Ectopic pregnancy in Sokoto, Northern Nigeria

Abstract

Ectopic pregnancy is an important cause of maternal mortality and morbidity in the first trimester of pregnancy. We report a descriptive, cross-sectional study of ectopic pregnancy presenting to the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, between 1990 and 1997. There were 140 cases of ectopic pregnancy with incidence of lS.l per 1,000 deliveries. The mean age of patients was 26.7 years and the median parity of cases of ectopic gestation was 1; 32 % were nulliparae. Abdominal pain and tenderness were the most frequent symptom and sign respec-I ntrod uction Ectopic Pregnancy (EP) is a condition in which the fertilized ovum implants at a site other than the normal endometrial cavity and is an important cause of maternal morbidity and mortality in the first trimester of pregnancy!,2,3. In the vast majority of cases, fetal loss is inevitable. Its incidence, which varies in different parts of the world, is reported to be increasing worldwide 3 ". Although the condition was first described by Albucasis in AD 963, it was not until 1883 that Lawson Tait performed the first successful operation, salpingectomy, for Eps. Recent advances in technology have led to earlier diagnosis of this life-threatening condition. As a result, conservative surgical procedures , as well as medical and expectant forms of treatment, are increasingly being used in its management 3. This study was carried out to determine the incidence, presentation , diagnosis, aetiology and management of EP at the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto. Methods The records of all cases of EP that presented at UDUTH between January 1990 and December, 1997 were reviewed. Information extracted from the records included demographic and biosocial parameters of the patients, clinical features, treatment given and outcome. The operating theatre records, as well as data pertaining to the number of deliveries during the study period, were also reviewed. Data thus obtained was subjected to simple descriptive statistics for frequency, mean and median. Results During the study period, there were 140 cases ofEP at UDUTH, Sokoto, and 7731 deliveries. The incidence of EP was 18.1 per 1,000 deliveries, or 1 in 55 deliveries. Only 138 case notes were available for detailed analysis. Table 1 shows the age and Table 2 the parity of patients with EP. The ages of patients ranged from 17 to 42 years, with a mean age of 26.7 years (Standard Deviation 5.6). The median parity in women with EP was l(range 0-6), and 32% of cases were nulliparae. 78%of patients were married women. Table 3 shows the clinical presentation of EP. Abdominal pain and tenderness were the most frequent symptom and sign, respectively, while cervical excitation ten,derness was the most frequently elicited sign on pelvic examination. Table 4 shows the duration of amenorrhoea in women w}th EP; the modal duration of amenorrhoea was 8 weeks. Paracentesis was carried out in 95 patients and was positive in Malawi Medical Journal Abstract tively. Diagnosis was usually based on clinical finding~ aug" mented by procedures including paracentesis abdominis, abdominal ultrasound scan and urine pregnancy test. The ectopic pregnancy was sited in the Fallopian tube in 92 % of cases. In 56 cases (41 %), there was macroscopic evidence of previous pelvic infection at surgery. 66 % of ectopic pregnancies had ruptured at presentation. Treatment was surgical in all but one case, and unilateral salpingectomy was the procedure most frequently performed. The case fatality rate was 1.5%. 88 (92.6%), while culdocentesis was performed in 12 cases and positive in 9 (75%). Trans abdominal ultrasound scan and laparoscopy were carried out to confirm the diagnosis in 32 and 8 patients respectively. Two of the patients had a previous history ofEP, and one patient had an intrauterine contraceptive device in-situ when she developed EP. The EP was sited in the Fallopian tube in 127 cases (92%)-64 on the right and 63 on the left. The ampulla was the commonest location of tubal ectopic pregnancies. The ovaries were the location of EPs in 5(3.6%) and abdominal or pelvic cavity in 6 cases (4.3%). All the EPs located in the ovaries were in the right ovary. In 56 cases (41 %), there was macroscopic evidence of previous pelvic infection at surgery. 66 % of EPs had ruptured at presentation. Table 5 shows the treatment given; unilateral salpingectomy was the most frequent procedure performed. All surgical procedures were carried out by open laparotomy. There were 2 deaths, giving a case fatality rate of 1.5%.