Comparison of transabdominal ultrasonography and surgical findings in patients with ectopic pregnancy seen in Moi Teaching and Referral Hospital, Eldoret Kenya

Abstract

Background: Ectopic pregnancy is a condition in which a fertilized ovum is implanted outside the uterine cavity. It’s one of the conditions that is an emergency in gynaecology and causes major morbidity and mortality. Globally its incidence has been rising over the last 20 years. Early sonographic diagnosis decreases morbidity, mortality and provides management options which promote modern treatment methods including expectant treatment, medical or conservative laparascopic surgeries. Objective: To describe ultrasonography and surgical findings of patients with ectopic pregnancy and assess level of agreement between ultrasound and surgery in diagnosing ectopic pregnancy. Methods: A cross-sectional study was done between October 2014 to August 2015. A total of 84 participants were included, pelvic scan was done and later laparatomy performed. Data was collected using structured questionnaire and entered in computer data base. Data on patient’s demographic, clinical presentation, ultrasound findings, and surgical outcomes were collected and level of agreement calculated. Analysis was done using software for data analysis known as R (R core Team, 2015). Descriptive statistics such as frequencies, means and standard deviations, and median and interquartile range were used to summarize the data. Results: The mean age was 22.8 ± 5.8 years. Majority 82% (n=69) of the participants were from Uasin Gishu County and 42.9% (n=36) were nulliparous. Amenorrhea was reported in 73% (n=61) with average duration of 7 weeks. The most common ultrasound finding was complex adnexal mass at 69.9% (n=58) with majority 55% (n=46) located on the right adnexa. Ruptured tubal pregnancy with haemoperitoneum was reported in 97% (n=82) of the participants. One participant had advanced abnorminal pregnancy at 25 weeks gestation as per ultrasound but was found to be a normal intrauterine pregnancy in a bicornuate uterus after laparatomy. The observed level of agreement was 81.7% while the expected level of agreement was 47.3%. This gives a Kappa value of 0.653.This value shows that the level of agreement was substantial according to Viera et al, 2005 who classified it between 0.61 – 0.80. Conclusion: Complex adnexal mass was the most common ultrasound finding while ruptured tubal ectopic pregnancy with haemoperitoneum was the commonest surgical findings.The observed level of agreement was 81.7% while the expected level of agreement was 47.3%. This gives a Kappa value of 0.653.This value shows that the level of agreement was substantial. Recommendations: The level of agreement of ultrasound and surgery to diagnose ectopic pregnancy is substantial and therefore all patients suspected to have the gynaecological condition are encouraged to have an ultrasound done to assist in diagnosis.