title: Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study.
abstract: BACKGROUND
  Ectopic Pregnancy (EP) is a life-threatening emergency commonly encountered by medical practitioners where diagnosis can often be missed. Any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding must raise the suspicion of an ectopic pregnancy to prevent mortality and morbidity.
  
  
  OBJECTIVE
  To review all cases of EP and determine the incidence of EP. To study the high risk factors and know the types of clinical presentation, methods of diagnosis, outcome and complications.
  
  
  METHODS
  This was a retrospective cohort study, conducted at a tertiary care medical teaching hospital in Pondicherry, India. Medical records of all women with an EP between 2009 and 2015 were retrieved. Demographic data, parity, risk factors, clinical features, mode of management and need for blood transfusion was noted. Main outcome measures studied were the incidence of EP, risk factors, mortality and morbidity in these women.
  
  
  METHODS
  Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 19.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean ± SD.
  
  
  RESULTS
  Seventy-two EP were diagnosed during the six-year period with an incidence of 9.1/1000 pregnancies. Majority of women were aged 21-30years (51.39%), 27.8% women were nulliparous. The most common risk factors were previous abortion (36.1%) and pelvic surgery (37.50%). Fifteen cases (20.8%) were diagnosed in women who had tubectomy. The classic triad of lower abdominal pain, amenorrhoea and vaginal bleeding was seen in 29(40.3%) cases. Ultrasonography was required to arrive at a diagnosis in 28(38.9%) cases. Urine pregnancy test was positive in 100% of cases. Majority (94.4%) were tubal ectopic pregnancies. Medical management with methotrexate alone benefitted 10(13.89%) of patients while another four required surgery for failed medical management. More than half of the patients (59.7%) required blood transfusion and two (2.8%) had transfusion related acute lung injury. No deaths were noted.
  
  
  CONCLUSIONS
  Common risk factors for EP must be identified. Use of transvaginal ultrasonography and human chorionic gonadotropin assay have revolutionised the management of EP and serve as valuable adjuncts to early diagnosis and management.
authors.affiliation: Assistant Professor, Department of Obstetrics & Gynaecology, Pondicherry Institute of Medical Sciences , Pondicherry, India .
authors.forename: S
authors.initials: S
authors.lastname: Tahmina
authors.affiliation: Professor and Head, Department of Obstetrics & Gynaecology, Pondicherry Institute of Medical Sciences , Pondicherry, India .
authors.forename: Mary
authors.initials: M
authors.lastname: Daniel
authors.affiliation: Junior Resident, Department of Obstetrics & Gynaecology, Pondicherry Institute of Medical Sciences , Pondicherry, India .
authors.forename: Preethy
authors.initials: P
authors.lastname: Solomon
keywords: Amenorrhoea; Maternal mortality; Risk factors; Tubal pregnancy; Ultrasonography; Vaginal bleeding