A descriptive analysis of patients presenting with ectopic pregnancies at King Edward VIII hospital, Durban.

Abstract

OBJECTIVE: To describe the patient profile, clinical features, risk factors, management options and complications in women with ectopic pregnancy. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: King Edward VIII Hospital, Congella, Durban from July 2005 – June 2006. MATERIALS AND METHODS: 130 case notes of women with the final diagnosis with ectopic pregnancy were examined retrospectively. Data was retrieved through a structured proforma. The variables studied included age, parity, signs and symptoms, treatment, management, complications and associated maternal morbidity and mortality. RESULTS: One hundred and twenty women diagnosed with ectopic pregnancy were included in this study. Ten patients were excluded due to failure to obtain clinical records. Women’s ages ranged from 17-40 years with 32 patients (26.7%) being nulliparous and 88 patients (73.3%) between parity 1-4. Twelve patients (10%) had a history of previous ectopic pregnancy. The commonest presenting symptom was abdominal pain in 106 (88.3%) patients whereas amenorrhoea and vaginal bleeding were found in 88 (73.3%) and 84 (70%) patients respectively. The most common physical sign was tenderness: Adnexal tenderness in 99 (82.5%) and pelvic tenderness in 91 (75.8%) of women. Fourteen women (11.7%) presented to the gynaecological outpatient’s department in acute shock with a blood pressure < 90/60 mmHg. The commonest ultrasound findings were the presence of an adnexal mass and an empty uterus in 82 (68.3%) and 80 (66.7%) women respectively. The most frequent risk factors were previous genital infection in 34 patients (28.3%) and multiple sexual partners in 32 patients (26.7%). One hundred and eleven 92.4%) women were managed by laparotomy: One hundred and four (87.4%) women via emergency laparotomy and 6 women (5%) had an elective laparotomy. One patient (0.8%) had a diagnostic laparoscopy which was converted to laparotomy. Only 8 patients (6.7%) were managed laparoscopically. Surgical treatment consisted of salpingectomy 101/120 (84.9%) and salpingotomy in 4 (3.4%) patients. Post- operation complications were minimal however the one maternal death was probably due to a pulmonary embolus. CONCLUSION: Risk factors may not always be present, hence ectopic pregnancy should be suspected in every women of reproductive age who present with unexplained abdominal pain, amenorrhoea and vaginal bleeding. Most women presented with ruptured ectopic pregnancies at King Edward VIII Hospital warranting emergency laparotomy.