Study on the Management of Ectopic Pregnancy in Women's Health Center-Assiut University Hospitals
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- Category: Vol. 82, December 2014
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Study on the Management of Ectopic Pregnancy in Women's Health Center-Assiut University Hospitals, LAILA M. ABD EL-KADER, HOSAM Th. SALIM, ALAA EL-DEIN A. YOUSIF and HAZEM S. MOHAMAD
Abstract
Objective: The aim of this work is to study, prospectively, the incidence of ectopic pregnancy among obstetric emergency cases at Woman’s Health Centre-Assiut University Hospital, the clinical presentations and tools used for confirming the diagnosis and the different lines for management of such cases at this university center.
Study design: This is a prospective descriptive, hospital based study that was carried out on one hundred (100) patients with ectopic pregnancy admitted to the Emergency Department of Woman’s Health center-Assiut, Egypt, during the period between August 2011, to March 2012.
A total of (100) patients with clinical, sonographic or laparoscopic evidence of extra-uterine pregnancy were included in this study. Data were collected directly from patients and their relatives in specially designed questionnaire. Resuscitation of the patients including adequate oxygenation and restoration of circulating volume either by crystalloids and/or blood transfusion was done. Patients were managed by either medical or surgical methods, the later may be laparoscopy or laparo-tomy.
Results: The percentage of (100) women presented with ectopic pregnancy out of total (13332) emergency obstetric cases during (7) months of the study period was 0.75%. Cases of ectopic pregnancy were common at the age of 20-39ys (90%) and also more common among multiparous women (1- 3 deliveries) (52%). 26% of cases had previous dilatation and curettage operation. History of pelvic inflammatory disease (PTD) was reported in 17% of cases. Also 6% of cases had a history of infertility and 5% had history of using intrauterine contraceptive device (IUCD). History of previous pelvic surgery was 4%, one of them was tubal surgery (right salpingo-oophorectomy due to hydrosalpinx). Meanwhile, history of ovulation induction by several lines of treatment was 4%. Obstetric history was normal in 61% of cases and no one patient reported history of previous ectopic pregnancy.
Regarding presentation, lower abdominal agonizing pain was the chief complaint in 77% of cases, delayed menses was 63% and bleeding per vagina was 32%. On examination, 81% had cervical-motion tendermess and 73% had palpable adnexal mass. The mode of therapy was surgical in 99%. Most cases had classical surgery and only 4% has loparoscopic surgical management. On fallow-up during hospital stay, no compli-cations and no maternal deaths were reported. Follow-up after discharge revealed that 2 cases got normal pregnancy afterthere.
Conclusion: This study found that ectopic pregnancy should be suspected in any women in the reproductive age with lower abdominal pain regardless of missed period or vaginal bleeding or even absence of risk factors. This study recommends a program of continuous medical education to be established in the hospital, to guarantee the awareness of physicians to critical medical situations leading to maternal morbidity and mortality such as ectopic pregnancy.