Management of ectopic pregnancy in Aminu Kano teaching hospital Kano Nigeria: A 3-year

Yakasai IA, Abdullahi J and Abubakar IS

Department of Obstetrics and Gynaecology Bayero University Kano/Aminu Kano Teaching Hospital Kano, Nigeria

*Corresponding author E-mil: ibrahimyakasai57@hotmail.com

Accepted 27 July, 2012

Abstract

Ectopic Pregnancy is one of the commonest causes of first trimester maternal death. In addition subsequent morbidity including reproductive challenges can be distressing. The risk of severe morbidity and mortality is related to gestational sac rupture. The study aimed to evaluate the pattern of presentation and management of ectopic pregnancy in our hospital as well as identify challenges and proffer suggestions to improve overall patient care. A retrospective review of the case records of women who had emergency laparotomy based on a clinical diagnosis of ectopic pregnancy in our department between 1^st November 2008 and 31^st October 2011 was done. Ectopic pregnancy represented 4.26% of all deliveries, 5.55% of all gynaecologic admissions and 26.01% of all gynaecological surgeries. The mean age of the patients was 27.8 years with a range of 15-41years. The highest frequency occurred in the 25-34 year age groups (61.39%). The commonest presenting symptoms were abdominal pain in 98 (97.03%), amenorrhoea in 74 (73.27%) and vaginal bleeding in 65(64.36%). Thirteen patients (12.87%) presented in shock had prompt resuscitation and surgery. The main site of occurrence was tubal 89 (88.12%) and all patients had laparotomy. Salpingectomy was done in 87 (86.14%) while 1 (0.99%) each had “milking out” and linear salpingostomy respectively. Excision and reconstruction was done for the 5 (4.95%) women with ovarian pregnancies. Laparotomy was negative in 5 (4.95%) of the women and only 2 (1.98%) had a diagnostic laparoscopy prior to laparotomy. The majority of the surgery was done by the senior resident (67.33%), followed by the Registrar (29.70%) and the consultant (2.97%). Eighty six (85.15%) of the surgeries were done during call hours. Ruptured ectopic pregnancy is the main mode of presentation in our setting and laparotomy with salpingectomy is the main stay of management. However, majority of the women are haemodynamically stable at presentation and operative laparoscopy could have been a viable alternative.

Keywords: Ectopic Pregnancy, Laparotomy, Laparoscopy, Salpingectomy, Kano.