Factors Associated with Ruptured Ectopic Pregnancy: A Review
Ectopic pregnancy, defined as the implantation of the embryo outside the uterine cavity, is a common, life-threatening gynaecological emergency. Worldwide, approximately 1–2% of all naturally conceived pregnancies result in ectopic implantation. Broadly, ectopic pregnancies may be tubal, nontubal, or heterotopic pregnancy, with tubal being the most common. In nontubal pregnancies, oocytes are fertilized at sites other than the fallopian tube, or the oocytes can be fertilized within the fallopian tube but extruded into the peritoneal cavity.
Although all sexually active women of childbearing age are at risk of ectopic pregnancy, different studies have identified several risk factors for its occurrence. Studies have established a link between ectopic pregnancy and maternal factors such as age, previous ectopic pregnancy, and history of pelvic infections. In addition, ectopic pregnancies have been associated with infertility and infertility treatment, including assisted reproductive techniques and tubal reconstructive surgery. Other risk factors are smoking and contraceptive use.Researchers found that majority of patients with ectopic pregnancies presented following a rupture. Marital status and period of amenorrhoea were significantly associated with ruptured ectopic gestation.The study has appeared in Hindawi Obstetrics and Gynecology International.
Treatment options for ectopic pregnancy include medical, laparoscopic, and laparotomy. Although the treatment success rate of ectopic pregnancy varies among studies, several studies have established no significant differences between the treatment methods.
Ectopic pregnancy may also give rise to several psychoemotional problems and financially burden both patients and healthcare institutions. Currently, there is still a paucity of information on the factors associated with clinical presentation and outcomes in our subregion, which is essential in determining the most appropriate treatment modalities. The objective of this study by Promise E. Sefogah and team was to conduct an epidemiological analysis of cases of ectopic pregnancy managed at the Lekma hospital to determine associated factors, patterns in presentation, treatment modalities, and outcomes. This study differs from other ectopic pregnancy-related studies as it analyzed a broader epidemiological aspect of archived clinical data to determine associations between various sociodemographic characteristics of the population seen, clinical presentation, and treatment outcomes.
Authors performed a ten-year retrospective chart review of cases of ectopic pregnancies managed at the Lekma hospital and assessed them for peculiar risk factors, clinical presentation, and outcomes.
Over the ten-year period, there were 115 ectopic pregnancies and 14,450 deliveries. The mean age ± standard deviation of the 115 patients was 27.61 ± 5.56. More than half of the patients were single (59/115, 51.3%). The majority (71.3%) of the patients presented with a ruptured ectopic pregnancy. After adjusting for covariates, the odds of an ectopic pregnancy presenting as ruptured among single patients was 2.63 times higher than that of married patients ( p = 0.01). Ectopic pregnancies located in the isthmic region of the tube had a 77% lower odds of presenting as ruptured than those located in the ampullary region (p = 0.01). The odds of rupturing were 1.69 times increased for every additional week after the missed period (p < 0.01). No mortalities were reported as a result of an ectopic pregnancy.
Study analysis demonstrated that the average period of amenorrhea was higher in patients presenting with ruptured ectopic pregnancies than in those with unruptured ectopic pregnancies. This finding could be explained by the fact that the ectopic gestational mass generally increases with increasing gestational age, and rupture becomes more likely when the size of the gestational mass outgrows the fallopian tube. The exception is interstitial ectopic pregnancy which can expand until 15 weeks of gestation. Because of the problems associated with misdiagnosis of interstitial ectopic, they also have a higher rate of presenting with a ruptured tube with severe haemoperitoneum.
In this study, marital status was significantly associated with ectopic rupture, with single women having three times higher odds of suffering a ruptured ectopic pregnancy than married women. Authors speculate that married couples are more likely to report earlier when they experience pregnancy symptoms and thus allow an earlier diagnosis of ectopic pregnancy when it is unruptured, which is then managed medically or surgically.
Even though the site of ectopic was found to be associated with a ruptured ectopic in the crude analysis, this was not found to be statistically significant in the adjusted model. Moreover, the mode of presentation, i.e., whether the patient presented with bleeding per vaginum or lower abdominal pain or both, or with sudden collapse, did not have any association with the outcome of a ruptured ectopic gestation.
The findings from this study have indicated strongly that despite the availability of this district facility, the majority of ectopic pregnancies present as ruptured. This may suggest some deficiencies in public health awareness and a lack of health-seeking behavior. Specifically, early reporting of secondary amenorrhea provides a crucial opportunity to diagnose ectopic pregnancies before they rupture and cause potentially life-threatening morbidity.
"The majority of patients with ectopic pregnancies presented following a rupture. Marital status and period of amenorrhoea are significantly associated with ruptured ectopic gestation. This suggests a deficiency in public health awareness and health-seeking behaviour for early reporting of missed periods in our setting."
Source: Promise E. Sefogah, Nana E. Oduro, Alim Swarray-Deen; Hindawi Obstetrics and Gynecology International Volume 2022
https://doi.org/10.1155/2022/1491419
