Trends in the Management of Ectopic Pregnancy and its Diagnosis: A Five-Year Retrospective Analysis in an Obstetrics and Gynaecology Unit

Abstract

Background: Ectopic pregnancy remains a significant cause of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries where delayed diagnosis and limited access to advanced diagnostic tools are common. The clinical importance of ectopic pregnancy lies not only in its acute risks but also in its long-term reproductive implications, including reduced fertility and recurrent episodes, which underscore the need for a sustained evaluation of its hospital-based trends in diagnosis and management. Despite improvements in imaging modalities and therapeutic options, ectopic pregnancy continues to pose diagnostic and management challenges in hospital-based obstetrics and gynaecology practice. Objective: This study aimed to evaluate the five-year hospital-based trends in the diagnosis and management of ectopic pregnancy in an obstetrics and gynaecology unit, with a focus on diagnostic modalities, treatment patterns, and patient outcomes. Methods: A retrospective review of medical records was conducted over a five-year period (2018–2022) in a tertiary obstetrics and gynaecology unit. Data collected included sociodemographic variables, clinical presentation, diagnostic methods, management strategies (surgical, medical, and expectant), intraoperative findings, complications, and outcomes. Descriptive statistics were applied to determine frequencies and trends, while chi-square tests were used to evaluate associations between patient characteristics and management outcomes. Results: A total of 215 cases of ectopic pregnancy were identified during the study period. The majority of patients (68%) presented with abdominal pain and amenorrhea, while ultrasound remained the most frequently utilised diagnostic tool (85%). Surgical management, primarily salpingectomy, was the dominant treatment modality (72%), though a gradual increase in medical management with methotrexate was observed over the study years. The overall case fatality rate was 1.4%, with tubal rupture accounting for most complications. Younger age, delayed presentation, and hemodynamic instability were significantly associated with adverse outcomes (p < 0.05). Conclusion: The study highlights persistent challenges in the timely diagnosis of ectopic pregnancy despite improved access to ultrasound, with surgical intervention remaining the mainstay of treatment. Strengthening early detection strategies and expanding the use of medical management could improve outcomes in hospital-based settings. In conclusion, this study demonstrates that while significant progress has been made in the diagnosis and management of ectopic pregnancy, challenges remain, particularly with delayed presentation, high rates of surgical intervention, and ongoing mortality.