|Year : 2019 | Volume
| Issue : 4 | Page : 235-238
Ectopic pregnancy in Dalhatu Araf Specialist Hospital Lafia Nigeria – A 5-year review
Chidiebere Nwakamma Ononuju, Adejo Emmanuel Ogbe, Lucky Lohnan Changkat, Blaise Ogedi Okwaraoha, Uzoma Emmanuel Chinaka
Department of Obstetrics and Gynaecology, Dalhatu Araf Specialist Hospital, Lafia Nasarawa State, Nigeria
|Date of Web Publication||4-Oct-2019|
Dr. Chidiebere Nwakamma Ononuju
Department of Obstetrics and Gynaecology, Dalhatu Araf Specialist Hospital Lafia, P.M.B. 007, Lafia-Nasarawa State
Source of Support: None, Conflict of Interest: None
Context: Ectopic pregnancy is a common life-threatening emergency and a notable cause of maternal morbidity and mortality. Aims: This study aims to determine the prevalence of ectopic gestation, the associated risk factors, the pattern of presentation and management of ectopic pregnancy in Dalhatu Araf Specialist Hospital (DASH) Lafia. Patients and Methods: This was a retrospective study of all cases of ectopic pregnancy managed at the gynaecological unit of the DASH Lafia, North-central Nigeria from 1st January, 2013 to 31st December, 2017. The data were analysed with simple descriptive statistics and were reported as frequencies and percentages. Results: During the 5-year period, there were a total of 93 ectopic pregnancies, 10,401 deliveries and 3399 gynaecological admissions in the hospital. The prevalence of ectopic pregnancy was 0.89% of all deliveries and 2.74% of all the gynaecological admissions. The majority of the patients were in the age group of 26–30 years, and significant number of the affected them were nulliparous, 30 (32.3%). Furthermore, majority of the patients had past history of sexually transmitted diseases 48 (51.6%), multiple sexual partners 40 (43.0%) and induced abortions. Abdominal pains, amenorrhoea and vaginal bleeding were the most common presenting complaints. Unilateral salpingectomy was done for majority of the patients. Conclusions: Ectopic pregnancy is an important gynaecological challenge associated with notable morbidity. Past history of sexually transmitted diseases, multiple sexual partners and induced abortions were the associated risk factors identified, and nulliparous women were mostly affected. This can limit their future reproductive accomplishments. Targeted health education campaigns should be embarked on to enlighten this group of women and the public at large.
Keywords: Abdominal pains, Dalhatu Araf Specialist Hospital, ectopic pregnancy, Lafia, risk factors
|How to cite this article:|
Ononuju CN, Ogbe AE, Changkat LL, Okwaraoha BO, Chinaka UE. Ectopic pregnancy in Dalhatu Araf Specialist Hospital Lafia Nigeria – A 5-year review. Niger Postgrad Med J 2019;26:235-8
|How to cite this URL:|
Ononuju CN, Ogbe AE, Changkat LL, Okwaraoha BO, Chinaka UE. Ectopic pregnancy in Dalhatu Araf Specialist Hospital Lafia Nigeria – A 5-year review. Niger Postgrad Med J [serial online] 2019 [cited 2019 Nov 18];26:235-8. Available from: http://www.npmj.org/text.asp?2019/26/4/235/268592
| Introduction|| |
Ectopic pregnancy is a pregnancy in which the fertilized ovum implants in any location other than the endometrial lining of the uterus. It is a significant cause of maternal morbidity and mortality, as well as foetal loss, especially in developing countries where majority of the patients present late with the ruptured variety. The reported incidences in most hospital-based studies in Nigeria range between 1.2% and 2.7% of all deliveries.,,, Pelvic inflammatory disease is the most common risk factor for ectopic pregnancy; other risk factors include the use of progesterone only pills, intrauterine contraceptive device, endometriosis, previous tubal surgery, infertility, previous abortions and assisted reproductive techniques.,, The clinical state, the site, the reproductive wish of the patient and the available facility influence the treatment of ectopic pregnancy. In the majority of cases, surgery is the mode of treatment.
Despite the giant strides achieved globally in the management of ectopic pregnancy, in terms of making early diagnosis and conservative treatment, our society is still confronted with late presentation and rupture in majority of the cases., These aforesaid challenges in our environment are worth reviewing. Therefore, this study was carried out to determine the prevalence of ectopic pregnancy, the associated risk factors, the pattern of presentation and management of ectopic pregnancy in Dalhatu Araf Specialist Hospital (DASH) Lafia.
| Patients And Methods|| |
This was a retrospective review of all the patients with ectopic pregnancies who were managed at the DASH Lafia between 1st January, 2013 and 31st December, 2017. All the 93 case files of ectopic gestation were retrieved from the medical records and augmented by information from the operating theatre, ward registers and the accidents and emergency department. Biosocial information like age, parity, gestational age and marital status was extracted from the case notes. Clinical presentation, diagnostic tools employed, treatment options, intraoperative findings and associated risk factors for the disease were also extracted. Patient's data confidentiality was ensured in the course of this review. Before the outset of the study, approval was obtained from the Health Research Ethics Committee of DASH, Lafia. The data were analysed with simple descriptive statistics analysis and data presented in frequencies and percentages.
Definition of risk factors for the purpose of this study
Past history of sexually transmitted diseases was noted in any patient who was previously diagnosed and/or treated for any of the various diseases or infections that can be transmitted by direct sexual contacts or sexual means like gonorrhoea, chlamydia, genital herpes, hepatitis B and human deficiency virus infections. Past history of multiple sexual partners was noted in any patient who had engaged in sexual activities with two or more people within the same time period. This can happen simultaneously or serially. Past history of induced abortions was noted in any patient with a previous history of induced termination of pregnancy. Past history of laparotomy was noted in any patient with a history of previous surgical procedure, in which an incision was made on the anterior abdominal wall to gain access into the abdominal cavity. History of infertility was defined as complaint of inability to conceive after 1 year of trying despite carefully timed, regular and unprotected sexual intercourse through the vagina. Cervical motion tenderness was defined as present in any patient who had pains when the cervix was moved in any direction during a pelvic examination. This is suggestive of pelvic pathology and maybe present in the setting of pelvic inflammatory disease or an ectopic pregnancy.
| Results|| |
Over the 5-year period of review, there were a total of 93 cases of ectopic pregnancies, 10,401 deliveries and 3399 gynaecological admissions in DASH. The prevalence of ectopic pregnancy was 0.89% of all deliveries and 2.74% of all gynaecological admissions.
The patient's age range was between 16 and 41 years. Majority of the patients were in the age group of 26–30 years, i.e. 37 (40.0%) and the least age group was those >40 years, 1 (1.1%). Significant number of the patients 40 (43.0%) had primary education, 18 (19.4%) had no formal education, whereas only 7 (7.5%) received tertiary education. Most of the affected patients were nulliparous 30 (32.3%), primiparous were 20 (21.5%) and the least affected were the grand multiparous women 7 (7.5%). Majority of the patients, 71 (76.3%) were married at the time of presentation, 20 (21.5%) were single and only 2 (2.2%) were divorced. The mean gestational age at presentation was 6.8 weeks [Table 1].
Associated risk factors for ectopic pregnancy in Dalhatu Araf Specialist Hospital
Majority of the patients, ie. 48 (51.6%) had past history of sexually transmitted disease, 40 (43.0%) had past history of multiple sexual partners, 30 (32.2%) had past history of induced abortions, while 4 (4.3%) were on oral contraceptive. [Table 2].
|Table 2: Associated risk factors for ectopic pregnancy in Dalhatu Araf Specialist Hospital|
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Clinical features of ectopic pregnancy
Majority of the patients, i.e. 92 (98.9%) presented with complaints of abdominal pains, and abdominal tenderness was elicited in 86 (92.5%). Also, significant number of them 79 (84.9%) had a history of amenorrhea, while 54 (58.1%) presented with vaginal bleeding [Table 3].
Site of ectopic pregnancy
Majority of the patients – 85 (91.4%) had tubal ectopic gestation, 5 (5.4%) and 3 (3.2%) were cited in the ovary and abdomen, respectively. Majority of the patients presented with tubal ectopic pregnancy – 85 (91.4%), of which 75 (80.6%) were of the ruptured variety. Majority of the tubal ectopic pregnancies occurred at the ampullary – 56.2 (60.4%), fimbriae – 18.6 (20.0%), cornual – 8.37 (9.0%) and isthmic regions – 1.86 (2.0%). All the patients with ectopic pregnancy had surgical management. Emergency laparotomy with unilateral salpingectomy was the most common surgical intervention. No mortality was recorded over these 5 years [Table 4].
| Discussion|| |
The prevalence of ectopic pregnancy in this review was 0.89% of all deliveries and 2.74% of all the gynaecological admissions. Comparatively, these values are lower than that reported by Abubakar et al. (1.5%) in Sokoto, Udigwe et al. (1.31%) in Nnewi, Gharoro and Igbafe  (1.68%) in Benin and Onwuhafua et al. (1.19%) in Zaria and Thonneau et al. (1.5%) in Conakry, Guinea. This finding highlights the fact that ectopic gestation is relatively common in our centre and environment.
Significant number of the women who had ectopic pregnancies was in the age group of 26–30 years. This finding resonates with that previously reported by Abubakar et al., Udigwe et al., Etuknwa et al. and Bello and Akinajo. This finding is hardly surprising as this corresponds to the age of peak sexual activity and reproduction, and high-risk sexual behaviour is synonymous with this age group. This review showed that many of the women were married. Similar finding has been reported elsewhere in Nigeria ,. However, Etuknwa et al reported that majority of the women were single . This possibly is a reflection of the surrounding environment in which the sociocultural and religious inclinations support early marriage.
The associated risk factors for ectopic pregnancy noted in this study were the past history of sexually transmitted diseases.multiple sexual partners and induced abortions. Also, it was remarkable that majority of the patients had more than one identifiable risk factor. These findings were similar to that reported by scholars in Lagos, Ibadan, IIorin and Enugu Nigeria.,,,,,,, This finding tends to support the hypothesis that tubal damage is a final common pathway for the occurrence of ectopic gestation.
A significant number of the patients presented with abdominal pains, amenorrhoea, vaginal bleeding and ruptured ectopic gestations. This finding is similar with the previously reported findings in Bauchi and Kano Nigeria, and in India.,, and unlike in the developed countries where most of the patients presented with unruptured ectopic pregnancies.,, Physicians and nurses should have a high index of suspicion for ectopic pregnancy, when caring for a woman in her reproductive age with complaints of abdominal pain, amenorrhoea and vaginal bleeding. This will ensure early diagnosis and prompt therapeutic intervention.
The diagnosis of ectopic pregnancy in our centre was made by history taking, clinical examination, and supported by pregnancy test, and findings at an ultrasound scan. Paracentesis abdominis was not done, and Laparoscopy machine was unavailable in our centre at the of this review.
Majority of the patients presented with tubal-ruptured ectopic pregnancy; this finding is similar to previous reports by other researchers in Nigeria;,,, at this point, conservative management is no longer feasible. Consequently, the surgical treatment option was offered. The most frequently performed operative procedure in this review was unilateral salpingectomy. Globally, there has been evolution from radical surgical procedures to conservative treatment of ectopic pregnancy aimed at the preservation of fertility., There were no maternal deaths reported in this review, which is similar to reports from Nnewi and Makurdi;, however, other studies showed maternal deaths as high as 1.4%–4%.,,,
Although all the patients' case notes were retrieved, a lot of time was wasted between applying for the case files, getting approval, and retrieving them from the medical records department. An average of 4–5 weeks was spent on this process. Also, many of the documentations were torn, badly stained or missing, thus making extraction of information difficult and also increasing the need for augmentation information from the records in the theatre and the wards. Therefore, to enhance record keeping and preservation, timely retrieval of patient's data and analysis, there is an urgent need to upgrade the operations at the medical records department from paper-based records to electronic-based record operations.
| Conclusions|| |
Ectopic pregnancy is an important gynaecological challenge associated with notable morbidity as shown in this study. Past history of sexually transmitted diseases, multiple sexual partners and induced abortions were the associated risk factors identified, and nulliparous women were commonly affected. This can limit their future reproductive accomplishments. Hence, targeted health education campaigns should be embarked on to enlighten this group of women and the public at large.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]