Clinical Presentation and Diagnosis of Ectopic Pregnancy-A Dilemma? Bhavna1*, Gupta Kumud Bala2, Jindal Monika3, Kaur Satwant3 1Senior Resident, Department of OBG, Maharishi Markandeshwar Medical College and Hospital (MMMCH), Kumarhatti, Solan, Himachal Pradesh-177044, India 2Professor and Head of the Department, Department of OBG, Maharishi Markandeshwar Medical College and Hospital (MMMCH), Kumarhatti, Solan, Himachal Pradesh-177044, India 3Assistant Professor, Department of OBG, Maharishi Markandeshwar Medical College and Hospital (MMMCH), Kumarhatti, Solan, Himachal Pradesh-177044, India *Corresponding author email id: bhavomedico@gmail.com
Abstract Background: Present study was conducted with a background in mind to study various clinical presentations and diagnostic modalities for ectopic pregnancy to reduce ectopic pregnancy related morbidity and mortality. Objective: To study the clinical presentation and diagnosis of ectopic pregnancy. Material and Methods: This prospective study was conducted over a period of 1 year at the Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital, Shimla, from March 2011 to February 2012. In this case-control study, all the diagnosed cases of ectopic pregnancy were taken as cases and controls were the age-matched women with normal intrauterine pregnancy of same gestation age. Total number of cases with ectopic pregnancy, who reported to our institute during the study period, was 110. Results: Overall incidence of ectopic pregnancy was 18.62 per 1000 deliveries in the present study, with mean age of 28.72 years. Maximum cases were multi-gravidae (80.90%). Most common symptoms were pain in the abdomen (90.90%), amenorrhoea (82.72%), bleeding per vaginum (75.45%), gastrointestinal symptoms (37.27%) and syncopal attacks (25.45%). Typical triad of ectopic pregnancy was present in 49.09% of the cases. Most common signs were cervical motion tenderness (67.27%), abdominal tenderness (70.90%) and pallor (56.36%). Shock was present in 10 cases. Signs and symptoms were more significantly present in cases when compared with controls. Urine pregnancy test was positive in 106 cases and negative in 4 cases. Ultrasonography diagnosed ectopic pregnancy in 101 cases. Conclusion: Ectopic pregnancy still remains a dreadful condition which has always challenged the clinical acumen of obstetricians and gynaecologists. Clinical findings associated with ectopic pregnancy have a wide spectrum, ranging from a completely asymptomatic status to hypovolemic shock. The classical pattern of period of amenorrhoea and abdominal pain may be lacking in most of the patients; however, a provisional diagnosis can be made in the light of clinical features along with the sonological findings. Delayed diagnosis may lead to disasters in the form of mortality or morbidity. Top Keywords Ectopic pregnancy, Clinical presentation, Diagnosis, Ultrasonography triad. Top |