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
Renato T Souza,
José Guilherme Cecatti,
Özge Tunçalp,
Veronique Filippi,
Jean-Paul Dossou,
Vanessa Brizuela,
Adama Baguiya,
Philip Govule,
Hedieh Mehrtash,
Kwame Adu-Bonsaffoh,
Luis Bahamondes,
Luiz Francisco Baccaro,
Charles M'poca Charles,
Camila Ayume Amano Cavalari,
Luis Henrique Leão
Affiliations
Renato T Souza
Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil
José Guilherme Cecatti
Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil
Özge Tunçalp
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
Veronique Filippi
London School of Hygiene & Tropical Medicine, London, UK
Jean-Paul Dossou
CNHU-HKM Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
Vanessa Brizuela
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
Adama Baguiya
Kaya Health and Demographic Surveillance System (Kaya-HDSS), Ouagadougou, Burkina Faso
Philip Govule
Health Sciences, Uganda Martyrs University Faculty of Health Sciences, Kampala, Uganda
Hedieh Mehrtash
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
Kwame Adu-Bonsaffoh
Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
Luis Bahamondes
Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil
Luiz Francisco Baccaro
Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil
Charles M'poca Charles
Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil
Camila Ayume Amano Cavalari
Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil
Luis Henrique Leão
Departamento de Tocoginecologia, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Sao Paulo, Brazil
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.