Pradhan Pramila, Thapamagar Suman Bahadur, Maskey Smriti
Department of Obstetrics and Gynaecology, Nepal Medical College Teaching Hospital, Kathmandu, Nepal.
Nepal Med Coll J. 2006 Dec;8(4):238-42.
A retrospective study of ectopic pregnancy at Nepal Medical College Teaching Hospital between January 2001 to June 2006 was carried out to determine incidence, demographic features, clinical presentation, duration at presentation and treatment, and the management protocol. A total of 36 cases of ectopic pregnancy were treated giving the incidence of ectopic pregnancy of 10.2/1000 deliveries and 7.3 /1000 pregnancies. The mean age is 30.1 years (range 23-45 years) and the mean parity is 1.2 with nulliparous at 49%. The mean gestational age is 6.9 weeks (range 5-11 weeks). Among the ethnicity, Mongolians constituted at 54.6%. The commonest risk factors present were infertility (33.3%), previous ectopic pregnancy (16.7%), pelvic inflammatory disease (13.9%) and tubal surgery (13.9%). The commonest symptoms at presentation are abdominal pain (94.4%), amenorrhea (72.2%) and abnormal vaginal bleeding (58.3%); and commonest signs were abdominal tenderness (91.7%), adnexal tenderness (72.2%) and cervical excitation (50.0%). The mean time from symptom to treatment was 176.58 hours and mean time from admission to treatment was 12.88 hours. Ectopic pregnancy was correctly diagnosed clinically in 85.0% patients including 42.5% (12/36) of ruptured ectopic pregnancy. Abdominal ultrasound and urinary â-hCG tests (ELISA test) were additional diagnostic tools. Sixty one percent (22/36) presented in subacute condition. Two cases (5.6%) were presented late causing diagnostic problem and more morbidity like anaemia, blood transfusion, adhesion needing major operations. Salpingectomy is the mainstay of treatment. Only one case has conservative surgery. Late presentation and ruptured ectopic pregnancy is associated with increased morbidity and mortality. High index of suspicion and early recourse to laparotomy save the life from this obstetric disaster.
对尼泊尔医学院教学医院2001年1月至2006年6月期间的异位妊娠进行了一项回顾性研究，以确定发病率、人口统计学特征、临床表现、就诊时的孕周和治疗情况以及管理方案。共治疗了36例异位妊娠病例，异位妊娠的发病率为每1000例分娩中有10.2例，每1000例妊娠中有7.3例。平均年龄为30.1岁（范围23 - 45岁），平均产次为1.2，未生育者占49%。平均孕周为6.9周（范围5 - 11周）。在种族方面，蒙古族人占54.6%。存在的最常见危险因素是不孕（33.3%）、既往异位妊娠（16.7%）、盆腔炎（13.9%）和输卵管手术（13.9%）。就诊时最常见的症状是腹痛（94.4%）、闭经（72.2%）和异常阴道出血（58.3%）；最常见的体征是腹部压痛（91.7%）、附件压痛（72.2%）和宫颈举痛（50.0%）。从症状出现到治疗的平均时间为176.58小时，从入院到治疗的平均时间为12.88小时。85.0%的患者通过临床正确诊断为异位妊娠，其中包括42.5%（12/36）的破裂异位妊娠病例诊断。腹部超声和尿β - hCG检测（ELISA检测）是辅助诊断工具。61%（22/36）的患者呈亚急性状态就诊。2例（5.6%）就诊较晚导致诊断困难，并出现更多如贫血、输血、粘连等需要大手术的并发症。输卵管切除术是主要的治疗方法。只有1例进行了保守手术。就诊较晚和破裂的异位妊娠与发病率和死亡率增加相关。高度的怀疑指数和早期进行剖腹探查可使患者免于这场产科灾难。
