Clinical presentations and outcomes of ectopic pregnancy at a tertiary referral hospital in Ghana

Background: Ectopic gestation is a major cause of morbidity and mortality among women of reproductive age. The clinical presentations vary depending on whether it is ruptured or not. Understanding the various modes of presentation is therefore critical to early detection and management to reduce associated morbidity and mortality. We determined the patterns of presentation and outcomes of ectopic pregnancy in the Korle Bu Teaching Hospital (KBTH) of Ghana.Objective: This study aimed to determine patterns of presentation of ectopic pregnancy in the KBTH of Ghana and the outcomes for patients presenting with the condition.Methods: We collected data from pregnant women presenting to the Obstetrics and Gynaecology Department of the KBTH during the study period and diagnosed with ectopic pregnancy. A case of ectopic pregnancy was any woman diagnosed by an obstetrician/gynaecologist either by clinical features or pelvic ultrasound. Data were collected on sociodemographic characteristics, as well as clinical history, examination findings, treatment, and outcomes. Data were analyzed descriptively to determine the patterns of presentation of ectopic gestations.Results: A total of 104 ectopic pregnancies representing 8.81% (n = 104/1,180) of gynaecological emergencies were recorded during the study period. Of the 104 ectopic pregnancies recorded, 6.7% (n = 7) were diagnosed as unruptured. The mean (± standard deviation) gestational age at diagnosis of ectopic pregnancy was 7.2 ±1.9 weeks. About 94.2% (n = 98) of patients with ectopic pregnancy had visited a health facility before the visit at which the diagnosis was eventually made, and 76.9% (n = 80) of the ectopic cases had ruptured at diagnosis. For 1.9% (n = 2) of the participants, ectopic pregnancy was detected by ultrasound. The triad of amenorrhoea in 91.3% (n = 95), lower abdominal pains in 91.3% (n = 95) and irregular vaginal bleeding in 47.1% (n = 49) of the ectopic pregnancies were the main presenting symptoms of ruptured ectopic pregnancy.Conclusion: The incidence of ruptured ectopic pregnancy in the KBTH was high. Primary health care practitioners should rule out ectopic pregnancy in women of the reproductive age group who present with the triad of amenorrhoea, lower abdominal pain and irregular vaginal bleeding

Pregnancy outcomes and associated characteristics at the expected date of delivery and beyond in a large tertiary hospital in Ghana

Background: Globally, pregnancies that have gone beyond the expected date of delivery (EDD) contribute significantly to maternal and perinatal morbidity and mortality.Objective: This study aimed to determine the proportion, pregnancy outcomes, and associated characteristics of deliveries at EDD and beyond at the Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana.Methods: This was a cross-sectional study conducted at the KBTH. Postpartum women who delivered at a gestational age of 40 weeks and beyond were selected from the labour wards, grouped according to gestational age, and followed up to their first postnatal visit. Data were collected on demographic, obstetric and postpartum health status. The association between study variables and delivery at and beyond EDD was determined using the F-test statistic and Chi-square test for continuous and categorical outcomes, respectively. A p < 0.05 was considered statistically significant.Results: Of the 300 participants, 44% (n = 132) delivered at 40 weeks plus 0 to 6 days (40 + 0 - 6 weeks) of gestation, 44.7% (n = 134) at 41 + 0 - 6 weeks, and 11.3% (n = 34) at ≥ 42 weeks. The proportion of deliveries at EDD and beyond was 9.9% (n = 300/304) of total deliveries during the period. The pregnancies ≥ 42 weeks were 1.1% (n = 34/3041) of total deliveries. Factors that were significant associations with women who delivered at ≥ 42 + 0 weeks were a referral from other hospitals (p < 0.017), labour induction (p < 0.001), a longer first stage of labour (p < 0.008), and a longer total labour duration (p < 0.009).Conclusion: The proportion of deliveries in which the pregnancies had progressed to the EDD and beyond and that of prolonged pregnancy at the KBTH were 9.9% and 1.1%, respectively. The duration of the first stage of labour and the total duration of labour was longer in women with pregnancies ≥ 42 weeks