Management outcome of ruptured ectopic pregnancy at a secondary level of health care delivery in south-west, Nigeria

Abstract

Background:  Ectopic pregnancy is a condition of high morbidity and mortality with an enormous threat to life. Therefore it is of immense
gynaecological importance, particularly in the developing world, where the majority of patients present late with rupture and haemodynamic instability.
Objectives: The objectives of this study were to determine the incidence and analyze the clinical presentations, risk factors, sites of ectopic pregnancy and associated morbidity and mortality.
Methods: This was a retrospective review of records of patients managed as cases of ruptured ectopic pregnancy at Our Lady of Apostle (O.L.A)
Catholic Hospital, Ibadan over a six-year period between January 1st 2010 and December 31st 2015.
Results: The incidence of ectopic pregnancy was 1.03% (65/6,342) of total deliveries, 2.9% (65/2280) of all gynaecological admissions and 13.5% (65/480) of gynaecological emergencies. Fifty-four case folders were analyzed. The leading symptom was pain 87.3% (47/54), followed by  amenorrhea 60.0% (32/54), while syncope attack and vaginal bleeding had 50.0% (27/54) and 36.4% (19/54) respectively. Pelvic infection was the leading risk factor of57.4% (31/54) of the study population, followed by induced abortion 36.4% (19/54). Two patients had previous ectopic pregnancy; hence the recurrent rate was 3.7%. Tubal pregnancy accounted for 85% (46/54) while the abdominaland cornual gestation accounted for 2% (1/54) and 13% (7/54) respectively. All patients with tubal pregnancy had salpingectomy while those with cornual pregnancy had wedged resection. The diagnosis was missed in 18.2% (10/54) of patients. There was no record of maternal death.
Conclusion: The fact that all cases were ruptured and that pelvic infection and induced abortion were the major risk factors, efforts should be made to improve on early detection of ectopic pregnancy before rupture and prevent pelvic infection and induced abortion among the women of  reproductive age.

Keywords: Ruptured ectopic pregnancy, secondary healthcare delivery, management outcome.