CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Ectopic pregnancy (EP) or extra uterine pregnancy, accepted from the Greek word ‘‘ektopos’’ meaning out of place [1], refers to the blastocyst implantation outside the uterine cavity endometrium with over 95.5 % implanting in the fallopian tube [2–6]; where fetus or embryo is often absent or stops growing. The other most common implantation sites are ovarian (3.2 %) and abdominal (1.3 %) sites [7]. This is a major track and significant cause of morbidity and mortality with associated risks of tubal rupture and intra abdominal hemorrhage in women and can lead to substantial future reproductive morbidity, including subsequent ectopic pregnancy and infertility [8–12]. Hence, it is a medical emergency that requires immediate treatment [13]. The annual incidence of EP has increased over the past 30 years [14]. In the western world 4–10 % of pregnancyrelated deaths have been observed [15, 16], from this issue and now it is a growing problem in developing countries also [17]. Although advances in diagnostic methods have allowed for earlier diagnosis, it still remains a life threatening condition. Approximately, 75 % of deaths in the first trimester and 9 % of all pregnancy-related deaths are due to EP [12]. Around 10,000 EP are diagnosed annually in the UK. The incidence of EP in the UK (11.1/1,000 pregnancies) is similar to that in other countries, such as Norway (14.9/ 1,000) and Australia (16.2/1,000) [18–20] from 1994, the overall rate of EP and resulting mortality (0.35/1,000 EP in 2003–2005) has been static in the UK [20]. A French population study undertaken from 1992 to 2002 found that, over the duration of the study, the rate of reproductive failure EP increased by 17 %. Haifa et al. studied that there is an increasing trend in terms of EP in the eastern countries like Saudi Arabia [21]. Calderon et al. [22] reported an EP rate in California of 11.2 per 1,000 pregnancies during 1991–2000; Sewell and Cundiff [23] noted a rate in Maryland of 5.2 per 10,000 women aged 15–44 years between 1994 and 1999

1.2 STATEMENT OF THE PROBLEM

Over the last few decades, the incidence of EP has steadily increased around the world. In the Western countries, it varies between 1–2% [9]. Yet this incidence is higher in developing countries, especially in Nigeria where it reaches 4.23% [7,12,13]. Some Sweden studies have demonstrated that the increased in EP’s incidence was strongly associated to a rise in the incidence of PID and some sexually transmitted infections (STIs) [14,15]. There are other risk factors that have been associated with EP including prior EP, previous tubal surgery, documented tubal pathology, history of infertility, cigarette smoking, assisted reproduction technologies (ARTs), multiple lifetime sexual partners, older maternal age, and in utero diethylstilbestrol (DES) exposure [16–20]. Some meta-analyses found that oral contraceptive pills (OCPs), intrauterine devices (IUDs), and female sterilization could increase the risk of EP to different degrees in cases of contraceptive failure [16,21]. The use of levonorgestrel-only pills for emergency contraception (LNG-EC) at the time of the conception has recently been identified as a risk factor for EP [19,20]. In Nigeria, where the era is for the promotion of family planning nationwide through the increased use of modern contraceptives, it would be important to evaluate their involvement and strength in EP’s occurrence in our context. Further, given that the mortality and morbidity associated with EP are related to the length of time required for diagnosis, increased awareness and knowledge on its risk could help by providing better prediction and prevention in at risk-women. Moreover, this could enable an early and accurate diagnosis prior to the rupture, resulting in a reduction in the need for surgery and some complications

1.3 AIM AND OBJECTIVES OF THE STUDY

The study seeks to examine the prevalence of ectopic pregnancy among women of child bearing age 15-50 years. The objectives of the study are:

1. To determine the effect of ectopic pregnancy on women of child bearing age 15-50 years.
2. To determine the causes of ectopic pregnancy among women of child bearing age 15-50 years
3. To determine the risk factors for ectopic pregnancy among women of child bearing age 15-50 years
4.  To identify the preventive measure for ectopic pregnancy among women of child bearing age 15-50 years

1.4 RESEARCH QUESTIONS

The following research questions guide the objectives of the study:

1. What is the effect of ectopic pregnancy on women of child bearing age 15-50 years?
2. What are the causes of ectopic pregnancy among women of child bearing age 15-50 years?
3. What are the risk factors for ectopic pregnancy among women of child bearing age 15-50 years?
4.  What are the preventive measures for ectopic pregnancy among women of child bearing age 15-50 years?

1.5 STATEMENT OF THE HYPOTHESIS

H0: ectopic pregnancy has no significant on women of child bearing age 15-50 years

H1: ectopic pregnancy has significant on women of child bearing age 15-50 years

1.6 SIGNIFICANCE OF THE STUDY

The study on the prevalence of ectopic pregnancy among women of child bearing age 15-50 years will be of immense help to Nigeria communities, women of child bearing age and the hospitals in Nigeria. The study findings of the study will also establish a correlation between ectopic pregnancy and women of child bearing age 15-50 years. The study will also serve as a source of information to hospitals and women of child bearing age and contribute to the body of the existing literature on the the prevalence of ectopic pregnancy among women of child bearing age 15-50.

1.7 SCOPE OF THE STUDY

The study covers on the prevalence of ectopic pregnancy among women of child bearing age 15-50

1.8 LIMITATION OF THE STUDY

TIME CONSTRAINTS: One the challenges experienced by the researcher is the issue of time; the research will simultaneously engage in departmental activities like seminars and attendance to lectures. But the researcher was able to meet up with the deadline for the submission of the project.

FINANCIAL CONSTRAINTS: Every research work needs funding; however lack of adequate funds might affect the speed of the researcher in getting materials for completion of the project.

1.9 DEFINITION OF TERMS

ECTOPIC PREGNANCY: A pregnancy in which the fertilised egg implants outside the uterus. The fertilised egg can't survive outside the uterus. If left to grow, it may damage nearby organs and cause life-threatening loss of blood

CHILD BEARING AGE: Technically, women can get pregnant and bear children from puberty when they start getting their menstrual period to menopause when they stop getting it. The average woman's reproductive years are between ages 12 and 51. Your fertility naturally declines as you get older, which could make it harder for you to conceive