{"paper_id":"1f31d882-addd-4cae-b13f-6a2a8b72e3cd","body_text":"Open Journal of Obstetrics and Gynecology, 2026, 16(2), 400-414 \nhttps://www.scirp.org/journal/ojog \nISSN Online: 2160-8806 \nISSN Print: 2160-8792 \n \nDOI: 10.4236/ojog.2026.162040  Feb. 24, 2026 400 Open Journal of Obstetrics and Gynecology \n \n \n \n \nPrevalence and Clinical Characteristics of \nEctopic Pregnancy at a Tertiary Referral \nHospital in Zambia: A Prospective  \nDescriptive Study \nHarry Chungu1, Victor Daka2, Elijah Kabelenga1,3,4, Imukusi Mutanekelwa5, Aubrey Shanzi6, \nMuyereka Nyirenda7, Sebastain Chinkoyo1, Mabvuto Zulu1* \n1Clinical Sciences Department, School of Medicine, Copperbelt University, Ndola, Zambia \n2Public Health Department, School of Medicine, Copperbelt University, Ndola, Zambia \n3Department of Obstetrics and Gynaecology, Ndola Teaching Hospital, Ndola, Zambia \n4Provincial Health Office, Ministry of Health, Ndola, Zambia \n5Department of Obstetrics and Gynaecology, Roan Antelope General Hospital, Luanshya, Zambia \n6Department of Obstetrics and Gynaecology, Levy Mwanawasa Medical University, Lusaka, Zambia \n7Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia \n \n \n \nAbstract \nBackground: Ectopic pregnancy (EP) remains a major cause of early preg-\nnancy-related morbidity and mortality, particularly in low -resource settings \nwhere late presentation and limited diagnostic capacity prevail. Despite being \na preventable cause of maternal death, loc al data on its burden and clinical \ncharacteristics in Zambia remain limited. Objective: To determine the preva-\nlence, socio -demographic patterns, clinical characteristics, and outcomes of \nectopic pregnancy at Ndola Teaching Hospital (NTH), Zambi a. Methods: A \nprospective, descriptive, hospital-based study was conducted among 94 women \nwith surgically confirmed ectopic pregnancies between June 2024 and April \n2025. Participants were recruited through purposive sampling. Data were col-\nlected using structured questionnaires and review of medical records, then an-\nalyzed using IBM SPSS version  \n27. Descriptive statistics were computed, and \nassociations between categorical variables were tested using the Chi -square \ntest at a significance level of p < 0.05. Results: Out of 9402 pregnant women \nmanaged during the study period, 94 were diagnosed with ectopic pregnancy, \nyielding a prevalence of 0.99%. The mean age was 28.3 ± 5.8 years, with most \nparticipants residing in low -income areas (79.8%) and being married (84%). \nA prior history of pelvic inflammatory disease (PID) was reported in 57.4%, \nHow to cite this paper: Chungu, H., Daka, \nV., Kabelenga, E., Mutanekelwa, I., Shanzi, \nA., Nyirenda, M., Chinkoyo, S. and Zulu, \nM. (2026) Prevalence and Clinical Charac-\nteristics of Ectopic Pregnancy at a Tertiary \nReferral Hospital in Zambia: A Prospective \nDescriptive Study. Open Journal of Obstet-\nrics and Gynecology, 16, 400-414. \nhttps://doi.org/10.4236/ojog.2026.162040 \n \nReceived:  December 24, 2025 \nAccepted: February 21, 2026 \nPublished: February 24, 2026 \n \nCopyright © 2026 by author(s) and  \nScientific Research Publishing Inc. \nThis work is licensed under the Creative \nCommons Attribution International  \nLicense (CC BY 4.0). \nhttp://creativecommons.org/licenses/by/4.0/   \n  \nOpen Access\n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 401 Open Journal of Obstetrics and Gynecology \n \nwhile 35.1% had used emergency contraception. The most frequent presenting \nsymptoms were lower abdominal pain (96.8%), amenorrhea (74.5%), and vag-\ninal bleeding (62.8%). At surgery, 88.3% of cases were ruptured, and 41.5% \npresented in haemorrhagic shock. Ab dominal pain showed a statistically sig-\nnificant association with ruptured ectopic pregnancy ( p < 0.001), while a his-\ntory of pelvic inflammatory disease was significantly associated with the pres-\nence of pelvic adhesions (p = 0.015). The case fatality rate w as 1.1%. Conclu-\nsion: Ectopic pregnancy at NTH remains a significant reproductive health \nchallenge, characterized by late presentation, high rupture rates, and severe \ncomplications. The findings highlight the need for strengthened early diag-\nnostic capacity, improved access to e mergency care, and enhanced reproduc-\ntive health education, particularly targeting women in low-income communi-\nties. \n \nKeywords \nEctopic Pregnancy, Prevalence, Ndola Teaching Hospital, Zambia \n \n1. Introduction \nEctopic pregnancy (EP) refers to the implantation of a fertilized ovum outside the \nendometrial lining of the uterus. Globally, it accounts for 1% - 2% [1], while Africa \nhas a prevalence of 1% -  4% of all pregnancies [ 2]. EP remains a life -threatening \ngynaecological emergency and a significant contributor to early pregnancy -re-\nlated maternal morbidity and mortality, particularly in low -resource settings [3]. \nRuptured EP is especially dangerous, accounting for approximately 2.7% of preg-\nnancy-related deaths in the general population [ 4], with even higher mortality \nrates reported in sub-Saharan Africa. In Cameroon, for example, EP was respon-\nsible for 12.5% of maternal deaths [5]. The incidence of EP varies widely across \nregions, influenced by multiple risk factors including advanced maternal age, pre-\nvious pelvic inflammatory disease (PID), tubal surgery, and a history of ectopic \npregnancy [6]. \nEarly clinical suspicion is crucial, as symptoms such as missed menstruation, \nabnormal uterine bleeding, and recent sexual activity should prompt immediate \npregnancy testing [ 1]. EP typically presents with lower abdominal pain, vaginal \nbleeding, and amenorrhea. In more severe cases, symptoms like shoulder tip pain \nor syncope may indicate rupture and necessitate urgent intervention [7]. Suliman \net al. [8] reported vaginal bleeding in 74.3% of EP cases, identifying it as the sec-\nond most common presenting symptom, while 40.47% of patients exhibited the \nclassical triad of amenorrhea, abdominal pain, and vaginal bleeding. Adnexal ec-\ntopic pregnancies often mani fest as unilateral, colicky pelvic or abdominal pain \n[1], a symptom pattern supported by studies from Chisha [9] at 97.8%. Neverthe-\nless, it is emphasized that these symptoms may not be present in all cases, under-\nscoring the need for vigilant and thorough clinical evaluation [1]. \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 402 Open Journal of Obstetrics and Gynecology \n \nThe risk of EP increases with age, particularly in women over 35 years [ 10], \n[11]. Moini et al. similarly found that the likelihood of EP was significantly higher \namong women aged 33  - 39 and those over 40, compared to those aged 20  - 24. \nCertain contraceptive methods, including progestogen- only methods such as \nLevonorgestrel emergency contraception (LNG -EC) and intrauterine contracep-\ntive devices (IUCDs), are associated with an elevated risk of EP in cases of contra-\nceptive failure, though they do not increase the overall incidence of EP [ 1]. Sup-\nporting this, Shurie [ 12] demonstrated a statistically significant association ( p < \n0.001) between EP and the use of both IUCDs and LNG -EC [12]. Chisha [9] also \nreported notable behavioural risk factors, including having had more than one \nsexual partner (55.6%) or concurrent sexual partners (14.4%), which increased \nsusceptibility to sexually transmitted infections (STIs), a known precursor to PID \nand EP. \nIn Zambia, prospective data on EP remain scarce. The only published study to \ndate, conducted at the University Teaching Hospital (UTH) in Lusaka, reported a \nprevalence of 0.05% [9], but lacked detailed analysis of associated risk factors, \nclinical profiles, and treatment outcomes. At Ndola Teaching Hospital (NTH), a \n2022 internal audit documented 114 EP cases among 8736 pregnancies, corre-\nsponding to a prevalence of 1.3%, and include d two maternal deaths (NTH, Ob-\nstetrics and Gynaecology maternal audit report, 2022). However, due to inade-\nquate documentation, the findings were limited in scope and utility, reinforcing \nthe need for a well-structured, prospective study. \nThis study was conducted to determine the prevalence and clinical characteris-\ntics of ectopic pregnancy at NTH. Specifically, it explores socio-demographic var-\niables, obstetric and gynaecological histories, presenting symptoms and clinical \noutcomes. The fin dings aim to inform the development of context -appropriate \nclinical protocols and enhance early diagnosis and management of EP in resource-\nconstrained settings. \n2. Methods and Materials \n2.1. Study Site, Study Design and Target Population \nThis was a prospective, descriptive, hospital -based cross- sectional study con-\nducted at Ndola Teaching Hospital (NTH), the second -largest tertiary referral \nhospital in Zambia, with a bed capacity of 851 and 91 cots. The hospital has an \nestablished Obstetrics and Gynaecology (OBGY) Department and serves as a teach-\ning and training centre affiliated with the Copperbelt University and the Zambia \nCollege of Medicine and Surgery, providing postgraduate training in various med-\nical specialties, including obstetrics and gynaecology. NTH is located in Ndola \nDistrict, Copperbelt Province, along Broadway Road. It receives referrals from \nacross northern Zambia and within Ndola District itself, which had an estimated \npopulation of 624,579 as per the 2022 Census [13]. The target population com-\nprised all patients who presented to Ndola Teaching Hospital with a suspected or \nconfirmed diagnosis of ectopic pregnancy during the study period. \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 403 Open Journal of Obstetrics and Gynecology \n \n2.2. Sample Size Determination \nThe sample size was calculated using Cochran’s formula [14] for an infinite pop-\nulation. \nAssumptions:  \nI. Normal distribution. \nII. Confidence Interval at 95%, marginal of error at 5%. \nIII. Z score of 1.96 at 95% CI. \nIV. The global prevalence of ectopic pregnancy is 1% to 2% [1] as indicated in \nliterature review. This prevalence was the same in majority of African \ncountries evidenced by literature review [ 2]. However, only one study in \nZambia evaluated prevalence of ectopic pregnancy at 0.05% [9]. Seeing \nthat the 0.05% prevalence resulted in less than 30 sample size which would \nhave not make the research statistically sound, an estimation of 5% preva-\nlence was made to calculate the sample size using the infinite formula con-\nsidering the highest glob al prevalence of 2% [ 1] and Africa prevalence of \n4% [2]. \n• Sample Size(n) = \n( )\n22z *p 1 p e −  \n• z = z-score. \n• e = margin of error. \n• p = prevalence (estimated). \n• n = [1.962 × 0.05 (1 − 0.05)]/0.052. \n• n = 73 was the actual sample size.  \nHowever, 94 participants were recruited in the present study. \n2.3. Sampling Technique \nThe present study employed a purposive sampling technique, a non- probability \nmethod in which participants were selected based on having a diagnosis of ectopic \npregnancy. All 94 participants had ectopic pregnancy and were included in the \nstudy. Purposive sampling is also known as judgmental sampling, which relies on \nthe researcher’s discretion to include participants from the target population (i.e. ec-\ntopic pregnancy). Within purposive sampling, the homogeneous sampling method \nwas used whereby participants with ectopic pregnancy were sampled, a subtype \nthat aligned with the study ’s objectives. The reason for employing homogeneous \nsampling was that the target population shared similar characteristics concerning \nectopic pregnancy, diagnostic and treatment methods, and presenting at the same \nhospital. \n2.4. Inclusion and Exclusion Criteria \n2.4.1. Inclusion Criteria \n• All women diagnosed with ectopic pregnancy who provided informed con-\nsent to participate. \n• For participants aged below 18 years, assent was obtained from the partici-\npant, and consent was provided by a parent or guardian. \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 404 Open Journal of Obstetrics and Gynecology \n \n2.4.2. Exclusion Criteria \n• Women who did not provide consent or whose guardians declined partici-\npation. \n• Patients who had been treated for ectopic pregnancy at other facilities.  \n• Individuals without a confirmed diagnosis of ectopic pregnancy. \n2.5. Data Collection Procedures \nData were collected between 15th June 2024 and 30th April 2025 using a struc-\ntured questionnaire as adapted from previous studies [9]. Information was obtained \ndirectly from consenting participants in private settings to ensure confidentiality. \nNo identifying information such as names or hospital numbers was recorded. The \ndiagnosis of ectopic pregnancy was confirmed through a review of medical rec-\nords, including clinical findings, laboratory investigations, and imaging results. \nFor participants who had difficulty understanding English, the consent form and \nquestionnaire were translated into a familiar local language to facilitate compre-\nhension and ensure informed participation. \n2.6. Data Analysis \nData were entered into Microsoft Excel for cleaning and verification before being \nexported to IBM SPSS Statistics version 27.0.1 for analysis. Descriptive statistics \nwere computed to summarize the data, including frequencies and percentages. \nThe Pearson Ch i-square test was used to assess associations between categorical \nvariables, with statistical significance set at p < 0.05 at a 95% confidence interval. \nResults are presented in tables illustrating frequencies and associations among se-\nlected variables. \n2.7. Ethical Considerations \nEthical clearance for this study was obtained from multiple authorities. The re-\nsearch proposal underwent initial review and approval by the respective school \nresearch committee, followed by ethical approval from the Tropical Diseases Re-\nsearch Centre (TDRC) Ethics Committee (Ref: TDREC125/06/24). Authorization \nto conduct the study was granted by Ndola Teaching Hospital management through \nthe Office of the Head of Clinical Care, and final approval was obtained from the \nNational Health Research Authority (NHRA) (Ref: NHRA-1623/09/10/2024). All \nparticipants were provided with a detailed explanation of the study objectives, \nprocedures, potential benefits, and risks, after which written informed consent \nwas obtained. For participants below 18 years of age, guardian consent and par-\nticipant assent were secured. Confidentiality and privacy were strictly observed \nduring data collection; interviews were conducted in secluded areas, and data were \nanonymized during analysis. Participants retained the right to withdraw from the \nstudy at any point without consequence. The study did not interfere with the par-\nticipants’ medical management, diagnostic processes, or treatment. The findings \nwill only be applied in clinical practice following validation and approval by the \nrelevant health authorities. \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 405 Open Journal of Obstetrics and Gynecology \n \n3. Results \n3.1. Sociodemographic Characteristics \nThe mean age of women was 28.33 years (range 17  - 43). Most resided in low -\nincome areas (79.8%) and the majority were married (84%). Secondary education \nwas the most common level attained (51.1%), and nearly half were unemployed \n(47.9%) (Table 1 ).  \n \nTable 1 . Sociodemographic characteristics of women with ectopic pregnancy at Ndola \nTeaching Hospital. \nCharacteristic  Category  N Percentage (%)  \nAge (years)  \nMean (SD) - 28.33 (±5.81) \nMinimum - Maximum - 17 - 43 \nHome Address  \nLow-income 75 79.8 \nHigh-income 7 7.4 \nOutside Ndola 12 12.8 \nMarital Status  \nMarried 79 84.0 \nSingle 15 16.0 \nLevel of Education  \nPrimary 31 33.0 \nSecondary 48 51.1 \nTertiary 15 16.0 \nEmployment Status  \nNot working 45 47.9 \nInformal 33 35.1 \nFormal 16 17.0 \nNote: SD = standard deviation. \n3.2. Prevalence of Ectopic Pregnancy \nDuring the study period, Ndola Teaching Hospital (NTH) managed a total of 9402 \npregnant women, of whom 94 were diagnosed with ectopic pregnancy, yielding a \nprevalence of 0.99%. \n3.3. Obstetric Characteristics of Women with Ectopic Pregnancy \nat Ndola Teaching Hospital \nTable 2  shows the obstetric characteristics of women in the study. Regarding ob-\nstetric history, 31.9% had one previous birth, while 20.2% were nulliparous. The \nmean gestational age at presentation was 5.4 weeks (range 4  - 20), with most \nwomen presenting between 5 and 8 weeks. \n3.4. Gynaecological History of Women with Ectopic Pregnancy at \nNdola Teaching Hospital \nThe history of pelvic inflammatory disease was noted in 57.4%, and 11.7% had \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 406 Open Journal of Obstetrics and Gynecology \n \nprevious abdominal or pelvic surgery. A small proportion reported prior ectopic \npregnancy (3.2%) or intrauterine contraceptive device use (2.1%). 35.1% of women \nused emergency contraception (Table 3 ). \n \nTable 2 . Obstetric characteristics of women with ectopic pregnancy a t Ndola Teaching \nHospital. \nCharacteristic  Category  N Percentage (%)  \nParity \n0 19 20.2 \n1 30 31.9 \n2 21 22.3 \n3 11 11.7 \n4 8 8.5 \n5 3 3.2 \n6 2 2.1 \nGestational Age  (weeks)  \nMean (SD) - 5.44 (±3.98) \nRange - 4 - 20 \n \nTable 3 . Gynecological history of women with ectopic pregnancy at Ndola Teaching Hos-\npital (N = 94). \nCharacteristic  Response  (s) N Percentage (%)  \nHistory of abdominal/pelvic Surgery  \nYes 11 11.7 \nNo 83 88.3 \nUse of emergency contraceptive  \n(Levonorgestrel)  \nYes 33 35.1 \nNo 61 64.9 \nUse of Intrauterine device (IUCD)  \nYes 2 2.1 \nNo 92 97.9 \nHistory of Pelvic Inflammatory Disease  \nYes 54 57.4 \nNo 40 42.6 \nHistory of Ectopic Pregnancy  \nYes 3 3.2 \nNo 91 96.8 \n3.5. Clinical Features of Women with Ectopic Pregnancy at Ndola \nTeaching Hospital \nAbdominal pain was the most common presenting symptom, reported in 96.8% \nof cases, followed by amenorrhea (74.5%) and vaginal bleeding (62.8%). Abdominal \ntenderness was present in 74.5%, dizziness in 37.2%, and shock in 21.3% of women. \nParacentesis was positive in 14 of 18 women tested, while culdocentesis was posi-\ntive in 26 of 34 women tested (\nTable 4 ). \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 407 Open Journal of Obstetrics and Gynecology \n \nTable 4. Clinical features of women with ectopic pregnancy at Ndola Teaching Hospital (N \n= 94). \nClinical Feature  Category  N Percentage (%)  \nLower Abdominal Pain  \nYes 91 96.8 \nNo 3 3.2 \nPer Vagina Bleeding  \nYes 59 62.8 \nNo 35 37.2 \nAmenorrhea  \nYes 70 74.5 \nNo 24 25.5 \nShock \nYes 20 21.3 \nNo 74 78.7 \nDizziness  \nYes 35 37.2 \nNo 59 62.8 \nAbdominal Tenderness  \nYes 70 74.5 \nNo 24 25.5 \nParacentesis  \nPositive 14 14.9 \nNegative 4 4.3 \nNot done 76 80.9 \nCuldocentesis  \nPositive 26 27.7 \nNegative 8 8.5 \nNot done 60 63.8 \n3.6. Clinical Outcomes and Admission Wards of Women with \nEctopic Pregnancy at Ndola Teaching Hospital (N = 94) \nTable 5 . Clinical outcomes and admission wards of women with ectopic pregnancy at \nNdola Teaching Hospital (N = 94). \nOutcome  Category  N Percentage (%)  \nIntraoperative finding  \nRuptured 83 88.3 \nPelvic adhesions 49 52.1 \nComplications  \nHaemorrhagic shock 39 41.5 \nDeath 1 1.1 \nNone 54 57.4 \nGynaecological ward 73 77.7 \nAdmission  \nICU 8 8.5 \nGHDU 4 4.3 \n \nAt surgery, 88.3% of cases had ruptured and 52.1% had pelvic adhesions.  Haem-\norrhagic shock was the most frequent complication, affecting 41.5% of women. \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 408 Open Journal of Obstetrics and Gynecology \n \nMore than half of the patients (57.4%) had no complications, while one record of \nmaternal death (1.1%). Most women had admissions to the gynaecological ward \n(77.7%), while smaller proportions had admissions to the obstetric high depend-\nency unit (9.6%), the intensive care unit (8.5%), and the gynaecological high de-\npendency unit (GHDU) (4.3%) (Table 5 ). \n3.7. Association between Two Categorical Variables \nTable 6  shows the association between categorical variables. The history of pelvic \ninflammatory disease (PID) was significantly associated with intraoperative find-\ning of pelvic adhesions with p = 0.015 and OR 2.833 (1.217 - 6.599), abdominal \npain was significantly associated with intraoperative finding of ruptured ectopic \npregnancy with p < 0.001 with cohort Not ruptured 0.088 (0.045 - 0.170) and ten-\nderness was associated with intraoperative findings of ruptured ectopic pregnancy \nwith p = 0.019 and OR 4.333 (1.185 - 15.856). \n \nTable 6 . Association between two categorical variables (N = 94). \nCategorical variables  \nLevel of  \nsignificance;  \np-value (<0.05)  \nRisk estimates  \nvalues \n95%CI \nLower upper \nHistory of PID * Pelvic  \nadhesions  0.015 Odds ratio for history  \nof PID Yes/No; 2.833 1.217 6.599 \nAbdominal pain * Ruptured  \nectopic pregnancy  <0.001 For cohort ruptured =  \nNo; 0.088 0.045 0.170 \nTenderness * Ruptured  \nectopic pregnancy  0.019 Odds ratio for tenderness \nYes/No; 4.333 1.185 15.856 \n4. Discussion \nThe prevalence of ectopic pregnancy (EP) observed at Ndola Teaching Hospital \n(NTH) was marginally higher than the one documented in different studies. For \ninstance, Chisha [ 9] reported a prevalence of 0.05% at the University Teaching \nHospital (UTH) in Lusaka, while Sefogah et al. [15] found a rate of 0.08% at Lekma \nHospital in Ghana. Berhe et al. [16] reported a higher prevalence of 0.5%. How-\never, it remains below the global range of 1% - 2% [15]. Notably, higher prevalence \nrates have been recorded in other settings, such as 2.1% in Ghana’s Volta Region \n[17], 2% at Bashair Teaching Hospital in Sudan [8], and 1.43% in Cameroon [18]. \nSuch variability in prevalence rates may stem from disparities in diagnostic capa-\nbilities, differences in clinical reporting practices, variations in health-seeking be-\nhaviour, patient’s load in these hospitals and unequal access to healthcare services. \nThese findings underscore the importance of enhanced surveillance mechanisms, \nlike involving referring centres in Ndola district to be vigilant in the recognition \nof ectopic pregnancy through signs and symptoms and refer them to NTH for \nfurther management, and systematic case documentation to more accurately cap-\n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 409 Open Journal of Obstetrics and Gynecology \n \nture the epidemiological landscape of ectopic pregnancy, particularly in referral \ninstitutions like NTH. Accurate capturing of epidemiological data for ectopic \npregnancy can be achieved by creating an early pregnancy unit (EPU) at NTH.  \nSociodemographic analysis revealed that 79.8% of the women diagnosed with \nEP resided in low-income areas, 84% were married, 51.1% had attained secondary \neducation, and 47.9% were unemployed. These characteristics are consistent with \nthose reported by Chish a [9], who found 62.2% of affected women from low -in-\ncome areas, 81.1% married, and 51.1% with secondary-level education. One study \n[19] also reported a significant proportion (74%) of EP cases among women from \nlow-income backgrounds, with only 26% from higher-income brackets compared \nto 7.4% in the current study. The consistent association across studies suggests a \nrelationship between socioeconomic disadvantage and increased EP risk. \nThe mean age in this cohort was 28 ± 5.82 years, ranging from 17 to 43 years, \nconsistent with findings by multiple other studies [ 9] [16] [18], who all reported \npeak incidence among women aged 26  - 30 years. Njingu et al. [18] similarly ob-\nserved that the majority of EPs in Cameroon occurred in women aged 20  - 34 \nyears. This reproductive age group is generally more sexually active, which in-\ncreases their vulnerability to sexually transmitted infections (STIs) and pelvic in-\nflammatory disease (PID), both of which are established risk factors for EP [ 16] \n[20]. \nObstetric history showed that 31.9% of patients were para one, 22.3% para 2, \nand 20.2% were primigravida. These findings contrast slightly with Santoso [ 21], \nwho found the highest EP incidence between second pregnancies (34.3%), fol-\nlowed by primigravida (32.2%), suggesting that EP is not confined to higher -par-\nity women. \nThe mean gestational age at presentation (5.98 ± 1.15 weeks) was similar to that \nreported by Khan \net al. [20]. However, Njingu et al. [18] reported a later presen-\ntation at 8.42 ± 3.25 weeks, while Suliman et al. [8] observed most presentations \nbetween 6 and 9 weeks. These differences may reflect variations in diagnostic \nawareness and healthcare access across settings. \nAnalysis of gynaecological history revealed that 57.4% of participants had a \nprior history of PID, confirming its established role in EP pathogenesis [18] [22]-\n[25]. A statistically significant association was found between PID and pelvic ad-\nhesion (p = 0.015) whose OR was 2.833 (1.217 - 6.599), suggesting environmental \nor socioeconomic contributors to infection risk for majority of these patient came \nfrom low social income areas (79.8%). These findings support the need for pre-\nventative public health interventions. \nAbout 3.2% of participants had history of previous EP, consistent with recur-\nrence trends noted in previous studies. Prasanna et al. [26] reported a 6% recur-\nrence, while Wang et al. [27] highlighted an increased risk due to pelvic and perit-\nubular adhesions. American College of Obstetricians and Gynaecologists esti-\nmates that the recurrence risk may range from 10% to 27%, underscoring the crit-\nical need for close surveillance and early diagn ostic evaluation in women with \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 410 Open Journal of Obstetrics and Gynecology \n \nsuch a history [28]. In the present study, 11.7% of the women had a documented \nhistory of pelvic surgery. This observation reinforces the widely acknowledged \nunderstanding that previous pelvic or abdominal surgical interventions can pre-\ndispose women to ectopic pregnancy by d isrupting normal tubal anatomy and \nfunction [29]. \nRegarding contraceptive use, 33% of women had used Levonorgestrel emer-\ngency contraceptive pills and 2.1% had IUCD. Tarafdari et al. [30] identified a \nsignificant association between EP and use of intrauterine devices (IUCDs) or \nemergency contraception (p < 0.001), underscoring the need for tailored contra-\nceptive counselling, particularly in high -risk populations. Additionally, Mahajan \net al. [6] has acknowledged the increased risk of ectopic gestation following con-\ntraceptive failure, particularly among women with existing predisposing factors \nsuch as a history of pelvic inflammatory disease, tubal surgery, or prior ectopic \npregnancy [6]. \nThe predominance of abdominal pain (96.8%), amenorrhea (74.5%), and vagi-\nnal bleeding (62.8%) aligns with the classic symptom triad described in the litera-\nture [1] [8] [12] [31]. These features remain the cornerstone of early clinical sus-\npicion, particularly in settings where laboratory and imaging support may be lim-\nited. Noticed similar trends in studies from Tanzania, reinforcing the universality \nof these symptoms even in varie d clinical environments [ 32]. Given diagnostic \nlimitations in many low -resource settings, awareness of these symptom patterns \nis critical for early detection and management as this study reviewed the associa-\ntion between abdominal pain and abdominal tenderness with ruptured ectopic \npregnancy \np-values of 0.001 and 0.019 (4.33 [1.185 - 15.856]) respectively. \nIn the current study, among women who underwent additional clinical diagno-\nsis, 27.7% demonstrated a positive Culdocentesis while 14.9% had a positive pa-\nracentesis. The identification of blood during Culdocentesis was a significant in-\ndicator of ruptured ectopic pregnancy, underscoring the strong correlation be-\ntween hemoperitoneum and tubal compromise [33] [34]. \nOutcomes at NTH indicated that 57.4% of patients had favourable clinical \ncourses. This aligns with Berhe et al. [16] who reported a 62% favourable outcome \nrate [17]. However, 41.5% developed haemorrhagic shock and 1.1% of cases re-\nsulted in mortality similar to the rate reported in Zambia [9]. By contrast, several \nother studies reported no EP -related deaths [8] [15] [31]. At NTH, 77.7% of pa-\ntients were managed in general gynaecological bays, reflecting constraints in ac-\ncess to high- dependency or ICU care. As Suresh et al.  [35] also notes, delayed \ndiagnosis often results in severe outcomes such as salpingectomy, blood transfu-\nsions, or hypovolemic shock procedures associated with increased morbidity and \nhealth system burden [35]. \nRuptured ectopic pregnancy is a serious gynaecological emergency associated \nwith significant maternal morbidity, primarily due to intra- abdominal bleeding \nwhich was a key finding of this study was the notably high incidence of ruptured \nectopic pregnancies, observed in 88.3% of the cases. Delayed presentation remains \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 411 Open Journal of Obstetrics and Gynecology \n \na critical contributing factor. In the current study, a large proportion of women \nwere either referred from peripheral facilities or self -presented only after severe \nsymptoms had developed. This mirrors the findings of Andola and Desai [ 25], \nwho reported that approximately 80% of patients presented after the EP ruptured. \nContributing factors to delayed presentation in this current study include poor \nawareness of being pregnant (gestational age) where 23.4% of participants were \nunsure of thei r last menstrual period and ongoing vaginal bleeding reported in \n62.8% of cases, which likely masked the early signs of pregnancy. Moreover, ab-\ndominal pain, which was reported by 96.8% of participants, typically only prompted \nhospital visits once the condition had progressed. \n5. Public Health Implications \nThe observed strong association between ectopic pregnancy (EP) and low-income \nresidential areas highlights the urgent need for targeted public health interven-\ntions in underserved communities. These should include comprehensive repro-\nductive health education and robust strategies for the prevention and management \nof sexually transmitted infections (STIs). With more than half of EP cases linked to \na prior history of pelvic inflammatory disease (PID), there is a critical need to \nexpand access to STI screening, treatment, and health education— particularly in \nlow-income and high-burden settings. Additionally, the considerable use of emer-\ngency contraception among affected individuals underscores the importance of in-\nformed contraceptive counselling. Healthcare providers should ensure that women, \nespecially those at elevated risk, are adequately informed about the potential risks \nassociated with methods such as Levonorgestrel emergency contraception (LNG-\nEC) and intrauterine contraceptive devices (IUCDs), including the possibility of \nectopic implantation. The high incidence of haemorrhagic shock further indicates \nthe necessity of improving emergency triage systems and increasing the availabil-\nity of high-dependency or intensive care units for gynaecological emergencies. Fi-\nnally, ongoing surveillance and the collection of region- specific epidemiological \ndata are vital to inform effective policy development and the design of targeted \nprograms aimed at reducing the burden of ectopic pregnancy. \n6. Strengths and Limitations \nA key strength of this study lies in its prospective design, which allowed for sys-\ntematic data collection across multiple domains— sociodemographic, clinical, im-\naging, and surgical — minimizing recall bias and improving data completeness. \nThe relatively large sample size (n = 94) for a single-centre study also contributed. \nBeing a cross-sectional study led to study limitations: \n• It did not determine the cause-effect of independent and dependent variables.  \n• Generalization of results is not statistically right to the entire population in \nNdola district for the research was hospital based (NTH). \n• It only focused on the immediate outcomes of ectopic pregnancy leaving out \nthe long-term outcomes like fertility issues. \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 412 Open Journal of Obstetrics and Gynecology \n \n7. Conclusions \nThis study provides critical insight into the epidemiology, clinical presentation, \nand outcomes of ectopic pregnancy (EP) at Ndola Teaching Hospital, highlighting \nboth consistencies and disparities when compared to national, regional, and in-\nternational data. The slightly elevated prevalence, combined with sociodemographic \nfindings such as a predominance of cases among low-income, unemployed, and rel-\natively young women, underscores the intersection between socioeconomic vulner-\nability and reproductive health outcomes. The high proportion of cases associated \nwith pelvic inflammatory disease, early gestational presentation, and use of emer-\ngency contraception points to identifiable and, in many cases, preventable risk \nfactors. \nThe significant incidence of haemorrhagic shock and the constraints in access-\ning high-dependency care further illustrate the challenges faced in resource- lim-\nited settings, where delayed diagnosis and limited emergency capacity contribute \nto maternal morbidity and mortality. These findings reinforce the urgent need for \npublic health strategies that prioritize early diagnosis, improve access to care, en-\nhance sexual and reproductive health education, and strengthen emergency re-\nsponse systems. \nOverall, the results of this study emphasize the importance of routine surveil-\nlance, context-specific health education, and health system strengthening to re-\nduce the burden of ectopic pregnancy and improve maternal health outcomes in \nZambia and similar settings. \nConflicts of Interest \nThe authors declare no conflict of interest related to the publication of this work.  \nReferences \n[1] Vadakekut, E.S. and Gnugnoli, D.M. (2025) Ectopic Pregnancy. NCBI.  \nhttps://www.ncbi.nlm.nih.gov/books/NBK539860/ \n[2] Njamen, T.N., Tchounzou, R., Nkwele, F.M., Eyong, I.M., Mbi, F.K., Wambo, A.G.S., \net al. (2025) A Case-Control Study to Assess the Risk Factors of Ectopic Pregnancy in \nTwo Referral Hospitals in Douala, Sub-Saharan Africa. Open Journal of Obstetrics \nand Gynecology, 15, 831-845. https://doi.org/10.4236/ojog.2025.155068 \n[3] Mullany, K., Minneci, M., Monjazeb, R. and Coiado, C.O. (2023) Overview of Ectopic \nPregnancy Diagnosis, Management, and Innovation. Women’s Health, 19, 1-13.  \nhttps://doi.org/10.1177/17455057231160349 \n[4] Jiménez-Oliver, K.D., Ortiz, M.I. and Barragán-Ramírez, G. (2023) Ectopic Preg-\nnancy: Incidence Associated with Fertility Treatment. Clinical and Experimental Ob-\nstetrics & Gynecology, 50, Article No. 233. https://doi.org/10.31083/j.ceog5011233 \n[5] Pierre-Marie, T., Gregory, H., Maxwell, D.I., Robinson, E.M., Yvette, M. and Nelson, \nF.J. (2015) Maternal Mortality in Cameroon: A University Teaching Hospital Report. \nPan African Medical Journal, 21, Article No. 16.  \nhttps://doi.org/10.11604/pamj.2015.21.16.3912 \n[6] Mahajan, N., Raina, R. and Sharma, P. (2021) Risk Factors for Ectopic Pregnancy: A \nCase-Control Study in Tertiary Care Hospitals of Jammu and Kashmir. Iberoameri-\ncan Journal of Medicine, 3, 293-299. https://doi.org/10.53986/ibjm.2021.0048 \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 413 Open Journal of Obstetrics and Gynecology \n \n[7] Lawani, O., Anozie, and Ezeonu (2013) Ectopic Pregnancy: A Life-Threatening Gy-\nnecological Emergency. International Journal of Women’s Health, 5, Article No. 515.  \nhttps://doi.org/10.2147/ijwh.s49672 \n[8] Suliman, A.A., Ahmed, H.S.I., Adam Hammad, K.M., Alsiddig, I.J.Y., Abdelgader, \nM.A.E., Elhag, A.O.E., et al. (2023) Ectopic Pregnancy Risk Factors Presentation and \nManagement Outcomes. Clinical Journal of Obstetrics and Gynecology, 6, 143-149.  \nhttps://doi.org/10.29328/journal.cjog.1001143 \n[9] Chisha, B.S.P. (2016) Epidemiology of Ectopic Pregnancy at the University Teaching \nHosipital Lusaka. http://dspace.unza.zm/handle/123456789/492 \n[10] Zhang, S., Liu, J., Yang, L., Li, H., Tang, J. and Hong, L. (2023) Global Burden and \nTrends of Ectopic Pregnancy: An Observational Trend Study from 1990 to 2019. \nPLOS ONE, 18, e0291316. https://doi.org/10.1371/journal.pone.0291316 \n[11] Ji, J., Liu, L., Huang, H., Chen, H., Xiao, L., Lu, X., et al. (2024) The Body Mass Index \nand the Risk of Ectopic Pregnancy: A 5-Year Retrospective Case-Control Study. BMC \nPregnancy and Childbirth, 24, Article No. 143.  \nhttps://doi.org/10.1186/s12884-024-06319-z \n[12] Shurie, S., Were, E., Orang’o, O. and Keter, A. (2018) Levonorgestrel Only Emergency \nContraceptive Use and Risk of Ectopic Pregnancy in Eldoret Kenya: A Case-Control \nStudy. Pan African Medical Journal, 31, Article No. 214.  \nhttps://doi.org/10.11604/pamj.2018.31.214.17484 \n[13] Central Statistical Office (CSO) (2022) 2022 Census of Population and Housing: Na-\ntional Analytical Report. Central Statistical Office. \n[14] Ahmed, S.K. (2024) How to Choose a Sampling Technique and Determine Sample \nSize for Research: A Simplified Guide for Researchers. Oral Oncology Reports, 12, \nArticle ID: 100662. https://doi.org/10.1016/j.oor.2024.100662 \n[15] Sefogah, P.E., Oduro, N.E., Swarray-Deen, A., Nuamah, H.G., Takyi, R.B., Nuamah, \nM.A., et al. (2022) Factors Associated with Ruptured Ectopic Pregnancy: A 10-Year \nReview at a District Hospital in Ghana. Obstetrics and Gynecology International, \n2022, Article ID: 1491419. https://doi.org/10.1155/2022/1491419 \n[16] Berhe, E.T., Kiros, K., Hagos, M.G., Gesesew, H.A., Ward, P.R. and Gebremeskel, \nT.G. (2021) Ectopic Pregnancy in Tigray, Ethiopia: A Cross-Sectional Survey of Prev-\nalence, Management Outcomes, and Associated Factors. Journal of Pregnancy, 2021, \nArticle ID: 4443117. https://doi.org/10.1155/2021/4443117 \n[17] Oppong, A.A., Agbemenyah, H.Y., Afeke, I., Jamfaru, I., Attachie, I. and Orish, V.N. \n(2016) Ectopic Pregnancy in a Referral Hospital in the Volta Region of Ghana West \nAfrica. OALib, 3, e2983. https://doi.org/10.4236/oalib.1102983 \n[18] Njingu, A.E., Cumber, S.N., Geh, M.M., Edgar, M.M.L., Nkfusai, C.N., Ngunde, J.P., \net al. (2020) Incidence, Risk Factors, Clinical Presentation and Treatment of Ectopic \nPregnancy in the Limbe and Buea Regional Hospitals in Cameroon. PAMJ Clinical \nMedicine, 2, Article No. 95. https://doi.org/10.11604/pamj-cm.2020.2.95.21279 \n[19] Shaik, M.V. (2016) A Study on Risk Factors and Clinical Presentation of Ectopic \nPregnancy in Women Attending a Tertiary Care Centre. http://iaimjournal.com \n[20] Khan, M., et al. (2021) Risk Factors and Presenting Complaints of Ectopic Pregnancy \nat a Tertiary Care Hospital. Pakistan Journal of Health Sciences, 15, 1226-1228.  \nhttps://www.researchgate.net/profile/Majida-Khan-2/publication/381888329 \n[21] Santoso, B. (2017) Analisis Faktor Risiko Kehamilan Ektopik. Jurnal Ners, 6, 164-168.  \nhttps://doi.org/10.20473/jn.v6i2.3986 \n\nH. Chungu et al. \n \n \nDOI: 10.4236/ojog.2026.162040 414 Open Journal of Obstetrics and Gynecology \n \n[22] Huang, C., Huang, C., Lin, S., Chang, C.Y., Lin, W., Chung, C., et al. (2019) Associa-\ntion of Pelvic Inflammatory Disease (PID) with Ectopic Pregnancy and Preterm La-\nbor in Taiwan Region: A Nationwide Population-Based Retrospective Cohort Study. \nPLOS ONE, 14, e0219351. https://doi.org/10.1371/journal.pone.0219351 \n[23] Lehr, S., Vier, J., Häcker, G. and Kirschnek, S. (2018) Activation of Neutrophils by \nChlamydia Trachomatis-Infected Epithelial Cells Is Modulated by the Chlamydial \nPlasmid. Microbes and Infection, 20, 284-292.  \nhttps://doi.org/10.1016/j.micinf.2018.02.007 \n[24] Mpiima, D.P., Wasswa Salongo, G., Lugobe, H., Ssemujju, A., Mumbere Mulisya, O., \nMasinda, A., et al. (2018) Association between Prior Chlamydia trachomatis Infection \nand Ectopic Pregnancy at a Tertiary Care Hospital in South Western Uganda. Ob-\nstetrics and Gynecology International, 2018, Article ID: 4827353.  \nhttps://doi.org/10.1155/2018/4827353 \n[25] Andola, S., Kumar, R.R., Desai, R.M. and S.A, K. (2021) Study of Risk Factors and \nTreatment Modalities of Ectopic Pregnancy. Journal of Family Medicine and Primary \nCare, 10, 724-729. https://doi.org/10.4103/jfmpc.jfmpc_1279_20 \n[26] Prasanna, B., Jhansi, C.B., Swathi, K. and Shaik, M.V. (2016) A Study on Risk Factors \nand Clinical Presentation of Ectopic Pregnancy in Women Attending a Tertiary Care \nCentre. International Archives of Integrated Medicine, 3, 90-96.  \nhttp://iaimjournal.com/ \n[27] Wang, X., Huang, L., Yu, Y., Xu, S., Lai, Y. and Zeng, W. (2020) Risk Factors and \nClinical Characteristics of Recurrent Ectopic Pregnancy: A Case-Control Study. Jour-\nnal of Obstetrics and Gynaecology Research, 46, 1098-1103.  \nhttps://doi.org/10.1111/jog.14253 \n[28] Petrini, A. and Spandorfer, S. (2020) Recurrent Ectopic Pregnancy: Current Perspec-\ntives. International Journal of Women’s Health, 12, 597-600.  \nhttps://doi.org/10.2147/ijwh.s223909 \n[29] Sivalingam, V.N., Duncan, W.C., Kirk, E., Shephard, L.A. and Horne, A.W. (2011) \nDiagnosis and Management of Ectopic Pregnancy. Journal of Family Planning and \nReproductive Health Care, 37, 231-240. https://doi.org/10.1136/jfprhc-2011-0073 \n[30] Tarafdari, A., Bandarian, M., Hantoushzadeh, S., Hadizadeh, A., Shahsavari, S. and \nRazavi, M.A. (2023) Assessing the Risk Factors and Management Outcomes of Ec-\ntopic Pregnancy: A Retrospective Case-Control Study. International Journal of Re-\nproductive BioMedicine, 21, 403-414. https://doi.org/10.18502/ijrm.v21i5.13475 \n[31] Al Naimi, A., Moore, P., Brüggmann, D., Krysa, L., Louwen, F. and Bahlmann, F. \n(2021) Ectopic Pregnancy: A Single-Center Experience over Ten Years. Reproductive \nBiology and Endocrinology, 19, Article No. 79.  \nhttps://doi.org/10.1186/s12958-021-00761-w \n[32] Kiwanuka, F. and Anyango Olyet, C. (2018) Knowledge, Attitude, and Beliefs on Ep-\nilepsy among Adults in Erute South, Lira District, Uganda. Epilepsia Open, 3, 264-\n269. https://doi.org/10.1002/epi4.12223 \n[33] Tang, P., Li, X., Li, W., Zhang, Y. and Yang, Y. (2021) The Risk Factors of Rupture \nand Abortion of Tubal Pregnancy— A Retrospective Study Based on 2280 Tubal Preg-\nnancy Cases. \n[34] Lafans, K. and Kok, S.J. (2024) Culdocentesis. StatPearls.  \nhttps://www.ncbi.nlm.nih.gov/books/NBK564360/ \n[35] Suresh, A., Devasia, J.M., Adla, B., Balachandran, A., et al. (2019) A Study on Ectopic \nPregnancies in a Tertiary Care Centre. Journal of Evidence Based Medicine and \nHealthcare, 6, 1654-1658. https://doi.org/10.18410/jebmh/2019/334","source_license":"CC0","license_restricted":false}