Fauzia Perveen, Subhana Tayyab.
Ruptured Ectopic Pregnancy: Clinical Presentation & Management.
J Surg Pak Jan ;12(2):47-51.

Objectives: To determine the clinical presentations and the management modalities of ruptured ectopic pregnancy (EP). Study design: This is a cross-sectional analytical study. Place & Duration of study: The study was conducted in Obstetrics & Gynaecology Department of Sindh Government Lyari General Hospital, Karachi , from 1st June 2002 to 31st May 2005. Patients & Methods: All women diagnosed with ruptured ectopic pregnancy were included in this study. Data were collected on a structured proforma. The variables studied included age, parity, presenting symptoms and signs, haemoglobin level, urinary hCG, beta hCG level, ultrasonographic findings, type of treatment provided and associated morbidity and mortality. Mean ± SD of continuous variables like age, parity and haemoglobin level were calculated while categorical variables like amenorrhea, abdominal pain, vaginal bleeding, anaemia, shock, abdominal tenderness, adnexal mass, cervical excitation and the other findings were given in numbers and percentages. Results: A total of 34 women were diagnosed as having EP. Frequency of ectopic pregnancy found was 1.22% of total 2790 deliveries. Out of these 33 patients (97.6%) had ruptured EP. The mean age was 26.18 years and the mean parity was 1.9. Common presenting symptoms were amenorrhea and abdominal pain, both found in 27(81.8%) patients and vaginal bleeding was present in 9(27.3%) cases. Common physical signs detected were abdominal tenderness and cervical excitation in 24(72.7%) and 21(63.6%) respectively. Anaemia was found in 21 subjects (63.6%) and mass in adnexa in 12 cases. Laparotomy was done in 32(96.9%) out of 33 patients. Salpingectomy was carried out in 22(66.7%) cases and salpingostomy in 6(18.2%). One patient underwent hysterectomy having cornual ectopic pregnancy. There was no maternal death in this study. Blood Transfusion was required in 27(81.8%) patients. Medical treatment was offered in only one patient who presented with a mass in adnexa and was haemodynamically stable but she left against medical advice. Conclusion: Abdominal pain, amenorrhea, anaemia and cervical excitation were the most consistent features of ruptured ectopic pregnancy. Therefore EP must be kept in mind in women having these features as conservative management is an option for early diagnosed cases. Shock and shoulder tip pain are late findings to appear therefore found in less number of patients. Surgical treatment was done in most of the cases because of late referrals. Early diagnosis and intervention would also reduce the maternal morbidity and mortality.

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