Ectopic Pregnancy at the Thiès (Sénégal) Regional Hospital: A Study of Diagnostic, Therapeutic and Prognostics

Research Article

Austin J Obstet Gynecol.2017; 4(2): 1073.

Ectopic Pregnancy at the Thiès (Sénégal) Regional Hospital: A Study of Diagnostic, Therapeutic and Prognostics

Gueye L¹*, Thiam M², Niang MM³, Ba PA4, Mahammat S¹ and Cisse ML²

¹Department of Obstetrics and Gynecology, Thiès Regional Hospital, Thiès, Senegal

²University of Thiès, Thiès, Senegal

³Department of Obstetrics and Gynecology, University Cheikh Anta Diop of Dakar, Senegal

4Department of General Surgery, Thiès Regional Hospital, Thiès, Senegal

*Corresponding author: Gueye L, Department of Obstetrics and Gynecology, Thiès Regional Hospital, Thiès, Senegal

Received: August 29, 2017; Accepted: September 14, 2017; Published: September 21, 2017

Abstract

Objective: To evaluate the diagnostic, therapeutic and prognostic aspects of ectopic pregnancy at the Regional Hospital of Thiès.

Methods and Materials: This is a prospective and descriptive study of patients received for Ectopic Pregnancy (EP) and managed in the gynecology and obstetrics department of the regional hospital of Thiès between 1 July 2013 and 31 December 2014. Diagnostic, therapeutic and prognostic aspects were studied. The data was compiled entered and analyzed using the Sphinx version 5 software.

Results: We registered 50 EPs from 695 patients presenting with metrorrhagia in the first trimester, which represents a frequency of 7.2%.

The epidemiological profile of the patients was that of a 29 years woman on average, few previous deliveries (28%) and referrals (48%). For the most part it involved a ruptured EP (92%) and of ampulla location (78%). Forty-nine patients (98%) had surgical treatment including 45 salpingectomies (90%). We had one maternal death, representing a 2% mortality rate. Fertility after EP was 33%.

Conclusion: EP remains a frequent condition in our hospital. The majority of patients arrive in a state of raptured EP requiring radical surgical interventions

Keywords: Ectopic pregnancy; Laparotomy; Salpingectomy

Introduction

Ectopic Pregnancy (EP) is the implantation and development of the fertilized egg outside the uterine cavity. It is the leading cause of maternal mortality in the first trimester of pregnancy and is a real public health problem. The prevalence rate remains elevated in developing countries, where diagnosis is often made late after development of complications, thus impacting maternal survival negatively [1]. Through this study, we have wanted to evaluate the diagnostic, therapeutic and prognostic aspects of ectopic pregnancy at the regional hospital of Thiès.

Patients and Methods

This is a prospective and descriptive study of patients received for Ectopic Pregnancy (EP) and taken care of in the gynecology and obstetrics department of the regional hospital of Thiès between 1 July 2013 and 31 December 2014, a period of 18 months. Diagnostic aspects, management and prognosis were analyzed. Surgical management consisted of emergency laparotomy for ruptured or symptomatic EPs. Medical treatment was reserved for non-raptured and or asymptomatic EPs with a visible gestational sac of less than 4cm, with a level of βHCG <5000 IU. Methotrexate was administered intramuscularly at a dose of 1mg/kg or 50mg/m². βHCG levels were checked on the 7th day and thereafter once a week until negative. Patient informed consent was necessary. The data were analyzed using the Sphinx version 5 software.

Results

Epidemiology

During the study period, we had 50 EPs, representing 7.2% of first trimester ante partum hemorrhage and 1% of live births. The epidemiological profile of the patients was that of a woman aged 29 years on average, few previous deliveries (28%), without any particular medical history (56%) and referred from another center in 48% of the cases.

Diagnostic aspects

The functional signs were dominated by amenorrhea (47 patients, 94% of cases), pelvic pain (46 patients, 92% of cases) and metrorrhagia (76% of cases). Forty-two patients (84%) presented with peritoneal irritation picture and six patients (12%) were admitted due hemorrhagic shock. Forty-one patients (82%) had a pelvic ultrasound and EP was found in 87.8% (36 patients). For the other five patients, ultrasound performed outside the hospital diagnosed abortion (2 cases), an ovarian cyst (2 cases), a progressive pregnancy with ascites (1case). Following thorough clinical and / or ultrasound scanning, a positive diagnosis of EP was established in 84% of cases on admission. These were thirty-eight ruptured EPs (76%) and 4 non-raptured EPs (8%). A diagnostic error was noted in 16% of the cases (Table 1).