| dc.description.abstract | Introduction
Ectopic pregnancy is amongst the top causes of maternal morbidity and mortality in the first
trimester of pregnancy. It represents one of the commonest gynaecological surgical
emergencies in Zimbabwe and other developing countries because most of the women
present to health care facilities after rupture has occurred.
Objectives
i. To determine the prevalence of ectopic pregnancy at Harare and Parirenyatwa
Hospitals.
ii. To determine the risk factors associated with ectopic pregnancy at Harare and
Parirenyatwa Hospitals.
iii. To determine the morbidity and mortality associated with ectopic pregnancy.
Design
Cross-sectional study.
Setting
Harare and Parirenyatwa Central Hospitals in Harare, Zimbabwe.
Subjects
Women attending the two hospitals with suspected ectopic pregnancy from 01 December
2012 to 30 April 2013.
Methods
All women with a suspected ectopic pregnancy who consented to participate in the study
were recruited. They were managed by the attending team in the acute phase of the illness.
Face to face interviews were conducted to collect information and probe for risk factors of
ectopic pregnancy. The management offered to the patient was then analysed using patient’s
notes. An HIV test was done on all consenting subjects after pre-counseling. The mortalities
were noted and the morbidity was assessed by checking the pre-operative haemodynamic
state of the patient, pre-operative haemoglobin count, use of blood or its products, need for
intensive care post-operatively and the mean hospital stay.
Results
During the study period there were a total of 11239 deliveries attended at the two hospitals. A
total of 138 suspected cases of ectopic pregnancy were recruited into the study. Of these, 126
(91.3%) were surgically confirmed as ectopic pregnancies and the remainder (12) were
wrongly diagnosed. The overall incidence of ectopic pregnancy was found to be 1.12%. Most
women were in the 21-30 year age group and had 2 children or less. The risk factors
identified were a reported history of sub-fertility, previous history of STI, previous abdominal
or pelvic surgery and a previous ectopic pregnancy. There was one maternal death due to
rupture (case fatality rate of 0.8%). The morbidity was significant with 87.3% presenting
after rupture, 38.8% being attended with signs of shock, 11.1% requiring intensive care
admission and 77% being transfused with blood. The mean hospital stay was 5 days
following salpingectomy via laparatomy. The prevalence of HIV amongst those with ectopic
pregnancies who were tested was 13.1%.
Conclusion
The morbidity associated with ectopic pregnancy remains high in young women of low parity
as the majority present after rupture. The subsequent impact on future fertility of these
women could be improved significantly if health strategists focused on primary prevention
and early diagnosis to prevent tubal rupture. This means ensuring universal reproductive
health care access thereby working towards achieving Millennium Development Goal 5
(MDG 5) by 2015. | |
