Author(s): Astrit M. Gashi*, Brikene Elshani, Hajrullah Latifi, Gent Sopa, Jakup Ismajli and Arianit Sherifi
Objective: The primary objective of the study was to determine the incidence of ectopic pregnancy in Kosovo during 2012-2019.
Design: Retrospective analysis.
Participants: Ectopic pregnancy admissions between January 2012 and January 2019.
Main Outcome Measures: Outcome measures for this study included the incidence, age group and mean gestational age, type of clinical presentation, site of ectopic pregnancy, complications, management modalities, mortality and morbidity.
Results: During 8 years there were 80.417 live births, of which 1004 cases have completed their pregnancy in the first trimester as ectopic pregnancies. During this period of 8 years at our institution, the incidence of ectopic pregnancy was 12.4 cases per 1000 pregnancies. Most women belonged to the age group between 21-30 years. The average gestational age was 6.3 weeks. 86.5 percent of hospitalized patients had at least one suspected symptom of ectopic pregnancy The classic triad of symptomatology of ectopic pregnancy (amenorrhea, vaginal bleeding, and abdominal pain) was present in 53% (532 cases), 33.5% (336 cases) had at least one of these symptoms, while 13.5% (136 cases) were referred after an ambulatory visit. Out of a total of 1004 cases of ectopic pregnancy, 47% (472) were hemodynamically unstable on admission, while 53% (532) of the cases were hospitalized in a stable hemodynamic state. Hemodynamically unstable patients underwent surgery as soon as they were diagnosed. More than half of these patients needed a blood transfusion (52%). Haemodynamically stable patients with serum ß-hCG levels less than 2000 mIU/mL have received expectant management. No maternal deaths were noted. The most common surgical procedures performed were unilateral salpingectomy 84.3% (847), while fallopian tubes were the most common site of ectopic pregnancy 94.7% (951).
Conclusion: The incidence of ectopic pregnancy in Kosovo is 12.4 per 1000 pregnancies, with the majority of patients presenting in their twenties. While the relatively small age of gestation on diagnosis is a good indicator, there is much to be done to increase the usage of laparoscopy and drugs as potential modes of management. Further research on this field is needed, to identify risk factors and potential obstacles to reducing the high number of hemodynamically unstable patients in admission opening the way for more conservative management.