The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Trends in the Treatment and Clinical Presentations of Tubal Ectopic Pregnancy in Imam Reza Hospital of Kermanshah, Iran (2007-2011)

Document Type : Original Article

Authors
Anisodoleh Nankali 1
Nooshin Shirzadi 2
Mansoor Rezaei 3
Sara Daeichin 4
1 Assistant Professor, Department of Obstetrics and Gynecology, Maternity Research Center, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
2 General Physician, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
3 Assistant Professor, Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
4 B.Sc. Student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
10.22038/ijogi.2014.2800
Abstract
Introduction: 1.2-1.4% of all reported pregnancies are ectopic. Ectopic pregnancy (EP) constitutes a major cause of maternal mortality in the first trimester of pregnancy and its incidence is increasing. The aim of this study was to evaluate the trends in management and clinical presentations of tubal ectopic pregnancy.
Methods: This descriptive-analytical study was conducted on women with tubal ectopic pregnancy who referred to Imam Reza hospital of Kermanshah, Iran during 2007-2011. Demographic information and variables such as maternal age, gestational age, gravidity and parity were collected. Data were analyzed by SPSS software version 16, chi-square, Kolmogorov-Smirnov, ANOVA and Kruskal–Wallis. P value less than 0.05 was considered significant.
Results: The most frequent ectopic pregnancy was observed in the 26-30 years age group. The most of the EP were admitted in 2011 (29%) and the least were in 2007 (15.5%). 228 patients (57%) were multiparous and thee mean of gestational age was 6.52±2.72 weeks. The most common clinical presentation was abdominal pain (74.0%) and then vaginal bleeding, amenorrhea and shock, respectively. The variables of trends in treatment (p=0.001) and bleeding (p=0.03) were statistically significant during the 5 years of study. The most common site of EP was in ampulla (50.0%) and 227 patients (56.8%) were treated surgically. The most common method of surgery was salpingectomy (75.8%). 49.1% of patients was treated with a single-dose methotrexate protocol were applied.
Conclusion: The results showed that patients with EP have been rising during the period of study. The most common clinical presentation was abdominal pain and vaginal bleeding. Trends in the treatment were developed to increase using medical treatment and decrease in surgical treatment.
Keywords
Clinical Presentation
Pregnancy/Tubal
Therapeutics
Trends
  1. Sakhavar N, Mirteimoory M. [A case report: intestinal obstruction in laparatomy with diagnosis of ectopic pregnancy] [Article in Persian]. Tabib-e-Shargh 2006;8(1):75-9.
  2. Alkatout I, Honemeyer U, Strauss A, Tinelli A, Malvasi A, Jonat W, et al. Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv 2013 Aug;68(8):571-81.
  3. Aflatoonian A. [Drug-therapy of unruptured ectopic pregnancy with Methotrexate] [Article in Persian]. J Ardabil Univ Med Sci 2003;2(8):13-9.
  4. Rana P, Kazmi I, Singh R, Afzal M, Al-Abbasi FA, Aseeri A, et al. Ectopic pregnancy: a review. Arch Gynecol Obstet 2013 Oct;288(4):747-57.
  5. Khalid T, Elahi N. Clinical presentation of chronic ectopic pregnancy. J Coll Physicians Surg Pak 2000;10:200- 3.
  6. Chohan A. Ectopic pregnancy. Fundamentals of gynaecology Lahore:MAR Publisher;2000:3-95.
  7. Bangsgaard N, Lund CO, Ottesen B, Nilas L. Improved fertility following conservative surgical treatment of ectopic pregnancy. BJOG 2003 Aug;110(8):765-70.
  8. Agdi M, Tulandi T. Surgical treatment of ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 2009 Aug;23(4):519-27.
  9. Milki AA, Moossazadeh J. Medical treatment of ectopic pregnancy. West J Med 1990 Apr;152(4):410.
  10. Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility. 7th h ed. Philadelphia:Lippincott Williams & Wilkins;2005.
  11. Damario MA, Rock JA. Ectopic pregnancy. In: Rock JA, Jones III HW. Te Linde’s operative gynecology. 9th ed. Philadelphia:Lippincott Williams & Wilkins;2003:507-36.
  12. Farquhar CM. Ectopic pregnancy. Lancet 2005 Aug 13-19;366(9485):583-91.
  13. Majhi AK, Roy N, Karmakar KS, Banerjee PK. Ectopic pregnancy--an analysis of 180 cases. J Indian Med Assoc 2007 Jun;105(6):308-12.
  14. Trabert B, Holt VL, Yu O, Van Den Eeden SK, Scholes D. Population-based ectopic pregnancy trends, 1993- 2007. Am J Prev Med 2011 May;40(5):556-60.
  15. Arora R, Rathore AM, Habeebullah S, Oumachigui A. Ectopic pregnancy--changing trends. J Indian Med Assoc 1998 Feb;96(2):53-7.
  16. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol 2010 Mar;115(3):495-502.
  17. Kamwendo F, Forslin L, Bodin L, Danielsson D. Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Sex Transm Infect 2000 Feb;76(1):28-32.
  18. Sohail N, Tayyab M, Iqbal F, Butt Maria, Naqi A. Tubal ectopic pregnancy, management in a tertiary care hospital. Pak J Med Health Sci 2010;4:472-5.
  19. Pradhan P, Thapamagar SB, Maskey S. A profile of ectopic pregnancy at Nepal medical college teaching hospital. Nepal Med Coll J 2006 Dec 8(4):238-42.
  20. Ayaz A, Emam S, Farooq MU. Clinical course of ectopic pregnancy: A single-center experience. J Hum Reprod Sci 2013 Jan;6(1):70-3.
  21. Igwegbe A, Eleje G, Okpala B. An appraisal of the management of ectopic pregnancy in a nigerian tertiary hospital. Ann Med Health Sci Res 2013 Apr;3(2):166-70.
  22. Shabab U, Hashemi HA. Different pattern of presentation of ectopic pregnancy and its management. J Surg Pak 2013 Jan-Mar;18(1):37-40.
  23. Gaddagi RA, Chandrashekhar AP. A clinical study of ectopic pregnancy. J Clin Diagn Res 2012 Jun;6(5):867.
  24. Sharma P, Sing BP, Shrestha B. Ectopic pregnancy in Nepalgunj Medical College. Ectopic pregnancy 2011. J Instit Med 2011 Aug;33(2):1. Available at: http://jiom.com.np/index.php?journal=jiomjournal&page=article&op=viewFile&path%5B%5D=517&path%5B %5D=479
  25. Mahboob U, Mazhar SB. Management of ectopic pregnancy: a two-year study. J Ayub Med Coll Abbottabad 2006 Oct-Dec;18(4):34-7.
  26. Udigwe GO, Umeononihu OS, Mbachu II. Ectopic pregnancy: a 5 year review of cases at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. Niger Med J 2010 Oct-Dec;51(4):160-3.
  27. Soriano D, Vicus D, Mashiach R, Schiff E, Seidman D, Goldenberg M. Laparoscopic treatment of cornual pregnancy: a series of 20 consecutive cases. Fertil Steril 2008 Sep;90(3):839-43.
  28. Aboud E, Chaliha C. Nine year survey of 138 ectopic pregnancies. Arch Gynecol Obstet 1998;261(2):83-7.
  29. Pal A, Gupta KB, Sarin R. A study of ectopic pregnancy and high risk factors in Himachal Pradesh. J Indian Med Assoc 1996 May;94(5):172-3, 202.
  30. Shah N, Khan NH. Ectopic pregnancy: presentation and risk factors. J Coll Physicians Surg Pak 2005 Sep;15(9):535-8.
  31. Fageeh WM. Diagnosis and management of ectopic pregnancy in King Abdulaziz university hospital: a four year experience. JKAU Med Sci 2008;15(2):15-25.
  32. Akhan SE, Baysal B. Laparotomy or laparoscopic surgery? Factors affecting the surgeon’s choice for the treatment of ectopic pregnancy. Arch Gynecol Obstet 2002 Apr;266(2):79-82.