Ectopic Pregnancy

Incidence of ectopic pregnancy is reducing in the western world but increasing in West Africa.

Between 1992 to 1996 there were about 45 cases per 1000 cases in Lagos State University Teaching Hospital (LUTH), In Usman Danfodio University Teaching Hospital (UDUTH) 10 years review, ectopic pregnancy incidence of 1.5% of 20,095 total deliveries and 4.1% of 7,254 gynaecological admissions were recorded between 2001 and 2011.

Several researches across Nigeria in Calabar, Benin and Abuja showed that incidence of ectopic pregnancy is on the rise.

What so ever delays transportation of fertilized ovum via the fallopian tubes to the uterine cavity will result in ectopic pregnancy.

The commonest causes include pelvic inflammatory diseases with inflamed fallopian tubes (salpingitis caused by gonorrhoea and chlamydia infections)
Previous tubal, pelvic surgery, endometriosis, abuse of postinor 2 and other progesterone medication and devices.

Failed bilateral tubal ligation.
Those above 35years are at risk of getting ectopic pregnancy, those with history of infertility and those undergoing IVF treatment.

Symptoms included missed period , abdominal pains and par vagina bleeding, it could result to emergency sometimes with tubal rupture leading to abdominal pains, bleeding, shock and death.

Sometimes it is not an emergency, could be silent and accidental discovery only, some present with slight abdominal pains with or without bleeding and painful sex.

Usually diagnosis is made with pregnancy test, but abdomino-pelvic scan will show nothing in the uterine cavity

Treatment, usually either surgical or medical, if tubes nor ruptured and pregnancy size is less than 3cm, No active bleeding, and BHCG titre is lower than expected concentration, and when blood in the pouch of douglas is less than 100mls surgery may not be needed.

In conclusion, the commonest cause of ectopic pregnancy is untreated gonorrhoea and chlamydia in women resulting in PID.