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A Comparative study on the Clinical Efficacy of Nd:Yag Laser alone Versus Nd:Yag Laser - R20 Method Versus A Sequential Combination of Ultrapulse Co2 Laser followed by Nd:Yag Laser in Tattoo Removal Using Split: Lesion Approach
No full textClinical Pattern of Neonatal Dermatoses in a Tertiary Care Hospital: An Observational study
No full textA Cross Sectional study on Screen Time usage among Children aged 2 to 5 Years in Chennai
No full textA Study on Assessing the Duration and the Reasons for Time Delay between the Onset of Symptoms and the Initiation of Treatment for New Sputum Positive Pulmonary Tuberculosis in Tertiary Care Hospital
No full textA Study on Prevalence of Premenstrual Dysphoric Disorder among Married and Unmarried Women and Its Association with Lifestyle and Socioeconomic Factors
No full textA Cross sectional study to evaluate the risk of patellar instability in contralateral Asymptomatic knee in unilateral anterior knee pain patients
No full textA Cross Sectional study of Functional Outcome of ACL Reconstruction using Hamstring Tendon Graft with Additional Distal Fixation
No full textStudy of Ectopic Pregnancy in Tirunelveli Medical College Hospital
Full text linkIn our study, the incidence of ectopic pregnancy was found to be 8.2 per 1000 livebirths. i.e. 0.82% of incidence. Similar results were obtained in a study conducted by Paneli DM [et al.] where the incidence was ranging between 1% and 2%. Chang D [et al.] conducted a study and found out the similar results.
• In our study, majority (30%) of the patients were in the age group of 25 to 29 years followed by the age group of 30 to 34 years old patients (29%) and 21-24 age group (20%). Hypotheses for this relation includes the more increased probability of exposure to most other types of risk factors with advancing age, increase in chromosomal abnormalities in trophoblastic tissue and age-related changes in tubal function which will delay the ovum transport, resulting in tubal implantation7. Mostly of cases occur in the age group between 21- 30 years. This is the age group where there is peak of sexual activity and
reproduction occurs. Also, chance of ectopic pregnancy is influenced by the tubal defects. Age is the utmost risk of Ectopic pregnancy that increases with advancing maternal age, with age over 35 being a significant risk factor. The incidence of the ectopic pregnancy showed a steady increase with the increase in maternal age at conception from 1.4% of all pregnancies in women aged 21 years to 6.9% of pregnancies in women aged 44 years or more.
• The classic triad of abdominal pain, amenorrhea and vaginal bleeding might not be seen in most cases. Women may be presented with non-specific symptoms like unaware of an on-going pregnancy situation or even may present with hemodynamic shock condition. However in our study, Majority of the patients are presented with the complaint of abdominal pain (56.80%), followed by bleeding (55%) and amenorrhea with bleeding (47%). Patients with an ectopic pregnancy usually present with pain and vaginal bleeding between 6 and 10 weeks gestation. But, these are common symptoms in early pregnancy, with one-third of women experiencing some pain and/or bleeding. The pain may be persistent and severe and is commonly unilateral. The clinical-triad of ectopic pregnancy includes abdominal pain, bleeding and amenorrhea. In a study conducted by G. Geovin Ranji [et al.], showed result supporting this. Also, these results are consistent with those from Tang BD et.al and Panti A [et al.]. In porwal sanjay et al study, 90% reported
amenorrhoea and 87.5% reported abdominal pain.
• In our study, half of the patients have moderate level of anemia (43.2%), followed by mild level anemic group (33.6%). About one-third of the patients had stage three hypovolemic shock. This was supported by the study conducted by Tay Ji [et al.] where they found that ecotopic pregnancy has to be
strongly suspected when there is sign of shock.
Nearly two-thirds (76%) of the patients are presented with the gestational age of five to eight weeks, followed by lesser than 5 weeks of gestation (11.6%).
Usually, Ectopic pregnancy is usually diagnosed in the first trimester of pregnancy. The most common gestational age at diagnosis is 6 to 10 weeks, but fetal viability can be discovered until the time of delivery.
• In our study, nearly two-thirds (75%) of patients had cervical motion tenderness. Similar results were found by Tay [et al.] in their study where they found that Cervical motion tenderness has been reported in upto 67% of cases and one- third of the patients did not have cervical motion tenderness. This was supported with the results obtained by Tay [et al.] where they reported that one-third of women with ectopic pregnancy have no clinical signs.
• In our study, 85.6% of the participants membrane were ruptured and 14.40% of them were Unruptured. Majority of the participants had ruptured membrane.
• Nearly one-third of our study participants had their site of ectopic pregnancy at ampulla (71.2%), followed by isthumus (9.6%), Interstitium (7.2%), Cornua (5.6%) and Fimbrial end (4%). This was supported by a study conducted by where they found Parts of Fallopian tube is the common site in most cases of tubal EP14. About 75–80% of EPsoccur in the ampullary portion, 10–15% in the isthmic amount, and about 5% in the fimbrial end of the Fallopiantube.
• In our study majority of the participants were found to be primiparous (37.6%) and multi-parous (30.4%). Among primiparous, all of them have only child. Similar results were found out in a study conducted by Shraddha Setty [et al.] and Laxmi karki et al where they found that more than half of the ectopic pregnant study subjects were multiparous women.
• Nearly two-thirds (73%) of the study participants did not use any contraceptives. Similar results were demonstrated in a study conducted by Cheng Li [et al.] Contraceptive Use and the Risk of Ectopic Pregnancy a Multi-Center Case-Control Study where they found current use of most contraceptives reduced the risk of both IUP and EP.
• In our study, one-fourth (26%) of study subjects had a history of previous abortion followed by tubal surgeries, sterilization failure and previous ectopic pregnancy. This result was supported by the study conducted by Shaik [et al.] where they found that the ectopic pregnant subjects had a previous history of abortion 20 (33%), previous surgery 12 (20%) and were seen as common risk factors. The commonest risk factors among the study population were previous LSCS, tubal surgeries, previous ectopic pregnancies, prior H/O abortions, H/O infertility and pelvic inflammatory disease. Similar risk factors were noted in various other studies. The increasing trend in caesarean section was found to be associated with increased risk of ectopic pregnancy.
• In our study, there was no significant association found between the ectopic pregnancy and conditions such as renal failure, ovarian cyst, thrombocytopenia and COVID.
More than two-third (67%) of the morbidity among the subjects were due to the anemia, followed by hypovolemic shock (4%) requiring mechanical ventilation and hysterectomy. Post-operative anaemia and fever were found
to be more common in ruptured ectopic pregnancies when compared to unruptured ectopic pregnancies.
• Among the study population with outcome, 1.60% of them were medical outcome, 98.4% of them were surgical outcome, 97.60% of them undergone Salpingectomy. Total/partial salphingectomy and salphingo oophorectomy were the common surgeries performed. In developing countries open method by laparotomy still remains the most commonly used management for ectopic pregnancy. However the trend is changing towards the laparoscopic surgery and conservative management. In Samiya Mufti [et al.] study the surgical management was by open method in all cases.
CONCLUSION:
1. Without timely diagnosis and treatment, ectopic pregnancy can become a life-threatening situation. Because of its diversity of clinical presentations and atypical presentations, strong suspicion is required for its early diagnosis.
2. Amenorrhoea is not necessary for the diagnosis of ectopic pregnancy. Advise UPT and USG to all reproductive age group patients presenting with abdominal pain or bleeding p/v with or without amenorrhoea.
3. One of the risk factors for ectopic pregnancy is previous H/O tubal surgeries (most common being sterilisation failure). Hence sterilisation could not rule out the possibility of an ectopic pregnancy. Advise the patients to come for check up if she misses the periods as early as possible.
4. Follow sterilisation techniques strictly.
5. Train the staff adequately to diagnose the ectopic pregnancy before rupture, so that immediate morbidities like anaemia, massive blood transfusion, shock requiring mechanical ventilation could be avoided.
6. Ultrasound is the simple and gold standard diagnostic method forectopic pregnancy in low resource settings.
7. Routine first trimester ultrasound should be done in all pregnantwomen at the first visit itself.
8. UPT kits and sonographic equipments should be made available in all primary health centres and emergency gynaecological units.
9. Staff should be trained adequately to use and interpret the clinical findings sonographic images.
10. Early diagnosis and referral is the key factor in reducing the maternal morbidity and in preserving the future fertility.
11. Because of the high incidence of tubal rupture in our set up, community education is required to inform the women to attend the health facilities as early as possible once they have symptoms
