Title: Suspected Ectopic Pregnancies and the Outcome in a Tertiary Care Hospital in South India
Authors: Dr Bindu P., Dr Preethi Y.
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.83
Abstract
Background: Ectopic pregnancy is potentially lethal obstetric emergency, early diagnosis of unruptured ectopic pregnancy is of paramount importance..During the past decade, transvaginal ultrasonography has given an earlier and clearer picture of early pregnancies, by ruling out ectopic pregnancy if intra uterine pregnancy is identified or it may strongly suggest an ectopic pregnancy if an adnexal mass is seen or in the presence of pelvic fluid. However in 15% of cases the report may be indeterminate, that is empty uterus, ectopic pregnancy not ruled out. It is this cohort of women with suspected Ectopic pregnancy that forms the subject of this study.
Aim of the study was to study the outcome of pregnancies with indeterminate early pregnancy pelvic ultrasounds, admitted with clinical suspicion of ectopic pregnancy.
Methodology: This is a retrospective cohort study conducted for 1 year in Sree Avittom Thirunal hospital, Government Medical College, Trivandrum, a tertiary care center.
Statistical tests used are mean, SD, Percentage, chi square and Odds Ratio to assess association of the selected parameters with the Ectopic pregnancy.
Results: The study identified 109 women admitted with clinical suspicion of ectopic pregnancy and were followed up of which 99 patients met the inclusion criteria.Of the 99 patients 26 were ectopic pregnancies, 34 were spontaneous miscarriages, and 39 were viable intra utrine pregnncy. The overall mean age of the patients at presentation was 26.87yrs. The majority of patients were in 25 - 29 yrs age group, which was also true for ectopic pregnancy and spontaneous abortions, but not for the patients in Intra Uterine pregnancy group where the maximum number of patients were in the g group of 20 – 24 yrs.( X2 =12.4,P =0.001).
There was more number of referred cases in all the three categories.60% 0f the suspected ectopic pregnancy were referred. Among the cases that were eventually ectopic pregnancy 65.38 had been referred. The association of gravidity and outcome was found significant with Chi-square =20.58; P =0.008. The majority of patients in Intra Uterine group were primi gravidas. The overall incidence of prior miscarriage in our study population was around 21%.History of Infertility was also studied and in this there were 14 (14.14%) patients with infertility. In the ectopic pregnancy group,19,2% gave history of treatment for infertility while 80.8% did not have history of infertility treatment. 11.53% of patients with ectopic pregnancy had a history of previous ectopic.
Conclusion: Early detection of ectopic pregnancy is of paramount importance. Early detection can be challenging and a number of early ectopic pregnancies are missed at the initial medical examination. Documentation of risk factor is an essential part of history-taking, and asymptomatic clinic patients with risk factors may benefit from routine early imaging. However, more than half of identified ectopic pregnancies are in women without known risk factors.
Keywords-Ectopic Pregnancy, Beta Human Chorionic Gonadotropin; Transvaginal ultrasonography.
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