Jornal de Cuidados com a Saúde da Mulher
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Management of extra-uterine pregnancy at the gynecology-obstetrical department of the Dakar social hygiene institute: about 60 cases collected between January 1, 2019 and July 31, 2021

Fatou SAMB*, Mouhamadou Mansour Niang, Donoly Rose Mbengue Owane, Cheikh Ahmed Tidiane Cisse

Objectives: Determine the frequency of ectopic pregnancy, specify the epidemiological and clinical profile of patients, describe paraclinical and therapeutic aspects, and assess maternal prognosis and factors associated with the type of ectopic pregnancy, treatment outcome and fertility after ectopic pregnancy.

Patients and methods: This was a retrospective, descriptive and analytical study conducted over a 31-month period (January 1, 2019 and July 31, 2021) and focused on the management of ectopic pregnancy at the Gynecology-Obstetrics Department of the IHS Hospital. We studied patients' socio-demographic characteristics, history, clinical and paraclinical data, therapeutic and prognostic aspects. Data were entered and analyzed using Excel 2010 and Epi info 7.2 software.

Results: We recorded 60 cases of EP in 5091 births, representing a frequency of 1.2% of deliveries. The epidemiological profile of the patients was that of a woman aged 29 years on average, nulliparous (40%), married (76.7%) and a housewife (68.3%). Functional signs were dominated by amenorrhea (100%), pelvic pain (80%) and metrorrhagia (65%). Hemodynamic status was stable, with cardiovascular collapse noted in 3 patients (5%). Abdominal palpation revealed abnormal sensitivity (55%) and a cry from the umbilicus (30%). Vaginal touch combined with abdominal palpation revealed a latero-uterine mass in 23.3% of cases. Plasma β-hCG assays were performed and found to be positive in 25 patients (41.7%), with levels mostly between 1,000 and 4,999 IU/L (20%). Blood counts revealed anemia in 17 patients (28.3%). Pelvic ultrasonography performed on all patients revealed direct signs of EP in 5 (8.3%). Indirect signs were dominated by uterine vacuity (80%), the existence of a latero-uterine mass (78.3%) and hemoperitoneum (73.3%). Fifty-three patients (88.3%) had undergone surgical treatment as first-line treatment, while the remaining 7 (11.7%) had undergone medical treatment with methotrexate. For the latter, we noted 4 cases of failure (57.3%), all of whom had undergone secondary surgery. Surgical procedures were dominated by total salpingectomy (96.5%). Short-term outcome was favorable (75%), with no maternal deaths. Fifteen patients (25%) had complications, dominated by anemia (16.7%). In the year following the EP, 7 pregnancies were recorded, representing a fertility rate of 11.7%. These resulted in 6 live births (10%) and one abortion (1.7%). No cases of recurrent EP were recorded. Ruptured EP was more frequent regardless of age (p=0.07) and parity (p=0.99). The outcome of medical treatment was more favorable the lower the serum β-hCG level (p=0.57) and the higher the dose used (p=0.001). More than a third of patients who had undergone primary surgery (36.8%) achieved pregnancy within a year of the EP, whereas this rate was nil in those who had received medical treatment (p=0.5).

Conclusion: Ectopic pregnancy is not uncommon in our practice. Despite the high proportion of ruptured ectopic pregnancies, which is the most frequent clinical form in our series, the maternal prognosis remains favorable thanks to well-codified, early and appropriate management.