Ectopic Pregnancy-Risk Factors, Clinical Presentation and Management in a Tertiary Centre of Jharkhand.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2019, Vol 4, Issue 1
Abstract
In spite of the tremendous advances in obstetric care and technology, ectopic pregnancy remains an enigma for a women full of dreams of blissful motherhood, as it may turn into a nightmare and a catastrophe. An ectopic pregnancy or eccyesis is a complication of pregnancy in which the embryo attaches outside the uterus1. An ectopic pregnancy is an obstetric emergency if not treated properly, it not only leads to fetal wastage, but also increases the incidence of maternal morbidity and mortality and may even lead to problems of future infertility. Objective-1.To determine the various risk factors.2.To assess the varied clinical presentations.3.To assess the mode of treatment.4.To determine the associated maternal morbidity and mortality. Place And Duration- The present study was conducted in RIMS, Ranchi from April 2016 – September 2017.Total 102 cases of ectopic pregnancy were admitted in this duration. This was a Prospective Observational type of study. Material and methods-All cases coming to RIMS, Obstetrics & Gynaecology suspected clinically as ectopic pregnancy were admitted .The diagnosis was made on detailed history, clinical examination, routine & special investigations[UPT,USG(TAS+TVS)].The diagnosis was confirmed on operative findings. The surgical and medical treatment given was noted and the post-operative period was observed.Data was analyzed to determine the incidence, risk factors, varied clinical presentations, mode of treatment and the morbidity and mortality associated with ectopic pregnancy. Patient’s performa- A detailed clinical record sheet was prepared for all patients at the time of admission with particular reference to following points:Name,Age,Religion-Hindu/Muslim/Christian /Others,Tribe/Non-tribal,Address History- I. Medical history 1.Complaints and their duration – They were noted in chronological order of their appearance. 2.Menstrual History-Age of menarche First day of last menstrual period Duration of menstruation Duration of cycle in days Amount of blood loss-average/heavy/ scanty Inter-menstrual bleeding or discharge 3.Obstetrical History-Each pregnancy was recorded in the following plan: Gravida ,Parity, Duration of pregnancy, Labour-normal / abnormal, Delivery-Home/Hospital, Pueperal period,Infant-Boy/Girl, alive/dead and well being,Birth weight, Breast fed or not Contraceptive History- Use of oral contraceptives, intrauterine contraceptive devices, history of ligation if present were recorded. Any history of infertility and the treatment given was noted. Past History- Previous history of illness such as tuberculosis, PID, appendicitis or any other gynaecological treatment including operative procedures. Family History- Family history of tuberculosis, hypertension, diabetes was enquired. Personal History-Vegetarian/non-vegetarian .Any addiction was noted. II. Social history Marital Status- Married with date of marriage, single, widow, Educational status Occupation, Socioeconomic status-Monthly family income Based on Kuppuswamy’s socioeconomic status scale 2007 the study group divided into Poor,Lower middle class,Upper middle class,High class. Physical Examination General Examination,Level of consciousness,Height in cm,Weight in kgs,Height-weight relation- thin/average/overweight,Anaemia,Cyanosis,Jaundice,Oedema,Temperature,Blood pressure,CVS,Chest Local Examination Per Abdomen-Inspection Palpation - to note tenderness, guarding, if any lump felt then its margins, consistency, surface, tenderness and mobility. Percussion- to note any shifting dullness and fluid thrill Auscultation. Pelvic Examination-Inspection of vulva, vagina and cervix,Bimanual examination Results- There were 13,204 total obstetric admission in which 102 cases were ectopic pregnancies. It shows that the incidence of ectopic pregnancy in RIMS is 7.7 cases per 1000 pregnancies. . Youngest patient admitted with ectopic pregnancy was of 19 years and oldest was of 38 years.Maximum incidence seen among the age group of 26-30 years is 36.42. Majority of the patients (71.57%) belonged to the non- tribal group and maximum in hindu females(68.63%). The lower socioeconomic strata i.e. poor 33.33% and lower middle 50% constituted the major bulk of the cases i.e. together they constituted 83.33% cases. The maximum number of patients were nullipara. The next group that was affected was the para 1 and para 2 patients. Conclusion- Incidence was high in the present series, mainly due to increased prevalence of PID and tuberculosis. - Ectopic pregnancy was more prevalent in nulliparous women. Average age incidence was lower in the population studied. It shows that the predisposing factors sets in the affected women in early reproductive life and as no parity status or age was spared, it proved that the factors are found in all age groups throughout a women’s reproductive life.
Authors and Affiliations
Dr. Niranjan Mardi
Keywords
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