Ectopic pregnancy: presentation and risk factors.

OBJECTIVE: To describe the clinical features and risk factors in ectopic pregnancy.

DESIGN: A descriptive study.

PLACE AND DURATION OF STUDY: The study was conducted in Unit III of the Department of Obstetrics and Gynaecology, Civil Hospital, Karachi from January 2002 to December 2003.

PATIENTS AND METHODS: A total of 38 women diagnosed with ectopic pregnancy were included in the study. Data was retrieved from the charts of all the patients diagnosed with ectopic pregnancy through a structured proforma. The variables studied included age, parity, symptoms and signs, risk factors, treatment and associated maternal morbidity.

RESULTS: Among the clinical features, the most common presenting symptom was abdominal pain in 37 (97.3%) patients whereas history of amenorrhea and vaginal bleeding were found in 28 (73.6%) and 22 (57.8%) patients respectively. The most common physical sign was tenderness: abdominal tenderness in 28 (73.6%) and pelvic tenderness in 23 (60.5%) patients. Cervical excitation was only present in 19 (50%) patients. Risk factors were present in 23 patients (60.5%), the most frequent being infertility in 9 patients (23.6%). Other risk factors were tuberculosis in 6 patients (15.7%), previous ectopic pregnancy in 3 (7.8%) and previous tubal surgery in 1 (2.6%) patient. History of IUCD was present in 1 (2.6%), injection Depo-provera in 4 (10.5%) and OCP in 3 (7.8%) patients. History of D & C and C-section were present in 7 (18.4%) and 4 (10.5%) patients respectively.

CONCLUSION: Abdominal pain was the single most consistent feature of ectopic pregnancy. Risk factors may not always be present. Therefore, ectopic pregnancy should be suspected in every woman of reproductive age who presents with unexplained abdominal pain, irrespective of amenorrhea and vaginal bleeding and whether risk factors were present in the past history or not.