Ectopic pregnancy (EP) is one of the leading causes of pregnancy-related death during the first trimester of pregnancy. There are several risk factors that are responsible for ectopic pregnancy. In our study, we have considered sociodemographic and socioeconomic variables (age, occupation, education, income, age of last child, and duration of marital status), pregnancy-related information (contraceptive history, previous history of MR and abortion, menstrual hygiene, and Anti-chlamydial antibody), and clinical information (contact with TB patients, white blood cell count, lymphocyte size, Erythrocyte Sedimentation Rate, and Endometrial sampling for TBPCR). Moreover, we have also determined the role of genital tuberculosis (TB) as an etiological factor for ectopic pregnancy.
In this study, only 3.54% of women had a previous history of ectopic pregnancy and nearly 5% of women tested positive for TB when using Endometrial sampling for TBPCR. Another study conducted in Chittagong, Bangladesh found that the incidence of ectopic pregnancy was 7.4/1000 deliveries (Yeasmin et al., 2014). There were several studies conducted in different areas of India and the findings of their study was that the prevalence of ectopic pregnancy was 5.6/1000 and 1:399 (Shaikh et al., 2014; Shetty & Shetty, 2014) which was lower than the present study. It is reported in different previous studies that the incidence of ectopic pregnancy varied and could be as low as 0.69% in some developed countries and as high as 19% in India (Hooda, R., Malik, S., & Nair, 2022). The mean age of the women with ectopic pregnancy is 27.03. A similar result was found in different studies (Khaleeque et al., 2001; Parikh et al., 1997; Sharma et al., 2014).
The present study also revealed that around 7.08% of patients were previously affected by tuberculosis but it was reported that 33% and 50% of affected women may have a past history of tuberculosis in India which was found in two different studies (Sharma et al., 2014)(Kamal et al., 2019) and in Chittagong, Bangladesh (2.12%) (Yeasmin et al., 2014). So, there was a huge discrepancy between Bangladesh and India. It is also found that 11.5% of patients were in contact with TB patients which is also lower than our neighboring country India (28.4%) (Hooda, R., Malik, S., & Nair, 2022).
We found that 19.47% of women had a previous history of MR, among them 16.74% had spontaneous abortions, 11.06% used D&C method, and 9.73% utilized induced abortion methods. Moreover, 22.57% of women tested positive for Anti-chlamydial antibody. However, different previous studies showed that patients with spontaneous abortion were 27% and 87.34% in India and southern India respectively (Hooda, R., Malik, S., & Nair, 2022) and spontaneous and induced abortion in Chittagong, Bangladesh was 23.49% (Yeasmin et al., 2014). The majority of the women preferred the vaginal delivery method (47.79%) during their lifetime whereas only 21.24% has undergone cesarean section delivery. According to the Bangladesh Demographic and Health Survey (BDHS) 2017–18, the prevalence of cesarean section delivery among Bangladeshi mothers was 34% (Ahmmed et al., 2021) which is higher than the present study.
We can see that the age of respondents, occupation, education, contraceptive history, previous history of MR, induced abortion, duration of marital life, type of delivery system, age of last child, and menstrual hygiene showed significant association with ectopic pregnancy which is similar to previous studies conducted in Mangalore, India, Shanghai, China, and Tamil Nadu, South India (Behera et al., 2018; Li et al., 2014).
In 2015, the adoption of the 17 Sustainable Development Goals (SDGs) paved the way for a future centered on principles of justice, inclusivity, improved health, including sexual and reproductive health and reproductive rights, enhanced education, and greater equality. The incidence of ectopic pregnancy is 7.4/1000 deliveries in Bangladesh (Behera et al., 2018). In order to enhance reproductive health and work towards achieving the SDGs, it is of paramount importance to address the concerns related to ectopic pregnancy patients. Due to the lack of extensive data usefulness of diagnosing and treating ectopic pregnancy to explore specific infectious or non-infectious etiology in order to avoid morbidity or subsequent complications, this study represents a novel approach to identify GTB as an etiologic factors in the population considered to be at risk and taking advantage of the chance to treat the same. Currently, in Bangladesh, GTB is recognized as a major determinant of reproductive morbidity as well as, it is well known that GTB is one of the most common causes of ectopic pregnancy. Till date, however, there has not been a lot of systematic research conducted to evaluate this issue. So, this study is to evaluate whether GTB is a risk factor for ectopic pregnancy along with other determinants in Bangladeshi women. So, the findings of this study assist policymakers and the government of Bangladesh in formulating essential measures to reduce the incidence of ectopic pregnancy.
Strength
The main strength of this study is that this is a novel study and only some researchers have explored this study before. Another strength of this study is that both sociodemographic, socioeconomic, clinical and pregnancy related factors are included in this study. Moreover, this is a new study in Bangladesh perspectives which included the genital TB as an etiological factor for assessing the association with ectopic pregnancy.
Limitations
Our study has several limitations that need to be acknowledged. Firstly, we conducted a cross-sectional study to investigate the common characteristics of ectopic pregnant patients. To gain a more comprehensive understanding of the long-term impact of these factors on ectopic pregnancy, it is imperative to conduct longitudinal research that tracks patients over an extended period.
Secondly, our study exclusively focused on individuals with ectopic pregnancies, which represents a one-sided perspective. To provide a more holistic view and facilitate clearer policymaking, it would be beneficial to compare our findings with a control group consisting of non-ectopic pregnant patients.
Furthermore, our sample size was limited to 226 participants, which may not be sufficient for generalizing our findings to the entire population of Bangladesh. While it is true that the incidence of ectopic pregnancies in Bangladesh is relatively low, conducting further research with a larger sample size would offer valuable insights to both researchers and medical professionals.