The prevalence and morbidity associated with ectopic pregnancies at Harare central and Parirenyatwa hospitals

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.