Risk Factors and Diagnosis of Ectopic Pregnancy in Sudanese Females

Abstract

Objectives: To determine the risk factors of ectopic pregnancy and to assess the accuracy of clinical presentation and ultrasound in diagnosing ectopic pregnancy. To measure the morbidity of ectopic pregnancy in term of need for blood transfusion & the duration of hospital stay. Settings: Three main teaching hospitals in Khartoum state. Study population: Ninty-three patients of confirmed ectopic pregnancy were admitted to these hospitals during the period April 2001-April 2002 Results: Most of the patients were in the age group 25-34 years that was 52(55.9%), 30(32.3%) were 35-45 years, 11(11.8%) were in the youngest age group 15-24 years.This condition is common in parous women (53.8%). The commonest risk factor was found to be history PID or STD it occurred in 63(67.7%) of cases. However ,the other risk factors such as post partum infection 14(15.2%),infertility 25(26.9%),abortion 30(31.5%),contraceptives 23(24.7%), pelvic surgery 24(25.8%) & the least was previous ectopic pregnancy was (2.2%). The commonest period of amnorrhoea was 6-8 weeks in (63.4%) of cases, vaginal bleeding and lower abdominal pain were found to be common symptoms among the study population as they occurred in F (94.6%) & (96.8%) respectively. On the other hand syncopal attacks occurred in only (20.4%). As the majority of patients had ruptured ectopic 71 case (74%), low blood pressure & pallor were common 63(68.5%) & 51(54.8%) respectively. Moreover, 81(87.1%) had abdominal tenderness. But only 21(22.6%) had abdominal mass. It was found that lower abdominal pain, low blood pressure, and pallor were significant indicators for ruptured ectopic pregnancy. Signs on vaginal examination, adnexal mass, fullness in the pouch of Douglas, and cervical excitation were found to be significant in relation to ruptured ectopic. It was found that the delay in the diagnosis increase the morbidity of the condition as measured by the duration of hospital stay and the need for blood transfusion as it was found to be statistically significant. Ultrasound scan was found to be the most common investigation performed in 73(78.5%) of cases, but it is results were operator dependant. The commonest procedure performed were salpingectomy 49(51.6%) and salpingoophorectomy 40(42.1%).