European Journal of Cardiovascular Medicine

Ectopic pregnancy (EP) is defined as the implantation of a fertilized ovum outside the endometrial lining of the uterine cavity, most commonly in the fallopian tube (over 90% of cases). (1) It is a significant cause of first-trimester maternal morbidity and mortality, especially in developing countries where delayed diagnosis and limited access to emergency care remain prevalent challenges. (2) Globally, the incidence of ectopic pregnancy ranges between 1% and 2% of all reported pregnancies. (3) However, the actual burden may be underestimated due to underreporting and unrecognized early losses in resource-limited settings. (4)

Over the past few decades, advances in transvaginal ultrasonography and quantitative serum beta-human chorionic gonadotropin (β-hCG) assays have improved the early detection of ectopic pregnancy. (5) Despite these diagnostic tools, ectopic pregnancy often presents a diagnostic dilemma due to its varied and sometimes subtle clinical manifestations. The classic triad—amenorrhea, abdominal pain, and vaginal bleeding—is only seen in approximately 50% of cases. (6) Furthermore, many women present late, often after rupture, with signs of intra-abdominal hemorrhage and hemodynamic instability. (7)

Several risk factors have been associated with ectopic pregnancy, including pelvic inflammatory disease, previous ectopic pregnancy, tubal or pelvic surgery, assisted reproductive technologies, and smoking. (8,9) However, a significant proportion of women diagnosed with ectopic pregnancy have no identifiable risk factors, highlighting the importance of maintaining a high index of clinical suspicion. (10)

Understanding the clinical features and presentation patterns of ectopic pregnancy in specific healthcare settings is essential for early diagnosis and timely intervention. Hospital-based studies provide valuable insights into the demographic profile, risk factors, symptomatology, and outcomes of affected patients, which can help guide clinical decision-making and policy formulation. In low-resource settings, where delays in seeking and receiving care are common, such data are especially critical to improve maternal health outcomes.

This study aims to describe the clinical features of ectopic pregnancy among women managed at a tertiary general hospital, with the goal of enhancing awareness among clinicians and informing the development of locally relevant diagnostic and management protocols.

OBJECTIVE:

To determine the clinical features of ectopic pregnancy among women presenting to a tertiary general hospital

Source of Data: Study conducted at the Government General Hospitals Kadapa on patients coming to out-patient and in-patient department of the Obstetrics and Gynecology. Study Design: Prospective study Study Period: 18 months. Method of Sampling: purposive sampling Sample Size: Patients diagnosed with ectopic pregnancy during study period are chosen and study was conducted taking them as sample.

Inclusion Criteria: All patients diagnosed as ectopic pregnancy either clinically or sonologically. Those who have given consent to participate in the clinical study.

Exclusion Criteria:  Patients with: Intrauterine pregnancies. Heterotropic pregnancy. Patients who are not willing and not given consent for the clinical study. Methodology for Collecting Data After getting the ethical clearance, Patients attending the outpatient and in-patient of the Government General Hospital, Kadapa to the Department of Obstetrics and Gynecology are examined clinically and sonologically. The patients who are diagnosed with ectopic pregnancy are selected for the clinical study after taking the consent from them. Statistical analysis: Data entered using the MS excel, Data analyzed using SPSS software 21, Frequency tables and percentages are calculated. Figures using bar diagrams and pie charts are demonstrated.

During the study period, 50 subjects were chosen for the study.

TABLE 1 – Age distribution In the current study, Majority (52%) of the study participants belong to the age group of 21 to 30 years followed by 21 to 40 years of age group (38%) and

TABLE - 2: Distribution of study participants according to gravidity Majority of the study participants were multigravidae (80%) while about 20% of them were primigravidae.

TABLE – 3: Distribution of study participants according to clinical presentation Majority of the study participants had amenorrhea (94%) and pain abdomen (90%) while bleeding PV (68%), fainting/Syncopal attack (18%) were other clinical symptoms.

Note: * Multiple responses

TABLE - 4: Distribution of study participants according to GPE Majority (46%) of the study participants had pallor on GPE and 16% had shock while among 38% no abnormality detected.

TABLE - 5: Distribution of study participants according to clinical findings Majority of the study participants had tenderness (94%), followed by distension (24%), guarding (12%) and among 6% No abnormality detected.

Note: * Multiple responses

TABLE - 6: Distribution of study participants according to haemoglobin Majority (62%) of the study participants had haemoglobin >7 grams, while about 38% had haemoglobin.

Table 7: Distribution of study participants according to UPT All the study participants had positive UPT.

Table 8: Distribution of study participants according to USG Majority (84%) of study participants had rupture of ectopic on USG, while remaining had unruptured ectopic.

The current study consists of 50 patients. In the present study, Majority (52%) of the study participants belonged to the age group of 21 to 30 years followed by 21 to 40 years of age group (38%) and < 20 years of age group (10%).

In a study by Manju Lata Verma et al (11) it was found that majority of the study participants had amenorrhea (93%) followed by abdominal pain 52 (82%) and vaginal bleeding (51%). About 39% of the study participants had classic triad. In a study by G. Geovin Ranji et al (12) it was observed that majority of the study participants amenorrhea (95.8%) followed by abdominal pain (62.2%), vaginal bleeding (41.2%), fainting attack (11.8%). In about 27.7% of the study participants had triad of symptoms and about 6.72% had all the four symptoms. In a study by Elsa Tesfa Berhe et al (13) it was observed that in contrast to our study, about majority of the study participants had abdominal pain (97.5%) followed by vaginal bleeding (81%) and vomiting (12.7%). In a study by Edward et al (14) it was observed that about 81.9% of the participants with extrauterine pregnancy had moderate or severe vaginal bleeding while 57.8% of women with ectopic pregnancy had pain.

In a study by Manju Lata Verma et al (11) it was observed that about 14.8% of the study participants were in hemodynamic shock. In a study by G. Geovin Ranji et al (12) it was observed that about 11.8% of the study participants had shock.

In a study by G. Geovin Ranji et al (12) it was observed that majority (68.1%) of the study participants had abdominal tenderness and 44.5% of them had pelvic tenderness and 5% of them had adnexal mass. In a study by Elsa Tesfa Berhe et al (13) it was observed that majority of the study participants had abdominal tenderness (94.9%) followed by cervical motion tenderness (30.4%) adnexal mass (2.5%) and adnexal tenderness (15.2%).

In a study by Manju Lata Verma et al47 it was observed that 45.3% of the patients had severe anemia (haemoglobin < 8 grams %). In a study by Elsa Tesfa Berhe et al (13) it was observed that majority (58.2%) of the study participants had haemoglobin 10.5 grams haemoglobin.

In a study by Manju Lata Verma et al (11) it was found that majority (98%) of the study participants had positive UPT while about 2% of them had negative UPT. In a study by Elsa Tesfa Berhe et al (13) it was observed that majority (97.5%) of the study participants had positive UPT while 2.5% of them had negative UPT.

In a study by Manju Lata Verma et al (11) it was observed that about 64.8% of them had acute ruptured ectopic pregnancies, 9.6% had chronic ruptured ectopic pregnancies while 25.6% of them had unruptured pregnancies. In a study by Elsa Tesfa Berhe et al (13) it was observed that 63.3% of the women had ruptured ectopic pregnancy while 36.7% of them had unruptured ectopic pregnancy.

Acknowledgements:

We would like to thank all the study participants and the authors from where we have cited the references for publication of this article.

Ethical issues & Ethical clearance: The study was taken up after the approval of

the Ethical committee of the medical college,

Conflict of Interest: Nil

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