[Treatment of ectopic pregnancies by laparotomy in under-equipped countries. A series of 144 cases at the Yaounde University Hospital Center (Cameroon)].

Abstract

We report in the context of a developing country the results of ectopic pregnancies treated by laparotomy in the last ten years (1984-1993) in the maternity unit of the Teaching Hospital Yaounde (Cameroons). There were 144 cases of ectopic pregnancies from a total of 12,507 deliveries; this corresponds to 11 cases of ectopic pregnancies for 1,000 deliveries. In 75 cases (52%) the patients were operated in emergency situations with clinical signs of ruptured ectopic pregnancy which were later confirmed at laparotomy. In 69 cases (47.9%) the patients were retained in hospital for definitive diagnosis and in the follow-up, the diagnosis was confirmed by laparoscopy in 37 cases (53.6%) and by ultrasonography in 22 cases (31.9%). In this study the frequency of ectopic pregnancy was most common among primiparous women (36 cases) and second parity (37 cases). The highest frequency of ectopic pregnancies was found in women in the age range between 25 and 30 years. Radical treatment of ectopic pregnancy was performed in 62 cases (43.0%) and conservative treatment in 82 cases (56.9%). The main complication during the operation was represented by severe hemorrhage in 65 cases (45.1%); blood transfusion was required in 25 cases. Among the patients who were followed up in the prenatal clinic (98 cases) 16 patients (16.3%) presented an intra-uterine pregnancy and 12 patients (12.2%) a recurrence of ectopic pregnancy. Ectopic pregnancy is a frequent pathology in Cameroon. In the absence of methods for early diagnosis of ectopic pregnancy such as endovaginal ultrasonography and the measurement of beta human chorionic gonadotropin (beta hCG), primary use of laparotomy is necessary when clinical signs of ectopic pregnancy exist. This procedure permits the avoidance of severe complications such as hemorrhage and maternal death. It can be said that laparotomy still has its place in the treatment of ectopic pregnancy in developing countries.