Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion
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Date
2024
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BMJ Open
Abstract
Introduction There are limited global data on ectopic
pregnancy (EP) and molar pregnancy (MP), making
it important to understand their epidemiology and
management across different regions. Our study aimed to
describe their prevalence for both conditions, severity of
their complications and management among women in
selected health facilities across 17 countries in Africa and
Latin America and the Caribbean (LAC).
Methods This is a secondary analysis of the WHO multi country survey on abortion. Data were collected from 280
healthcare facilities across 11 countries in Africa and 6 in
LAC. Sociodemographic information, signs and symptoms,
management and clinical outcomes were extracted from
medical records. Facility-level data on post-abortion care
(PAC) capabilities were also collected, and facilities were
classified accordingly. χ2
or Fisher’s exact tests were used
to compare categorical data.
Results The total number of women with EP and MP
across both regions was 9.9% (2 415/24 424) where
EP accounted for 7.8% (1 904/24 424) and MP for
2.1% (511/24 424). EP presented a higher severity of
complications than MP. At admission, 49.8% of EP had
signs of peritoneal irritation. The most common surgical
management for EP was laparotomy (87.2%) and for
MP, uterine evacuation (89.8%). Facilities with higher
scores in infrastructure and capability to provide PAC
more frequently provided minimal invasive management
using methotrexate/other medical treatment (34.9%) and
laparoscopy (5.1%).
Conclusion In Africa and LAC, EP and MP cause
significant maternal morbidity and mortality. The disparity
in the provision of good quality care highlights the need
to strengthen the implementation of evidence-based
recommendations in the clinical and surgical management
of EP and MP
Description
Research Article
Keywords
ectopic, Africa, abortion
Citation
Cavalari CAA, Mehrtash H, Brizuela V, et al. Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion. BMJ Open 2024;14:e086723. doi:10.1136/ bmjopen-2024-086723