EVALUATION OF RISK FACTORS, CLINICAL PRESENTATION AND MANAGEMENT OF ECTOPIC PREGNANCY

Abstract

INTRODUCTION: Ectopic Pregnancy is dened as implantation and development of the blastocyst at a site other than the uterine cavity. In a normal pregnancy, the zygote enters the uterine cavity in the form of Morula 4 days after fertilization and implantation in the endometrium begins 6-7 days after fertilization. In a small percentage of pregnancies, however, the embryo implants in extra uterine locations leading to an ectopic pregnancy. The most common site of ectopic pregnancy is the fallopian tube. Ectopic pregnancy is one of the main cause of maternal death in early pregnancy. In an ectopic pregnancy, as the pregnancy continues, it can cause the tube to rupture with internal bleeding. This situation is life threatening and needs to be treated as a medical emergency. AIM: The present study is undertaken to determine the incidence, risk factors, clinical presentation, diagnosis, and management of ectopic pregnancy in Obstetrics and Gynaecology department at Patna Medical College & Hospital, Patna. Type of study: Prospective study Study period: 2 years (November 2019 to October 2021) MATERIALS AND METHODS: This is a prospective study conducted in Obstetrics and Gynaecology department at Patna Medical College & Hospital,Patna.Medicalrecords of allwomenwith an ectopic pregnancy betweenNovember 2019 andOctober 2021 are analyzed.The total number of admissions and deliveries during the study period, details of age characteristics, symptoms and signs, gravida, gestational age at presentation, site of ectopicpregnancy,riskfactorsfor ectopicpregnancy,diagnosticmodality, andtreatment(whethersurgicalormedical) are recorded. RESULT: A total of 12,316 admissions and 9740 deliveries are conducted in the study period. 77 patients are diagnosed with ectopic pregnancy during the study period of 2 years. The incidence of ectopic pregnancy is 3.1 per 1000 patients-year. 62.34% of the patients are in the range of 21-30 years of age. In the present study, ectopic pregnancy is found more in multigravida and only 11.69% of the patients are primigravida. The mean gestational age at presentation is 7.25 weeks period of gestation with majority of the patients (46.75%) presenting at 6-8 weeks. The most common risk factor is previous history of ectopic pregnancy followed by history of Pelvic Inammatory Disease. 75 patients out of total of 77 patients presented with features of ruptured ectopic pregnancy. The most common site of ectopic pregnancy is ampulla of fallopian tube with 69.74% of the patients falling in this. Medical Management with single dose Methotrexate was done in 2 patients who presented with un-ruptured ectopic pregnancy. CONCLUSION: Patient with risk factor for ectopic pregnancy should be encouraged to visit her obstetrician for an early diagnosis. PMCH being a tertiary care centre, most of the cases are referred, hence in the present study most of the patients presented very late with ruptured ectopic pregnancy. This being a medical emergency, immediate resuscitation and laparotomy is done in them.