Management of Ectopic Pregnancies by Healthcare Practitioners in Southeast Nigeria: A Mixed-method Study

Abstract

Background: Ectopic pregnancy remains a significant cause of early maternal illness and death in low-resource settings, where challenges in timely diagnosis and proper treatment continue to limit outcomes. Understanding how healthcare practitioners manage ectopic pregnancies, as well as the system-level factors that influence clinical decisions, is crucial for improving the quality of care. This study examined practitioner-level knowledge and practice, facility readiness, diagnostic and treatment patterns, and the contextual barriers affecting the management of ectopic pregnancies in Abia State, Nigeria. Methods: A mixed methods design was used, combining a cross-sectional survey of 150 healthcare practitioners, a retrospective review of eighty-seven confirmed ectopic pregnancy cases, and qualitative interviews with sixteen key informants. Eligible practitioners were selected through simple random sampling, while all eligible clinical records within the review period were assessed. Quantitative data captured practitioner characteristics, diagnostic and treatment practices, and patient outcomes. Facility readiness was assessed using a structured checklist. Qualitative interviews explored decision-making processes and contextual challenges. Quantitative data were analysed with descriptive statistics, chi-square tests, correlation analysis, and logistic regression. Qualitative data were analysed thematically. Results: Among the practitioners surveyed, 38.7% demonstrated good guideline-compliant practice, and training within the last three years showed a strong, independent association with good practice. Facility readiness, years of experience, and frequency of managing ectopic cases also correlated positively with practice scores. Among the eighty-seven reviewed instances, abdominal pain was the most common presenting symptom, and transvaginal ultrasound provided the primary mode of diagnosis. Surgical management dominated, with salpingectomy accounting for most procedures. Two maternal deaths were recorded. The mean time from presentation to diagnosis was 18.4 hours, and delays were more pronounced among medically managed cases. Qualitative findings identified limited round-the-clock imaging, irregular methotrexate availability, staff training gaps, and weak referral pathways as major barriers to optimal care. Conclusion: Management of ectopic pregnancy in the study setting is shaped by a complex interaction of practitioner expertise, facility capacity, and systemic constraints. Strengthening routine training, improving imaging and medication availability, and instituting standardised protocols may enhance adherence to evidence-based practice and improve maternal outcomes.