Ectopic pregnancy, A Prospective Study In Al-Batool Teaching Hospital In Mosul – Iraq

Abstract

Background: Ectopic pregnancy (EP) is the implantation of pregnancy at an extra uterine site. EP accounts for approximately 2 % of reported pregnancy. The largest risk factors are upper genital tract infection due to sexually transmitted diseases (STDs), as well as other risk factors as smoking, the use of intrauterine device, previous tubal or pelvic surgery, history of infertility, and the risk of age and parity. It is difficult to diagnose EP clinically. However diagnostic aids like B-hCG assessment and ultrasound scan has proved to be of great help. The treatment trends for ectopic pregnancy have changed to more conservative procedures like salpingostomy, segmental resection and fimbrial expression.
Methods: From September 2000 to September 2002, a prospective study was conducted to forty patients who were admitted at Al-Batool teaching hospital, as proven or suspected cases of ectopic pregnancy.
Complete assessment of the patients through detailed history and clinical examination was carried out, and accordingly patients were classified into unstable and stable groups.
The investigations has included pregnancy test (PT), ultrasound scan (USS), and laparoscopy.
The operative procedures were either salpingectomy, or conservative surgery in the form of salpingostomy and milking of the tubes.
Histopathological examination confirmed EP in all surgically treated patients.
Results: Forty cases of ectopic pregnancies were collected. 67.5 % were in the age group 26 – 35 year.
Women with higher parity had the highest percent with EP (37.5 %).
Twenty - seven cases (67.5 %) were clinically unstable.
USS was performed for twenty – six (65 %) patients with positive results in all, where twenty – one patients (80.76 %) had an adnexial mass.
Diagnostic laparoscopy was carried out in four cases (10 %) only.
Among the forty cases of EP the findings at laparotomy were as follows:
Tubal abortion was evident in four cases ( 10 % ). Intact ampullary pregnancy in fourteen patients (35 % ), two isthmic gestations (5 %), two ovarian pregnancies ( 5 %) , and one corneal pregnancy( 2.5 %). In seventeen cases (42.5 %) there was ruptured ectopic pregnancy. There was accompanying ovarian cysts in five patients (12.5 %),
The operative procedures included: Salpingectomy in thirty one patients ( 77.5 % ) , salpingostomy in two cases ( 5 % ), milking of the tube in four cases ( 10% ), and conservative removal of the products of conception from the ovarian tissue with adequate haemostasis in the two cases of ovarian pregnancy ( 5 % ).
The route of exploration and management was through opened laparotomy in all. Two cases that were treated through laparoscopy.
Conclusion: Early diagnosis of cases of ectopic pregnancy would reduce the morbidity and even the mortality of ectopic pregnancy. It allows more conservative form of treatment to be applied, and thus giving a better chance for the patient to preserve fertility.
Key word: Ectopic pregnancy, tubal pregnancy, risk factors in ectopic pregnancy