Management and Outcome of Ectopic Pregnancy in Developing Countries

Abstract

Ectopic pregnancy is a common life-threatening emergency in the developing world and its frequency is still high. Ectopic pregnancy is the commonest cause of maternal morbidity and mortality in the first trimester of pregnancy (Airede & Ekele 2005, Grimes 1994, Okunlola et al 2006). Complications of early pregnancy are common clinical conditions that often require emergency care. The patient may or may not be aware that she is pregnant at the time of evaluation at the emergency department (Complications of pregnancy, 2007). Diagnosis is frequently missed and should be considered in any woman in the reproductive age group presenting with abdominal pain or vaginal bleeding especially when combined with an episode of collapse or syncope. Ectopic pregnancy is a complication of pregnancy in which the products of conception develop outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. By far the commonest site is the fallopian tube (Hanretty, 2004). It is a tragedy of reproduction and a form of reproductive failure in the index pregnancy of affected women. Such women have a 7-15% chance of recurrence and only 40-60% chance of conceiving after surgery (Aboyeji et al, 2002). Ectopic pregnancy remains a major gynaecological problem in contemporary gynaecological practice. Not only do women die from this disease but also of greater clinical importance is the indirect morbidity of poor fertility prognosis and adverse outcome in subsequent pregnancies (Musa et al, 2009). Ectopic pregnancy may not necessarily be managed by a gynaecologist especially in hospitals in rural settings where there are no specialist doctors or if present are limited in number. In such district hospitals, general practitioners with surgical and gynaecological skills manage them in low-income countries where most patients present late as emergencies. Gynaecological emergencies form a large proportion of the workload of a gynaecologist. Gynaecological emergencies, diagnosis, and treatment have progressed in the light of evidence-based medicine combined with a good clinical assessment. This allows for appropriate management. Any primary health care doctor should be prepared to encounter and to handle gynaecological emergencies in patients even those in critical ill states. Ectopic pregnancy is a condition that occurs in all races, in all countries and in any socio-economic class of women during the reproductive years. It is a life threatening surgical gynaecological emergency in our environment (Nwagha et al 2007, Adesiyun et al 2001). Whilst there are many conditions that may lead to an emergency presentation, there are four emergencies, which account for the great majority. These are spontaneous abortion, pelvis sepsis