Ruptured Ectopic Pregnancy in a Nigerian Tertiary Hospital: What has Changed?
DOI:
https://doi.org/10.31907/2309-4400.2020.08.04Keywords:
Pelvic inflammatory disease, good quality review, ruptured, cornual rupture.Abstract
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.
References
Cai H, Mol BW, Li P, Liu X, Watrelot A, Shi J. Tubal factor infertility with prior ectopic pregnancy: a double whammy? A retrospective cohort study of 2,892 women [published online ahead of print, 2020 Mar 3]. Fertil Steril 2020; S0015- 0282(19)32688-3. https://doi.org/10.1016/j.fertnstert.2019.12.036
Udigwe GO, Umeononihu OS, Mbachu II. Ectopic pregnancy. A5 year review of cases at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. Niger MED J 2010; 51: 160-3
Abubakar P, Nwobodo EI, Omokanye OL, Ahmed Y, Shehu CE, Borodo TA. Ectopic pregnancy at Usmanu Danfodiyo University Teaching Sokoto: A ten year review. Ann Nigeria Med 2012; 6(2): 87-91. https://doi.org/10.4103/0331-3131.108128
Arup KM, Nilopta SK, Pradip KB. Ectopic Pregnancy, an analysis of 180 cases. Journal of the Indian Med Assoc 2007; 105: 308-14.
Lawani OL, Anozie OB, Ezeonu PO. Ectopic: a life – threatening gynaecological emergency. International Journal of Women’s Health 2013; 5: 515-521. https://doi.org/10.2147/IJWH.S49672
Airede LR, Ekele BA. Ectopic pregnancy in Sokoto, Northern Nigeria. Malaria Med J 2005; 17: 14-6. https://doi.org/10.4314/mmj.v17i1.10864
Anorlu RI, Oluwole A, Abudu OO, Adebayo S. Risk factors for ectopic pregnanacy in Lagos Nigeria. Acta Obstet Gynaecol Scand 2005; 84: 184-8. https://doi.org/10.1111/j.0001-6349.2005.00684.x
Etuknwa BA, Azu OO, Peter AI, Ekandem GJ, Olaifa K, Aquaisua AN. Ectopic Pregnancy: A Nigerian Urban Experience. Korean J Obstet Gynaecol 2012; 55(5): 309-14. https://doi.org/10.5468/KJOG.2012.55.5.309
Musa J, Daru PH, Mutihir JJ, Ujar IA. Ectopic pregnancy in Jos, Northern Nigeria. Prevalence and Impact on Subsequent fertility. Niger J Med 2009; 18: 35-8.
Igwegbe AO, Eleje GU, Okpala BC. An Appraisal of the Management of Ectopic Pregnancy in a Nigeria Tertiary Hospital. Ann Med Heath Sci Res 2013; 3(2): 166-170. https://doi.org/10.4103/2141-9248.113655
Igberase GO, Ebeigbe PN, Igbekoyi OF, Ajufoli BI. Ectopic pregnancy: an 11 year review in the tertiary centre in Niger Delta. Trop Doct 2005; 35(17): 175-7. https://doi.org/10.1258/0049475054620888
Walker JJ. Ectopic pregnancy. In: Clinical Obstetric and Gynaecology. Lippincott William and Wilkins, Inc 2007; 50(1): 121-6. https://doi.org/10.1097/GRF.0b013e31802f4f79
Abbas A, Akram EK. Ectopic pregnancy: Audit at Maula Teaching Hospital Sagodha Professional. Med J 2011; 18: 24-7.
Shaw JT, Dry SK, Crichley HO, Horne AW. Current Knowledge of the aetiology of human tubal Ectopic pregnancy. Human Reprod Update 2010; 16: 32-44. https://doi.org/10.1093/humupd/dmp057
Ugboma HAA, Oputa OAV, Orazulike NC, Allagoa DO. Ectopic Pregnancy: Recent Experience in a Tertiary Hospital, South-Southern Nigeria. International Journal of Tropical Disease & Health 2017; 21(1): 1-6. https://doi.org/10.9734/IJTDH/2017/29181
Poonam Y, Uprely D, Banerjee B. Ectopic Pregnancy –two years review from BPKIHS, Nepal Kathmandu University Med J 2005; 3: 365-9.
Swende TZ, Jogo AA. Ruptured tubal pregnancy in Markurdi, North Central Nigeria. Niger J med 2008; 17(1): 75-7. https://doi.org/10.4314/njm.v17i1.37361
Udigwe GO, Eleje GU, Ihekwoaba EC, Udegbunam OI, Egeonu RO, Okwuosa AO. Acute Intestinal Obstruction Complicating Abdominal Pregnancy: Conservative Management and Successful Outcome. Case Rep Obstet Gynecol 2016; 2016: 2576280. https://doi.org/10.1155/2016/2576280
Nwosu B, Igwegbe A, Eleje G, Ugboaja J, Etoniru I, Egwuonwu O, Okor L. Full Term Secondary Abdominal Pregnancy in a Jehovah’s Witness: a case Report. Case Report in Clinical Medicine 2012; 1: 19-22. https://doi.org/10.4236/crcm.2012.12006
Eleje GU, Ezebialu IU, Okpala BC, Okolie VE, Onyegbule OA. Advanced Abdominal Pregnancy in a Diabetic Multiparais Delivery of the Placenta Always a Problem? A Case Report. Afrimedic Journal 2011; 2(2): 32-34.
Eleje GU, Udigwe GO, Egeonu RO, Okegbe IO, Okoh TN. Spontaneous Heterotopic Pregnancy after Four Previous Caesarean Sections: Successful Salpingectomy and IntraUterine Term Pregnancy. Int. Biol Biomed J Spring 2017; 3(2): 101-104.
