CLINICAL ANATOMICAL PATTERNS AND ASSOCIATED EARLY MANAGEMENT OUTCOMES OF ECTOPIC PREGNANCY AMONG PREGNANT WOMEN AT IRINGA REGIONAL REFERRAL HOSPITAL

Background: Ectopic pregnancy is a life threatening clinical condition which when not diagnosed and promptly managed early leads to maternal morbidity and mortality. Currently the exact prevalence, clinical anatomical patterns and associated early management outcomes in our setting is not well documented and also an associated morbidities put unknown resource burden to facilities during management of women with ectopic pregnancy at Iringa regional referral hospital in Tanzania. This study therefore is aimed at determining clinical anatomical patterns and associated management outcomes.
Methods: This was a prospective cross sectional study carried at Iringa Regional Referral Hospital from June to December 2020. Ectopic pregnancy was diagnosed based on history taking, physical examinations urinary pregnancy test, ultrasonography and incidental ectopic pregnancy findings at laparotomy. All findings at laparotomy, surgical procedures performed, postoperative early managements outcomes were all entered in the questionnaire and all patients were followed up till discharge. Filled questionnaires were entered in statistical program and were analyzed by using a IBM SPSS version 25. Results were summarized into frequencies and percentages while numerical variables were summarized into means, median and standard deviations.
Results: A total of 105 women with confirmed ectopic pregnancy were included. Tubal ectopic pregnancy was the predominant anatomical pattern (71.4%), with the ampulla being the most common site (45.6%), while 28.6% had non-tubal ectopic pregnancy. Salpingectomy was the most frequently performed surgical procedure (64.8%). Overall, 99.1% of women recovered and were discharged, although 76.0% experienced at least one early complication. Blood transfusion (71.4%) and intractable intraoperative bleeding (24.8%) were the most common early management outcomes. After adjustment for age, gravidity, and previous surgery, women with tubal ectopic pregnancy had significantly lower odds of intractable intraoperative bleeding (AOR=0.10, 95% CI: 0.03–0.32; p<0.001) and blood transfusion (AOR=0.20, 95% CI: 0.06–0.73; p=0.015) compared with those with non-tubal ectopic pregnancy.
Conclusion: The encouragement of early health seeking, early diagnosis and timely referral to hospital is needed to decrease the rate of tubal rupture and the resulting morbidity and mortality. During EP management much attention should be given to patient with non-tubal ectopic pregnancies since they are associated with adverse early management outcomes.