INTRODUCTION An ectopic pregnancy (EP) occurs when a fertilized ovum 1 implants outside the normal uterine cavity. Ectopic pregnancy (EP) is a condition presenting as a major health problem for 2 women of childbearing age. The incidence of EP varies with the population, but it has been accounted for 1-2% of all 3-4reported pregnancies. Ectopic pregnancy (EP) is the leading cause of maternal death during the rst trimester of pregnancy, accounting for approximately 10 % of all 5 pregnancy-related deaths. It has been shown to reduce subsequent fertility and increase the chances of subsequent 6 EP. Over recent decades, there has been a rise in the incidence 7of EP. Approximately 1/100 pregnancies are ectopic, with the 8 conceptus usually implanting in the fallopian tube. Approximately 75.0% of deaths in the rst trimester and 9.0% 9of all pregnancy-related deaths are due to EP. Almost all EPs occur in the fallopian tube (98.0%), the ampulla is the most common site of implantation (80.0%), followed by the isthmus (12.0%), mbria (5.0%), cornua (2.0%), and 10,11 interstitial (2.0-3.0%). The etiology of EP remains uncertain 12although a number of risk factors have been identied. A common factor for the development of such ectopics is the 13 presence of a pathologic fallopian tube. EP may be asymptomatic, and the most common clinical presentation is 14rst trimester vaginal bleeding and/or abdominal pain. In current practice, in developed countries, diagnosis relies on a combination of ultrasound scanning and serial serum beta- 15human chorionic gonadotropin (�-hCG) measurements. METHODS This is a retrospective observational study conducted in a tertiary care centre in Ahmedabad from November 2017 to November 2018. All patients diagnosed with ectopic pregnancy (by clinical examination, USG and/or B hCG) were included in the study. The aims and objectives of the present study were to determine the demographic distribution of patients presenting with EP, determine the risk factors associated with the patients presenting with ectopic pregnancy, to describe the various locations and stats (ruptured/unruptured/tubal abortion) of ectopic pregnancies to describe the various modalities of treatment used in EP. RESULTS The incidence of ectopic pregnancies over one year was 1.17%. The commonest age of presentation was between 35- 40 years (Table 1). Table 1: Age at presentation. ECTOPIC PREGNANCY: CLINICAL FEATURES, MANAGEMENT AND COMPLICATIONS Original Research Paper Dr. Pushpa A. Yadava Professor and Head of Unit, Department of Obstetrics and Gynecology, Smt. N.H.L Municipal Medical College, Ahmedabad. X 29GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Obstetrics and Gynecology Background: An ectopic pregnancy (EP) occurs when a fertilized ovum implants outside the normal uterine cavity. The incidence of EP varies with the population, but it has been accounted for 1-2% of all reported pregnancies. EP is one of the few medical conditions that can be managed expectantly, medically or surgically. Surgical methods are still the mainstay in the management of EP, and in developed societies, laparoscopic surgery is currently the gold standard. Methods: This is a retrospective observational study conducted in a tertiary care centre in Ahmedabad from November 2017 to November 2018. All patients diagnosed with ectopic pregnancy (by clinical examination, USG and/or B hCG) were included in the study. The aims and objectives of the study were to determine the demographic distribution, risk factors, clinical features, treatment modalities and complications in patients presenting with EP. Results: The incidence of ectopic pregnancies in one year was 1.17%. The commonest age of presentation of EP was between 35-40 years, most of the patients were Gravida 4 (28.57%). Majority of patients presented at a gestational age between 6-8 weeks. Most patients (64.28%) were found to have ruptured ectopic. 28.57% patients had a previous history of abortion. 14.28% of each EP were cornual and heterotopic as found intra-operatively. There was 1 interstitial and 1 scar ectopic pregnancy. The most common associated risk factor in these patients were a history of some form of pelvic surgeries in the past. Most of these patients presented with pain in abdomen and were found to be anaemic. 64.28% of cases were diagnosed by combination of TVS and serum BhCG levels. Two cases were managed medically, and obstetric hysterectomy was needed in the patient with ruptured scar ectopic gestation. Conclusion: Ectopic pregnancy has a rising incidence in today's world. With the use of better diagnostic modalities, ectopic pregnancies can be detected early and treated appropriately. Also, because of its subtle presentations, patients often present late in the course of the disease, wherein management of the condition can be sometimes life - saving. Treatment however is easy and patients respond wonderfully with both medical and surgical management. ABSTRACT KEYWORDS : BhCG, Ectopic pregnancy, Tubal pregnancy, Ultrasonography Dr. Apoorva G. Patil* 3rd Year Resident, Department of Obstetrics and Gynecology, Smt. N.H.L Municipal Medical College, Ahmedabad. *Corresponding Author Dr. Riya R. Patel 3rd Year Resident, Department of Obstetrics and Gynecology, Smt. N.H.L Municipal Medical College, Ahmedabad. VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Age in years Number of cases Percentage Less than 20 1 7.14 20-25 3 21.42 25-30 3 21.42 30-35 1 7.14 35-40 4 28.57 ≥40 2 14.28 30 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Table 2: Obstetric score at presentation. Most patients presented at a gestational age between 6-8 weeks (Table 3). Table 3: Gestational age at presentation. Table 4: Intra-op (Ruptured/Unruptured). There was 1 interstitial and 1 scar ectopic pregnancy. 8 other EP were found in other parts of the fallopian tube (Table 5). Table 5: Location of ectopic. 42.85% of patients have had some form of pelvic surgeries in the past. There were two cases (14.28%) of EP after tubal ligation (Table 6). Table 6: Risk factors. Table 7: Management Modalities. Maximum cases (85.71%) were managed surgically and only 14.29% cases managed medically. DISCUSSION The incidence of ectopic gestation in our study was 1.17%. The incidence of ectopic pregnancy is on a rise due to better diagnostic technologies, IUCDs, increased incidence of PID and earlier diagnosis and management. In this study, the commonest age group of presentation was between 35-40 years. Shafquat et al, showed the peak age of incidence as 26-30 years which was consistent with by 16,17 Igbarese et al. Aging may result in progressive loss of myoelectrical activity along the fallopian tubes. Age related changes in tubal function and tubal diverticula which increases with age, predispose patients to ectopic 18pregnancy. A study conducted at Department of the General Hospital “George Gennimatas” in Athens, Greece proved statistically signicant positive association between ectopic pregnancy 19rupture and parity. The average gestational age at presentation, in this study was between 6-8 weeks. Mean gestational age at diagnosis of EP 20was 7.1 in the study conducted by Tahmina S et al . The incidence of ruptured ectopic in our study was 35.71% and Unruptured ectopic was 57.15%. However, in a study conducted by Jani S et al, 35% of women had an unruptured 21 tubal pregnancy and 26% had a ruptured tube. Thus, the incidence of ruptured ectopic pregnancy is lower as compared to unruptured ectopic pregnancy. The reason for this is the early detection and management of cases due to better diagnostic modalities. The incidence of heterotopic pregnancy in this study was 14.28%. Heterotopic pregnancy was present in 4.2% of the 22ectopic pregnancies as per Yeasmin et al. The commonest predisposing factors in EP were tubectomy, spontaneous and induced abortion and history of infertility, prior history of Copper-T insertion and previous LSCS in this 23study. Similar risk factors were noted in various other studies. There has been one case of Caesarean scar ectopic in our study. Jurkovic et al. and Seow et al. have estimated that the prevalence of Caesarean scar pregnancy in their local population of women attending the early pregnancy assessment unit is~1:1800 and 1:2216 respectively. Its true incidence, however, has not been determined because so few cases have been reported in the literature: only 18 cases appeared in the literature between 1978 and 2001 (Fylstra, 24-262002). Serum β-hCG and ultrasound were the diagnostic tools used for diagnosis of ectopic pregnancy in our study. Studies have shown that Ultrasonography should be the initial investigation for symptomatic women in their rst trimester; when the results are indeterminate, the serum β human chorionic gonadotropin concentration should be measured. The positive identication of a non-cystic adnexal mass with an empty uterus has a sensitivity of 84-90% and a specicity of 94-99% for the diagnosis of an ectopic gestation. In one large prospective study of 6621 patients, ectopic pregnancy was correctly diagnosed by TVS with a sensitivity of 90.9% and 27specicity of 99.9%. In our study, two cases were managed medically. Both these cases were of primigravidae for whom medical management was considered for fertility sparing. It was found that the overall success rate for women treated with methotrexate for 27an ectopic pregnancy was 89% Surgical management was done in 12 cases which included total salpingectomy. Canis M et al in their study concluded that the surgical treatment should be performed if the patient is hemodynamically unstable, ß-hCG is >10 000 mIU/mL, the ectopic pregnancy is 4cm in diameter, if there is a medical contraindication to methotrexate, and if the patient may not be 28followed adequately after treatment. No maternal mortality found in our study, consistent with Abbas and H. Akram 29 study. CONCLUSION: Ectopic pregnancy has a rising incidence in today's world. With the use of better diagnostic modalities, ectopic pregnancies can be detected early and treated appropriately. Also, because of its subtle presentations, patients often present late in the course of the disease, wherein management of the condition can be sometimes life - saving. Treatment however is easy and patients respond wonderfully VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Gravida Number of cases Percentage G1 4 28.57 G2 3 21.42 G3 2 14.28 G4 4 28.57 G5 - - G6 1 7.14 Gestational age (weeks) Number of cases Percentage 4-6 4 28.57 6-8 8 57.14 8-10 1 7.14 ≥ 10 1 7.14 Number of cases Percentage Ruptured ectopic 5 35.71 Unruptured ectopic 8 57.15 Tubal abortion 1 7.14 Location Number of patients Percentage Cornual 2 14.28 Interstitial 1 7.14 Other sites on tube 8 57.14 Heterotopic 2 14.28 Scar ectopic 1 7.14 Risk factor Number of patients Percentage Infertility 1 7.14 Pelvic surgery 6 42.85 History of tubal ligation 2 14.28 None 5 35.71 Management modality Number of cases Percentage Surgical 12 85.71 Medical 2 14.29 with both medical and surgical management. Wider availability of diagnostic modalities leads to early diagnosis and prompt management of ectopic pregnancy. REFERENCES 1. Berek JS. 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