Ectopic pregnancy in King Fahad Hofuf Hospital: A five year experience

Out of a total of 45,836 deliveries over a five-year period (1986-1990), 128 cases of ectopic pregnancy (0.28% incidence) managed during this period was compared with other previously published data in terms of presentation and management. There were no maternal deaths among the cases treated. The age distribution was 16-144 years with higher incidence 46 (36%) occurring in the range of 25-30. One hundred thirty (93%) were multipara. The presenting complaints included pain (100%), vaginal bleeding (78.4%) and amenorrhea (39.8%). The most consistent clinical findings was cervical excitation tenderness (88%). Ultrasonography (88%) and laparoscopy (50%) were adjunctive only to history and physical examination which was found to be the most important in the diagnosis. Detection of an adnexal mass separate from the ovaries with or without hemoperitoneum was diagnostic of ectopic pregnancy. One hundred two (79.6%) diagnosed as rupture, 17 (13%) as aborted and five (3.9%) as intact. With the changing picture of ectopic pregnancy, one case each was initially diagnosed as appendicitis, urinary tract infection and anemia and admitted in the medical ward before further review confirmed the diagnosis of ectopic pregnancy. The sites of implantation included 123 in ampulla (96%), one each in ovary, cornual and cervix with two diagnosed as having abdominal pregnancy. The predisposing factors include pelvic inflammatory disease (22.6%), previous ectopic (10.2%) and recent IUCD (9%), but none insitu at the time of ectopic. Our treatment of choice is salpingectomy but 12% had salping-oophorectomy for various reasons, while total abdominal hysterectomy was performed for the cervical pregnancy for uncontrollable hemorrage.