596 deliveries were recorded while there were 2067 gynecological admissions. One hundred and seventy two (172) patients had ectopic pregnancies accounting for 1.27% of all deliveries and 8.3% of gynecological admissions. The mean age of the patients was 29±5years. The peak age group was 20-25 years (32.0%); 92(53.5%) had secondary school as their highest level of education; 135(78.5%) were married and 49(28.4%) were multigravida. All the patients; 172(100%) presented with a history of abdominal pain while 8(4.7%) presented in shock. A total of 161(93.6%) were diagnosed based on history and clinical examination findings; 152(88.4%) had trans-abdominal scan and 12(7.0%) had abdominal paracentesis (though frowned at in modern day practice). The commonest identifiable risk factors for ectopic pregnancies were pelvic inflammatory disease(PID) in 111(64.5%) of patients followed by previous history of abortions in 17(9.9%) of patients. A total number of 169(98.3%) of the patients had total salpingectomy for ruptured ectopic pregnancies via open abdominal surgeries with 87(50.6%) done on the right fallopian tubes. Three (1.7%) of the patients had oophorectomy. Eighty one(47.1%) of the patients had blood transfusion with no case fatality.

Conclusion: Ectopic pregnancy still remains a major health challenge among women of reproductive age group in Nigeria. Efforts should therefore be directed at prompt and timely management to reduce maternal morbidity and mortality in developing countries, availability and accessibility of contraceptive methods, accessibility to healthcare centers and affordable healthcare, proper treatment of PID, use of better technologies in management of cases and human capacity development.

Keywords: Prevalence, reproductive age group, ectopic pregnancy, resource poor settings, life threatening, emergency