MANAGEMENT OUTCOME OF RUPTURED ECTOPIC PREGNANCY AT A SECONDARY LEVEL OF HEALTH CARE DELIVERY IN SOUTH-WEST, NIGERIA.

Mathew Adeyemo, Mary Ajayi, Oshemi Uchenna Jude

Abstract

BACKGROUND: Ectopic pregnancy is a condition of high morbidity and mortality with enormous threat to life, therefore it is of immense gynaecological importance, particularly in the developing world, where the majority of patients present late with rupture and haemodynamic instability.

OBJECTIVES: The objectives of this study were to determine the incidence and analyze the clinical presentations, risk factors, sites of ectopic pregnancy and associated morbidity and mortality.

METHODS: This was a retrospective review of records of patients admitted and managed as cases of ruptured ectopic pregnancy at Our Lady of Apostle (O.L.A) Catholic Hospital, Ibadan over a six-year period between January 1st 2010 and December 31st 2015.

RESULTS: The incidence of ectopic pregnancy found this center during the study period was 1.03%.
The leading symptom was abdominal pain (87.3%), followed by amenorrhea (60.0%), while syncope  attack and vaginal bleeding had 50.0% and 36.4% respectively. Pelvic infection was the leading risk factor (57.4%) of the study population, followed by induced abortion (36.4%). Up to 16.7% of the patients had no identifiable associated risk factor. Two out of 54 patients had previous ectopic pregnancy, hence the recurrent rate was 3.7%. Eighty-five percent of the cases were tubal pregnancy while the abdominal and cornual gestation accounted for 2% and 13% respectively. Fifty-two percent (28/54) had
partial salpingectomy while 46% (25/54) had total salpingectomy and 66.7% (36/54) of the patients were to be transfused. The diagnosis was missed in 18.2% (10/54) of patients, however, the correct diagnosis was made at laparotomy. There was no record of maternal death.

CONCLUSION: Since ruptured ectopic pregnancy remains a gynaecological catastrophe in sub-Saharan African countries, it should be considered a relevant public health issue. Therefore, it is necessary to devise means of early detection and prompt treatment by providing adequate materials, manpower, and equipment to our health facilities especially, the secondary health care facilities which seem nearer to the populace than tertiary centers

Keywords

Ruptured ectopic pregnancy, secondary healthcare delivery, management outcome

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