A study of tubal ectopic pregnancy

Abstract

OBJECTIVE: Tubal pregnancy remains an important cause of maternal morbidity and mortality. Published data on this important disease is scarce in Sri Lanka. The aim of this study is to describe a group of mothers presenting with ectopic pregnancy to the Gynaecology Department of the THP during 2003 and 2004. Method: The Teaching Hospital, Peradeniya is a 700- bed tertiary referral center, serving patients in the Central and Sabaragamuwa provinces of Sri Lanka. Data of in-patient records (bed head

tickets) of mothers presented to the Gynaecology Department of the THP during 2003 and 2004 were collected and the variables of socio-demographic characteristics, relevant findings in history, examination and intra operative findings at surgery were analysed. All patients with an ectopic pregnancy (ICD 9 ' revision, codes 633.1, 633.9, 646.9) were identified and 94 patients were sampled. Patients were included in the study based on the criteria of positive urine beta HCG and objective evidence of a tubal mass on ultrasound examination or at surgery and received their definitive treatment at the Teaching Hospital Peradeniya. Of the 94 cases 3 records could not be located, three were excluded: 2 were not pregnant 3 had no tuboovarianmass. This left a final patient sample of 83. RESULTS: The mean age of the 83 women included in the sample was 29.7 years (range 16-43).Ninety five percent of women were married. More than seventy percent of the population was housewives (n=58). Majority of women had direct admission to THP (71 %) and rest was transferred from other hospitals. Risk factors for ectopic pregnancy have not been identified in most women but four women had past history of ectopic and five had past tubal surgery and six women had past history of PID. Thirty nine percent of women showed cervical motion tenderness in pelvic examination. Examination and investigation based diagnosis revealed 57% patients had clinically ruptured ectopic (76% found to rupture at surgery). Clinically not ruptured and inconclusive ectopic pregnancy was noted in an equal percentage of women. Hemoperitoneum was noted in most of the women and ranged 50 ml to 2500 ml. Sixty seven women had ectopic pregnancy on the fallopian tube and 60%, 14%, 10%, 1% had it on fimbrial end, ampullary region, isthmus and cornual region respectively. Discussion: Determining which tubal pregnancy requires immediate treatment to avert rupture remains a challenge. The factors important in diagnosing tubal pregnancy are not helpful in predicting risk of rupture. Therefore early diagnosis of site of pregnancy with transvaginal ultrasound scan is recommended.