incidence of ep ranges between 0.25% to 2% of all pregnancies . in 95% of eps ,
fertilized ovum implants in the tubes , but rarely in other organs like abdomen , ovaries , cervix , spleen , omentum , cessarian section scar , and intramural .
the death rate is about 1 per 2000 eps and 15% of all maternal deaths .
incidence of ep is nearly double in black women who also have a four times greater risk of ep - related mortality than white women .
the risk factors for ep include pelvic inflammatory disease , previous tubal surgery , previous tubal pregnancy , progestin contraceptive , assisted reproduction , ovulation induction , induced abortion , salpingitis isthmica nodosa , smoking , and diethyl stilbestrol exposure .
most of the tubal pregnancies become symptomatic within 12 weeks , but a small number of them progress beyond this gestation and are diagnosed late .
proper management of ep needs early diagnosis , resuscitation , timely treatment , and follow - up .
early diagnosis of ep is a difficult task but can be possible with the help of quantitative -human chorionic gonadotropin ( -hcg ) level , transvaginal ultrasonography , and laparoscopy .
knowledge of the risk factors for ep helps in rapid diagnosis and could reduce the need for surgery and suggest actions to improve prognosis .
however , several studies assessing risk factors for ep have been published from developed countries .
saudi women have different characteristics , like cultural , religious , sociodemographic , sexual behavior , beliefs , and contraception practices , than those of developed countries and may have different risk factors for ep .
the purpose of this study was to highlight the frequency and predisposing factors of ep , and to elucidate the outcome after different treatment modalities in a general hospital .
this retrospective descriptive study was conducted at hera general hospital , makkah , saudi arabia , over a duration of 18 months from july 1 , 2009 to december 31 , 2010 .
the study subjects included all females in their reproductive age who were admitted at the obstetrics and gynaecology department with suspicion of ep .
data were retrieved from the medical record office by exploring the patients files in detail .
patients files were looked for age ; gravidity ; gestational age ; clinical presenting features ; and ep risk factors , like history of previous abortion , infertility treatment , current use of intrauterine contraceptive device ( iucd ) , history of previous tubal surgery and pelvic surgery , previous ectopic and/or pelvic inflammatory disease .
peak level of -hcg , transvaginal ultrasonographic findings , mode of treatment , and type of surgical procedure were also retrieved . a woman experiencing several eps during the study period generated multiple case entries , one for each ep episode . in this study , seven women experienced two , and two women experienced three eps .
the duration from symptoms onset to admission and admission to definite treatment was also recorded .
numerical data were subjected to descriptive analysis , with mean  standard deviation ( sd ) .
the institutional review board of hera general hospital , makkah , saudi arabia , granted us permission to conduct this study .
the institutional review board of hera general hospital , makkah , saudi arabia , granted us permission to conduct this study .
incidence was 0.58% out of 7654 pregnant women admitted at the department of obstetrics and gynaecology ( 5.8/1000 pregnancies ) .
the mean age of the women was 27.9  7 years and only 2 ( 4.5% ) were more than 40 years old .
twenty - five ( 56.8% ) were multigravida whereas 21 ( 47.7% ) presented at 7 - 8 weeks of gestation .
the range of gestational age was 3 - 9 weeks at presentation . only 24 ( 54.5% ) patients presented within 24 h , 6 patients within 1 - 2 days , and 14 patients presented after 2 days of onset of symptoms of ep .
the most common presenting feature was amenorrhea ( 41 , 93.2% ) , followed by abdominal pain ( 39 , 88.6% ) and abdominal tenderness ( 38 , 86% ) .
fluid in pouch of douglas was found in 21 ( 55.3% ) cases and ectopic mass in 13 ( 34.2% ) cases [ tables 1 and 2 ] .
demography and obstetrical history clinical presentation of ectopic pregnancy sixteen ( 36.3% ) females presented with hemoglobin levels of 8 - 10 gm% , followed by 13 ( 29.5% ) with  10 - 12 gm% , 9 ( 20.5% ) with  12 - 14 gm% , and 6 ( 13.6% ) with  8 gm% . twenty - three ( 52.3% ) patients did not receive any blood transfusion during their hospital stay , but 11 patients received one , 5 received two , 3 received three , and 2 patients received  4 units of blood transfusion . out of 44 patients ,
25 underwent emergency laparotomy whereas the remaining 19 patients were admitted for observation and further diagnosis .
when diagnosis was proved , 12 underwent laparoscopy whereas seven received medical treatment by methotrexate ( mtx ) and it was successful in all cases . on the other hand , salpingectomy was performed in 33 ( 89.1% ) cases followed by salpingostomy in 2 ( 5.4% ) , whereas one case underwent salpingotomy and resection of ectopic mass was performed for the remaining one patient .
pre - operative findings for 37 cases revealed that 35 ( 94.6% ) females had ep in the fallopian tube , whereas one case had within the ovary and one had heterotopic pregnancy , i.e. , combined intra- and extra - uterine .
average hospital stay after surgery was 4 days in laparotomy and 2 days in laparoscopy .
eighty percent ( n = 35 ) had some risk factors , whereas previous pelvic surgery was most frequently seen ( 13 , 29.5% ) followed by history of pelvic inflammatory disease ( 10 , 22.7% ) [ table 3 ] .
the rate of ep was 1.9% as reported by lozeau and potter in usa , and 1.04% and 1% by bangash and ahmad , and waseem , respectively , in pakistan .
our study was conducted in a secondary healthcare center , which is why we were not receiving referral cases from the whole of the makkah region , and incidence represented the incidence in hera general hospital rather than the general population of the region .
mtx treatment of ep was safe and effective for selected patients with unruptured tubal ep , with no major side effects as found by dhar et al .
a paper presented in a conference proceeding highlighted management of advanced ep , i.e. , in bahrain , managements of ep were as follows : laparotomy and salpingectomy ( 84.2% and 5.3% ) , mtx alone ( 5.3% ) and mtx followed by laparotomy and salpingectomy ( 10.5% ) , whereas in qatar it was laparoscopy and salpingectomy ( 77.6% ) , mtx alone ( 19.4% ) , and mtx followed by laparoscopy and salpingectomy ( 3% ) .
laparoscopy in qatar and laparotomy in bahrain were the treatment of choice to treat advance ectopic cases .
lozeau and potter reported a success rate of 88% in a single - dose versus 93% in a multiple - dose regimen of mtx .
salpingostomy was concluded as a better option than salpingectomy regarding the future fertility outcome in one study .
we tried in our study to increase the clinical knowledge and the degree of suspicion of the physicians to diagnose the ep as early as possible .
this will avoid delay in presentation and diagnosis , which is vital to avoid morbidity and mortality in patients with ep .
after a review of the literature and our study results , we are in a position to recommend the following steps at three levels i.e. , public , primary healthcare , and specialist center .
aim should be early diagnosis and prompt treatment of ep without unnecessary delay in presentation , diagnosis , and treatment .
we should launch a public awareness program about the risk factors to educate all females through electronic media like tv , radio , or newspapers .
all these patients should register themselves at a specialist hospital for care of their pregnancy where specialist gynecologists and facilities for diagnosis and treatment of ep are available .
general practitioners working in primary healthcare centers should be educated to have a high index of suspicion for ep . at specialist - level hospitals , all females ( at their child - bearing age ) presenting with hemodynamic instability or pain in the lower abdomen should be admitted and immediate investigations like pregnancy test , -hcg , and ultrasound ( both trans - abdominal and trans - vaginal ) should be ensured even if there is no history of amenorrhea .
this study found that previous pelvic surgery , infertility treatment , and pelvic inflammatory disease were the major predisposing factors for ep .
the most common site was the fallopian tube and the success rate of mtx was found to be 100% .
to avoid emergency laparotomy that has its own post - operative complications , timely diagnosis of ep should be encouraged .
 objectives : the objective was to highlight the frequency , clinical profile , and predisposing factors of ectopic pregnancy ( ep ) in a general hospital.materials and methods : this descriptive study was conducted at the obstetrics and gynaecology department of hera general hospital , makkah , saudi arabia , from july 1 , 2009 to december 29 , 2010 . 
 data were collected on chief medical complaints , sociodemographic characteristics , past obstetrics and gynecological history , management done , and outcome of management . 
 data were analyzed using microsoft office excel ( version 2007).results : out of total 7564 pregnancies , 44 ( 0.58% ) patients were diagnosed as ep . out of 44 , 22 ( 50% ) 
 patients presented within 24 h of onset of symptoms . 
 mean age was 28  7 years . 
 multigravida were predominant in 25 ( 57% ) , and 21 ( 48% ) had gestational age of 6 - 8 weeks at the time of presentation ; the common presenting features were amenorrhea ( 41 , 93.2% ) , abdominal pain ( 39 , 88.6% ) , and tenderness ( 38 , 86% ) . 
 previous pelvic surgery ( 13 , 29.5% ) , infertility treatment ( 11 , 25% ) , and pelvic inflammatory disease ( 10 , 22.7% ) were the common predisposing factors . 
 twenty - five ( 57% ) presented with ruptured ep and were operated within 24 h , and the remaining were kept under observation till further diagnosis . after confirming the diagnosis , 12/19 underwent laparoscopy , whereas 7/19 received medical treatment . 
 surgery confirmed fallopian tube pregnancies in 35 ( 94.5% ) . 
 no mortality was observed.conclusion:previous pelvic surgeries were the major etiological factor for ep . 
 other factors were infertility treatment and pelvic inflammatory disease . 
 the most common site of ep was fallopian tubes . 