ABSTRACT AIM:1.To study rising trend in the cases of ectopic pregnancy . 2.To evaluate risk factors and suggest methods to reduce its incidence. METHOD: A total of 85 cases of ectopic pregnancy were analyzed, over a period of 1 year that is from June 2017 to May 2018 at S.M.S Medical College and Hospital. RESULTS:The incidence of ectopic pregnancy was 12.8/1000 deliveries. Majority of cases were multigravidas and of gestation age between 6 to 10 weeks. The common risk factors were PID, previous history of abortion, prior tubal surgery, infertility. Ultrasound, urine pregnancy test, serum B-hCG titre were done. Laparotomy was done in all cases. Surgery in form of salpingectomy, salpingo-oophorectomy ,and uterine reconstruction was done. No maternal mortality occurred. CONCLUSION:Early diagnosis, identifying risk factors and timely management in form of conservative/ surgical treatment helps in reducing the morbidity and mortality. ORIGINAL RESEARCH PAPER Medical Science RISING TREND IN ECTOPIC PREGNANCY: A CLINICAL STUDY AT A TERTIARY CARE HOSPITAL OFJAIPUR, RAJASTHAN KEY WORDS: Ectopic, Laparotomy, Salpingectomy. INTRODUCTION Ectopic pregnancy is defined as a pregnancy where the fertilized ovum gets implanted and develops at a site other than normal uterine cavity. It represents a serious hazard to a woman's health and reproductive potential requiring prompt recognition and early aggressive intervention. It is a leading cause of maternal morbidity and mortality in the first trimester. The incidence of ectopic pregnancy has steadily risen. It ranges from 1:25 to 1:250.pregancies. Average range is 1 in 100 pregnancies. The incidence has increased due to increased incidence of PID, use of IUCD,Tubal surgeries, and Assisted Reproductive Techniques(ART). Now it accounts for nearly 2% of all pregnancies. The risk of EP is approximately 2 % with late marriages and late child bearing and 5 % with ART respectively. Recurrence rate for Ectopic Pregnancy is 15% after 1; and 25% after 2 ectopics. Transvaginal ultrasonography (TVS) coupled with quantitative serum beta hCG estimation has increased the diagnostic accuracy manifolds although each modality has its own limitation. Despite tremendous advances in the medical science, diagnosis of ectopic pregnancy is not always easy..The classic clinical triad of amenorrhoea, lower abdominal pain, and bleeding per vaginum is present in less than 50% of cases. MATERIALS AND METHODS Clinically and/or sonologically suspected cases of ectopic pregnancy admitted over a period of 1 year extending from June 2017 to May 2018 in a tertiary care hospital of Jaipur, Rajasthan formed the study group. A total of 85 cases reported during this time frame with ectopic pregnancy were included in this study. The case records of the patients were traced from medical records department and operation theatre registers. Information regarding total number of deliveries during study period, details of demographic characteristics, presenting clinical symptoms and signs, detailed obstetric history, parity, gestational age at presentation, use of contraception, risk factors for ectopic pregnancy, diagnostic tool used, treatment modalities (whether surgical or medical), intraoperative findings and outcomes of ectopic pregnancy were recorded. Data were collected, tabulated and analysed. Detailed clinical, menstrual and treatment history was obtained from each patient. A urine pregnancy test was performed as a bedside test to diagnose pregnancy. Baseline beta hCG levels were obtained. A Trans vaginal sonography (6-10 MHz) was performed in all the suspected cases to establish the diagnosis RESULTS Table 1: Age and parity wise distribution of cases Table1:During the study period, there were a total of 6600 deliveries and 85 cases of ectopic pregnancy were admitted in the hospital. The incidence of ectopic pregnancy in the present study was 12.8 per 1000 deliveries. Majority (77.61%) of the patients were in the age group of 20 to 29 years. Multiparous women were found to be more prone to have ectopic pregnancy (65.75%, 67/85) as depicted. TABLE 2:RISK FACTORS FOR ECTOPIC Table: 2 Presents a glance at the major risk factors among the study participants. The majority (48.2%) of the patients had previous history of pelvic inflammatory disease. Out of the six patients who underwent sterilization, two had post-partum sterilization and four had laparoscopic sterilization. None of the patients had concurrent sterilization with caesarean section. Four out of the 85 patients had previous ectopic pregnancy hence the recurrence rate was 4.71%. TABLE 3: CLINICAL PRESENTATION Dr Sonali Sharma* Senior Resident, Mahila Chikitsalya, S.M.S Medical College and Hospital, Jaipur, Rajasthan. *Corresponding Author www.worldwidejournals.com 9 Dr B. S Meena Professor and Unit Head Dept of obstetrics and gynaecology Mahila Chikitsalya S.M.S Medical College Jaipur DISTRIBUTION NO OF CASES PERCENTAGE(%) AGE(Years) Below 20 7 8.2 Between 20-29 66 77.6 >/= 30 12 14.1 PARITY 0 18 21.1 1 23 27.1 2 25 29.4 =/>3 19 22.3 RISK FACTOR NO. OF CASES PERCENTAGE(%) Previous abortion 15 17.6 Previous LSCS 10 11.8 Previous Ectopic 04 4.7 Pelvic Inflammatory Disease 41 48.2 Infertility Treatment 09 10.6 Tubal Surgery (Ligation/Tubo plasty) 06 7.1 Intra uterine Contraceptive Device - - CLINICAL SYMPTOM NO. OF CASES PERCENTAGE(%) Asymptomatic 03 3.5 Abdominal Pain 75 88.2 PARIPEX - INDIAN JOURNAL OF RESEARCH Volume-8 | Issue-3 | March-2019 | PRINT ISSN No - 2250-1991