Extrauterine Pregnancy: A Nine-Year Review of Incidence, Seasonality and Management at a Tertiary Hospital in Southern Ghana

Introduction: Most cases of extrauterine pregnancies present in the ruptured state in low-resource settings and patients with haemodynamic instability risk mortality without swift intervention. An idea of when ectopic gestations are likely to present may be useful for logistic planning and facility readiness for case management. The study sought to assess the incidence of extrauterine gestation, mode of management and any link with seasonal and/or sociocultural events within the Cape Coast metropolis of Ghana over a 9-year review period.?Methods: A retrospective review of all cases of extrauterine pregnancies managed at the Cape Coast Teaching Hospital (CCTH) from January 2010 to December 2018 was conducted. Data on patient age, parity, month of presentation, site and laterality of ectopic gestation, number of abortions and deliveries were retrieved from hospital records and analysed. Yearly and monthly aggregated incidence of extrauterine pregnancies were computed.?Result: A total of 480 ectopic pregnancies out of 26,850 total pregnancies were seen over the period, giving an overall occurence of 17.9/1000 pregnancies and almost all were managed surgically. Half of all the cases occurred in the 20?-?29 years age group while the extremes of age recorded the lowest. An average of about 53 cases per year was recorded for the period under review. The peak months of occurrence were October and November. About 83% were ruptured with the ampulla region being the commonest site. Conclusion: The data suggests increased ectopic gestation occurrence in the Cape Coast metropolis about two months after the major traditional festivals and this may have implications for instituting mitigating measures, logistic management and facility preparedness for case management.

Extrauterine Causes of Severe and Concealed Postpartum Bleeding: Clinical Aspects and Challenges

Objective To describe the challenges in diagnosing concealed postpartum bleeding,a rare but potentially life-threatening condition,and to highlight key factors in identifying and managing this condition.Methods We reviewed clinical cases and diagnostic approaches where concealed postpartum bleeding was suspected,focusing on the role of imaging,serologic markers,and angiography.We examined instances of hemodynamic instability,the utility of pelvic space analysis via computed tomography,and the limitations of digital angiography,particularly in identifying bleeding sources in the posterior iliac internal artery division.Results Concealed postpartum bleeding often originates from venous damage or,less commonly,arterial injury.Hemodynamic instability was noted to occur periodically,despite negative findings on vaginal examination and ultrasound,leading to diagnostic delays.Digital angiography often yields negative results when the focus is limited to the anterior division of the internal iliac artery.Bleeding typically arises from damage to the vaginal muscular layer or levator ani muscle,both supplied by branches of the internal pudendal artery(posterior iliac division).In some cases,laparotomy also failed to locate the source due to the bleeding being in the subperitoneal spaces.Conclusion Concealed postpartum bleeding presents a diagnostic challenge due to intermittent hemodynamic instability and often negative imaging results.A detailed pelvic space analysis and awareness of posterior iliac internal artery involvement are crucial.Advanced expertise,along with serologic markers of hidden bleeding,is essential for timely diagnosis and management.