Extra-uterine pregnancy at the National Hospital of Nouakchott: epidemiological, clinical and therapeutic aspects.

Abstract

Introduction: Ectopic pregnancy (EP) is the implantation and development of the egg outside the uterine cavity. Objective : The aim of this study was to evaluate the epidemiological, diagnostic and therapeutic complications as well as the prognosis of EP. Methodology : This is a descriptive cross-sectional study with prospective recruiting data that concerns 44 cases hospitalized and treated for ectopic pregnancy in the maternity ward CHN Nouakchott during a period of one year, from May 1, 2013 to April 30, 2014. Results : Our study has led to the following results: The Frequency of ectopic pregnancy is 1/100 pregnancies. The average age of patients was 29.84 years, with extremes ranging from 15 to 44 years. Women from age 25 to 34 were the most affected (61.4%). Women with the fewest number of children were the most affected (54.6%). The most frequently risk factors found were: STI (36.6%) oral contraception (36.3%), history of spontaneous abortions (25%), infertility (18.2%) and abdominal and pelvic surgery (13.6%). The clinical triade, pelvic pain (91%) delayed menstruation (86.3%) and bleeding (61.4%) were the main tell-tale signs of EP. The early diagnosis means available to the hospital was ultrasound (93%) coupled to urine pregnancy test (59%) and plasma -HCG (45.5%). Most cases were diagnosed late resulting in complications. 81.8% cases ended in a ruptured ectopic pregnancy, among them 34% were admitted in cardiovascular collapse state. Laparotomy was the only immediately effective therapeutic means. Tubal pregnancy represented 86.2% of cases. Its location was ampullar in 50%. The postoperative course was uneventful and there were no maternal death. Radical treatment is the best choice because of the delay in consultation therefore. salpingectomy was frequently used (86.4%) as well as adnexectomy (6.8%). This high frequency of non-conservative surgery (93.2%) in our study is likely to endanger the future of obstetrical patients. Conclusion : EP remains a serious condition and therefore is a public health problem. All practitioners need to think about this disease before any suggestive sign. Improving the management of EP is based on prevention of risk factors, incitement of the population to consult early and use of minimally or non-invasive therapeutic means in order to reduce morbidity.