ABSTRACT
Introduction: ectopic pregnancy (EP) is the leading cause of maternal mortality in the first trimester of pregnancy in our environment. This study aimed at evaluating the incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon. Methods: this was a retrospective nested case control study carried out from December 2006 to December 2016. A ratio for control vs cases of 3:1 was obtained. Any pregnancy implanted outside the normal uterine cavity was considered as an ectopic pregnancy. Student's t-test was used to compare continuous variables and Pearson's Chi-square test for categorical variables. The association between EP and the demographical and clinical variables was estimated using logistic regression. Statistical significance was set at p-values<0.05.Results: a total of 247 cases of EP were registered out of 17221 deliveries giving an incidence of 1.43% in ten years. History of pelvic inflammatory disease (OR = 3.10, CI (1.76-5.44), p < 0.001), previous EP (OR = 10.22, CI (2.61-14.82), p < 0.001), History of induced abortion (OR = 2.68, CI (3.32-9.73), p< 0.001), history of adnexa surgery (OR = 4.37, CI (2.17-10.32), p < 0.001) and history of appendectomy (OR = 2.16, CI (0.99-6.64) p< 0.001), were also found to be associated with increased risk of EP. More than five percent (5.52%) of the patients were in shock at presentation. Diagnosis was confirmed mainly by use of ultrasound (78.53%) and treatment was principally by laparotomy (97.55%) with salpingectomy (95.60%). Most (90.18%) of ectopic pregnancies were ruptured at presentation. Only 2.45% of cases were manage medically with the use of methotrexate. Conclusion: the incidence of ectopic pregnancy (EP) in our environment is within the global range (hospital-based incidence of 1.43%) and is rising. Late presentation, lack of modern diagnostic and management tools have made laparotomy with salpingectomy the principal method of management of ectopic pregnancy in our environment
Subject(s)
Cameroon , Incidence , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Risk FactorsABSTRACT
Ectopic pregnancy (EP) is a common diagnosis; frequently misdiagnosed early in its presentation and a leading cause of first trimester mortality. Ultrasound (US) is a key component of evidence-based diagnostic algorithms. We present a systematic review on the frequency of the use of US in the diagnosis of EP in Sub-Saharan Africa. Methods A librarian-assisted search of PUBMED; EMBASE; Cochrane; Web of Science; and POPLINE databases was performed. Inclusion criteria were original research studies that reported the proportion of patients receiving US as part of a workup for EP in a Sub-Saharan African country. Abstracts were reviewed and those potentially meeting criteria had a formal survey of the manuscript. Results: The initial search revealed 784 original publications. Manual review of abstracts narrowed this to 91 papers with potential relevance; and 12 studies were included in the final analysis. A total of 6055 patients diagnosed with EP were included. 8.7 received a pregnancy test. 92.3 were ruptured at the time of presentation. 42.9 were in shock and 75.8 received red blood cell transfusion. 73.7 were unaware of the pregnancy and 24.9 were seen by a healthcare worker prior to presentation; 1.1 of patients died. Overall; 12.6 received US to aid in the diagnosis.Conclusion :In this study; overall utilisation of US in the diagnosis of EP was found to be low. In this population; patients presented late and critically ill; obviating the need for US in many cases. However; studies in Sub-Saharan Africa in populations of patients with similar rates of late presentations have shown a substantial increase in the diagnosis of unruptured EP with the routine use of US
Subject(s)
Pregnancy, Ectopic/diagnosis , Ultrasonography , Utilization ReviewABSTRACT
La grossesse heterotopique spontanee est une pathologie rare mais aussi une urgence chirurgicale souvent passee inapercue. Le but de cet article est d'en rapporter deux cas a travers lesquels nous relatons la difficulte diagnostic devant la mise en evidence premiere de la grossesse intra-uterine. Cette situation retarde la prise en charge et met en danger la vie des patientes
Subject(s)
Emergency Medical Services , Obstetric Surgical Procedures , Pregnancy, Ectopic/diagnosisABSTRACT
"L'etude retrospective descriptive realisee dans le service de gynecologie et d'obstetrique du CHU de Cocody du 1er Janvier 1999 au 30 Juin 1999 concerne 93 cas de grossesse tubaire correspondant une frequence de 49sur1000 accouchements. Les facteurs de risque sont domines par les antecedents d'infections genitales (45;5 pour cent) et d'avortements a risque (38;7 pour cent). L'echographie a ete necessaire au diagnostic dans 45;5 pour cent des cas. Le traitement a consiste en une salpingectomie dans 91;3 pour cent des cas. L'analyse de cette situation rend necessaire l'amelioration du diagnostic de la grossesse tubaire. Ceci ""est possible qu'en rendant systematique la realisation d'echographie precoce chez les femmes a risque lorsque les signes cliniques de grossesse tubaire sont presents. A ce prix; nous pouvons esperer eviter les traitements radicaux et proposer des techniques modernes comme la chirurgie coelioscopique et le traitement medical considerees a priori comme les traitements de reference"