Prevalence and Clinical Characteristics of Ectopic Pregnancy at a Tertiary Referral Hospital in Zambia: A Prospective Descriptive Study

Background: Ectopic pregnancy (EP) remains a major cause of early preg- nancy-related morbidity and mortality, particularly in low -resource settings where late presentation and limited diagnostic capacity prevail. Despite being a preventable cause of maternal death, loc al data on its burden and clinical characteristics in Zambia remain limited. Objective: To determine the preva- lence, socio -demographic patterns, clinical characteristics, and outcomes of ectopic pregnancy at Ndola Teaching Hospital (NTH), Zambi a. Methods: A prospective, descriptive, hospital-based study was conducted among 94 women with surgically confirmed ectopic pregnancies between June 2024 and April 2025. Participants were recruited through purposive sampling. Data were col- lected using structured questionnaires and review of medical records, then an- alyzed using IBM SPSS version 27. Descriptive statistics were computed, and associations between categorical variables were tested using the Chi -square test at a significance level of p < 0.05. Results: Out of 9402 pregnant women managed during the study period, 94 were diagnosed with ectopic pregnancy, yielding a prevalence of 0.99%. The mean age was 28.3 ± 5.8 years, with most participants residing in low -income areas (79.8%) and being married (84%). A prior history of pelvic inflammatory disease (PID) was reported in 57.4%, How to cite this paper: Chungu, H., Daka, V., Kabelenga, E., Mutanekelwa, I., Shanzi, A., Nyirenda, M., Chinkoyo, S. and Zulu, M. (2026) Prevalence and Clinical Charac- teristics of Ectopic Pregnancy at a Tertiary Referral Hospital in Zambia: A Prospective Descriptive Study. Open Journal of Obstet- rics and Gynecology, 16, 400-414. https://doi.org/10.4236/ojog.2026.162040 Received: December 24, 2025 Accepted: February 21, 2026 Published: February 24, 2026 Copyright © 2026 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access H. Chungu et al. DOI: 10.4236/ojog.2026.162040 401 Open Journal of Obstetrics and Gynecology while 35.1% had used emergency contraception. The most frequent presenting symptoms were lower abdominal pain (96.8%), amenorrhea (74.5%), and vag- inal bleeding (62.8%). At surgery, 88.3% of cases were ruptured, and 41.5% presented in haemorrhagic shock. Ab dominal pain showed a statistically sig- nificant association with ruptured ectopic pregnancy ( p < 0.001), while a his- tory of pelvic inflammatory disease was significantly associated with the pres- ence of pelvic adhesions (p = 0.015). The case fatality rate w as 1.1%. Conclu- sion: Ectopic pregnancy at NTH remains a significant reproductive health challenge, characterized by late presentation, high rupture rates, and severe complications. The findings highlight the need for strengthened early diag- nostic capacity, improved access to e mergency care, and enhanced reproduc- tive health education, particularly targeting women in low-income communi- ties.

Ectopic Pregnancy, Prevalence, Ndola Teaching Hospital, Zambia 1. Introduction Ectopic pregnancy (EP) refers to the implantation of a fertilized ovum outside the endometrial lining of the uterus. Globally, it accounts for 1% - 2% [1], while Africa has a prevalence of 1% - 4% of all pregnancies [ 2]. EP remains a life -threatening gynaecological emergency and a significant contributor to early pregnancy -re- lated maternal morbidity and mortality, particularly in low -resource settings [3]. Ruptured EP is especially dangerous, accounting for approximately 2.7% of preg- nancy-related deaths in the general population [ 4], with even higher mortality rates reported in sub-Saharan Africa. In Cameroon, for example, EP was respon- sible for 12.5% of maternal deaths [5]. The incidence of EP varies widely across regions, influenced by multiple risk factors including advanced maternal age, pre- vious pelvic inflammatory disease (PID), tubal surgery, and a history of ectopic pregnancy [6]. Early clinical suspicion is crucial, as symptoms such as missed menstruation, abnormal uterine bleeding, and recent sexual activity should prompt immediate pregnancy testing [ 1]. EP typically presents with lower abdominal pain, vaginal bleeding, and amenorrhea. In more severe cases, symptoms like shoulder tip pain or syncope may indicate rupture and necessitate urgent intervention [7]. Suliman et al. [8] reported vaginal bleeding in 74.3% of EP cases, identifying it as the sec- ond most common presenting symptom, while 40.47% of patients exhibited the classical triad of amenorrhea, abdominal pain, and vaginal bleeding. Adnexal ec- topic pregnancies often mani fest as unilateral, colicky pelvic or abdominal pain [1], a symptom pattern supported by studies from Chisha [9] at 97.8%. Neverthe- less, it is emphasized that these symptoms may not be present in all cases, under- scoring the need for vigilant and thorough clinical evaluation [1]. H. Chungu et al. DOI: 10.4236/ojog.2026.162040 402 Open Journal of Obstetrics and Gynecology The risk of EP increases with age, particularly in women over 35 years [ 10], [11]. Moini et al. similarly found that the likelihood of EP was significantly higher among women aged 33 - 39 and those over 40, compared to those aged 20 - 24. Certain contraceptive methods, including progestogen- only methods such as Levonorgestrel emergency contraception (LNG -EC) and intrauterine contracep- tive devices (IUCDs), are associated with an elevated risk of EP in cases of contra- ceptive failure, though they do not increase the overall incidence of EP [ 1]. Sup- porting this, Shurie [ 12] demonstrated a statistically significant association ( p < 0.001) between EP and the use of both IUCDs and LNG -EC [12]. Chisha [9] also reported notable behavioural risk factors, including having had more than one sexual partner (55.6%) or concurrent sexual partners (14.4%), which increased susceptibility to sexually transmitted infections (STIs), a known precursor to PID and EP. In Zambia, prospective data on EP remain scarce. The only published study to date, conducted at the University Teaching Hospital (UTH) in Lusaka, reported a prevalence of 0.05% [9], but lacked detailed analysis of associated risk factors, clinical profiles, and treatment outcomes. At Ndola Teaching Hospital (NTH), a 2022 internal audit documented 114 EP cases among 8736 pregnancies, corre- sponding to a prevalence of 1.3%, and include d two maternal deaths (NTH, Ob- stetrics and Gynaecology maternal audit report, 2022). However, due to inade- quate documentation, the findings were limited in scope and utility, reinforcing the need for a well-structured, prospective study. This study was conducted to determine the prevalence and clinical characteris- tics of ectopic pregnancy at NTH. Specifically, it explores socio-demographic var- iables, obstetric and gynaecological histories, presenting symptoms and clinical outcomes. The fin dings aim to inform the development of context -appropriate clinical protocols and enhance early diagnosis and management of EP in resource- constrained settings. 2. Methods and Materials 2.1. Study Site, Study Design and Target Population This was a prospective, descriptive, hospital -based cross- sectional study con- ducted at Ndola Teaching Hospital (NTH), the second -largest tertiary referral hospital in Zambia, with a bed capacity of 851 and 91 cots. The hospital has an established Obstetrics and Gynaecology (OBGY) Department and serves as a teach- ing and training centre affiliated with the Copperbelt University and the Zambia College of Medicine and Surgery, providing postgraduate training in various med- ical specialties, including obstetrics and gynaecology. NTH is located in Ndola District, Copperbelt Province, along Broadway Road. It receives referrals from across northern Zambia and within Ndola District itself, which had an estimated population of 624,579 as per the 2022 Census [13]. The target population com- prised all patients who presented to Ndola Teaching Hospital with a suspected or confirmed diagnosis of ectopic pregnancy during the study period. H. Chungu et al. DOI: 10.4236/ojog.2026.162040 403 Open Journal of Obstetrics and Gynecology 2.2. Sample Size Determination The sample size was calculated using Cochran’s formula [14] for an infinite pop- ulation. Assumptions: I. Normal distribution. II. Confidence Interval at 95%, marginal of error at 5%. III. Z score of 1.96 at 95% CI. IV. The global prevalence of ectopic pregnancy is 1% to 2% [1] as indicated in literature review. This prevalence was the same in majority of African countries evidenced by literature review [ 2]. However, only one study in Zambia evaluated prevalence of ectopic pregnancy at 0.05% [9]. Seeing that the 0.05% prevalence resulted in less than 30 sample size which would have not make the research statistically sound, an estimation of 5% preva- lence was made to calculate the sample size using the infinite formula con- sidering the highest glob al prevalence of 2% [ 1] and Africa prevalence of 4% [2]. • Sample Size(n) = ( ) 22z *p 1 p e − • z = z-score. • e = margin of error. • p = prevalence (estimated). • n = [1.962 × 0.05 (1 − 0.05)]/0.052. • n = 73 was the actual sample size. However, 94 participants were recruited in the present study. 2.3. Sampling Technique The present study employed a purposive sampling technique, a non- probability

in which participants were selected based on having a diagnosis of ectopic pregnancy. All 94 participants had ectopic pregnancy and were included in the study. Purposive sampling is also known as judgmental sampling, which relies on the researcher’s discretion to include participants from the target population (i.e. ec- topic pregnancy). Within purposive sampling, the homogeneous sampling method was used whereby participants with ectopic pregnancy were sampled, a subtype that aligned with the study ’s objectives. The reason for employing homogeneous sampling was that the target population shared similar characteristics concerning ectopic pregnancy, diagnostic and treatment methods, and presenting at the same hospital. 2.4. Inclusion and Exclusion Criteria 2.4.1. Inclusion Criteria • All women diagnosed with ectopic pregnancy who provided informed con- sent to participate. • For participants aged below 18 years, assent was obtained from the partici- pant, and consent was provided by a parent or guardian. H. Chungu et al. DOI: 10.4236/ojog.2026.162040 404 Open Journal of Obstetrics and Gynecology 2.4.2. Exclusion Criteria • Women who did not provide consent or whose guardians declined partici- pation. • Patients who had been treated for ectopic pregnancy at other facilities. • Individuals without a confirmed diagnosis of ectopic pregnancy. 2.5. Data Collection Procedures Data were collected between 15th June 2024 and 30th April 2025 using a struc- tured questionnaire as adapted from previous studies [9]. Information was obtained directly from consenting participants in private settings to ensure confidentiality. No identifying information such as names or hospital numbers was recorded. The diagnosis of ectopic pregnancy was confirmed through a review of medical rec- ords, including clinical findings, laboratory investigations, and imaging results. For participants who had difficulty understanding English, the consent form and questionnaire were translated into a familiar local language to facilitate compre- hension and ensure informed participation. 2.6. Data Analysis Data were entered into Microsoft Excel for cleaning and verification before being exported to IBM SPSS Statistics version 27.0.1 for analysis. Descriptive statistics were computed to summarize the data, including frequencies and percentages. The Pearson Ch i-square test was used to assess associations between categorical variables, with statistical significance set at p < 0.05 at a 95% confidence interval.

are presented in tables illustrating frequencies and associations among se- lected variables. 2.7. Ethical Considerations Ethical clearance for this study was obtained from multiple authorities. The re- search proposal underwent initial review and approval by the respective school research committee, followed by ethical approval from the Tropical Diseases Re- search Centre (TDRC) Ethics Committee (Ref: TDREC125/06/24). Authorization to conduct the study was granted by Ndola Teaching Hospital management through the Office of the Head of Clinical Care, and final approval was obtained from the National Health Research Authority (NHRA) (Ref: NHRA-1623/09/10/2024). All participants were provided with a detailed explanation of the study objectives, procedures, potential benefits, and risks, after which written informed consent was obtained. For participants below 18 years of age, guardian consent and par- ticipant assent were secured. Confidentiality and privacy were strictly observed during data collection; interviews were conducted in secluded areas, and data were anonymized during analysis. Participants retained the right to withdraw from the study at any point without consequence. The study did not interfere with the par- ticipants’ medical management, diagnostic processes, or treatment. The findings will only be applied in clinical practice following validation and approval by the relevant health authorities. H. Chungu et al. DOI: 10.4236/ojog.2026.162040 405 Open Journal of Obstetrics and Gynecology 3. Results 3.1. Sociodemographic Characteristics The mean age of women was 28.33 years (range 17 - 43). Most resided in low - income areas (79.8%) and the majority were married (84%). Secondary education was the most common level attained (51.1%), and nearly half were unemployed (47.9%) (Table 1 ). Table 1 . Sociodemographic characteristics of women with ectopic pregnancy at Ndola Teaching Hospital. Characteristic Category N Percentage (%) Age (years) Mean (SD) - 28.33 (±5.81) Minimum - Maximum - 17 - 43 Home Address Low-income 75 79.8 High-income 7 7.4 Outside Ndola 12 12.8 Marital Status Married 79 84.0 Single 15 16.0 Level of Education Primary 31 33.0 Secondary 48 51.1 Tertiary 15 16.0 Employment Status Not working 45 47.9 Informal 33 35.1 Formal 16 17.0 Note: SD = standard deviation. 3.2. Prevalence of Ectopic Pregnancy During the study period, Ndola Teaching Hospital (NTH) managed a total of 9402 pregnant women, of whom 94 were diagnosed with ectopic pregnancy, yielding a prevalence of 0.99%. 3.3. Obstetric Characteristics of Women with Ectopic Pregnancy at Ndola Teaching Hospital Table 2 shows the obstetric characteristics of women in the study. Regarding ob- stetric history, 31.9% had one previous birth, while 20.2% were nulliparous. The mean gestational age at presentation was 5.4 weeks (range 4 - 20), with most women presenting between 5 and 8 weeks. 3.4. Gynaecological History of Women with Ectopic Pregnancy at Ndola Teaching Hospital The history of pelvic inflammatory disease was noted in 57.4%, and 11.7% had H. Chungu et al. DOI: 10.4236/ojog.2026.162040 406 Open Journal of Obstetrics and Gynecology previous abdominal or pelvic surgery. A small proportion reported prior ectopic pregnancy (3.2%) or intrauterine contraceptive device use (2.1%). 35.1% of women used emergency contraception (Table 3 ). Table 2 . Obstetric characteristics of women with ectopic pregnancy a t Ndola Teaching Hospital. Characteristic Category N Percentage (%) Parity 0 19 20.2 1 30 31.9 2 21 22.3 3 11 11.7 4 8 8.5 5 3 3.2 6 2 2.1 Gestational Age (weeks) Mean (SD) - 5.44 (±3.98) Range - 4 - 20 Table 3 . Gynecological history of women with ectopic pregnancy at Ndola Teaching Hos- pital (N = 94). Characteristic Response (s) N Percentage (%) History of abdominal/pelvic Surgery Yes 11 11.7 No 83 88.3 Use of emergency contraceptive (Levonorgestrel) Yes 33 35.1 No 61 64.9 Use of Intrauterine device (IUCD) Yes 2 2.1 No 92 97.9 History of Pelvic Inflammatory Disease Yes 54 57.4 No 40 42.6 History of Ectopic Pregnancy Yes 3 3.2 No 91 96.8 3.5. Clinical Features of Women with Ectopic Pregnancy at Ndola Teaching Hospital Abdominal pain was the most common presenting symptom, reported in 96.8% of cases, followed by amenorrhea (74.5%) and vaginal bleeding (62.8%). Abdominal tenderness was present in 74.5%, dizziness in 37.2%, and shock in 21.3% of women. Paracentesis was positive in 14 of 18 women tested, while culdocentesis was posi- tive in 26 of 34 women tested ( Table 4 ). H. Chungu et al. DOI: 10.4236/ojog.2026.162040 407 Open Journal of Obstetrics and Gynecology Table 4. Clinical features of women with ectopic pregnancy at Ndola Teaching Hospital (N = 94). Clinical Feature Category N Percentage (%) Lower Abdominal Pain Yes 91 96.8 No 3 3.2 Per Vagina Bleeding Yes 59 62.8 No 35 37.2 Amenorrhea Yes 70 74.5 No 24 25.5 Shock Yes 20 21.3 No 74 78.7 Dizziness Yes 35 37.2 No 59 62.8 Abdominal Tenderness Yes 70 74.5 No 24 25.5 Paracentesis Positive 14 14.9 Negative 4 4.3 Not done 76 80.9 Culdocentesis Positive 26 27.7 Negative 8 8.5 Not done 60 63.8 3.6. Clinical Outcomes and Admission Wards of Women with Ectopic Pregnancy at Ndola Teaching Hospital (N = 94) Table 5 . Clinical outcomes and admission wards of women with ectopic pregnancy at Ndola Teaching Hospital (N = 94). Outcome Category N Percentage (%) Intraoperative finding Ruptured 83 88.3 Pelvic adhesions 49 52.1 Complications Haemorrhagic shock 39 41.5 Death 1 1.1 None 54 57.4 Gynaecological ward 73 77.7 Admission ICU 8 8.5 GHDU 4 4.3 At surgery, 88.3% of cases had ruptured and 52.1% had pelvic adhesions. Haem- orrhagic shock was the most frequent complication, affecting 41.5% of women. H. Chungu et al. DOI: 10.4236/ojog.2026.162040 408 Open Journal of Obstetrics and Gynecology More than half of the patients (57.4%) had no complications, while one record of maternal death (1.1%). Most women had admissions to the gynaecological ward (77.7%), while smaller proportions had admissions to the obstetric high depend- ency unit (9.6%), the intensive care unit (8.5%), and the gynaecological high de- pendency unit (GHDU) (4.3%) (Table 5 ). 3.7. Association between Two Categorical Variables Table 6 shows the association between categorical variables. The history of pelvic inflammatory disease (PID) was significantly associated with intraoperative find- ing of pelvic adhesions with p = 0.015 and OR 2.833 (1.217 - 6.599), abdominal pain was significantly associated with intraoperative finding of ruptured ectopic pregnancy with p < 0.001 with cohort Not ruptured 0.088 (0.045 - 0.170) and ten- derness was associated with intraoperative findings of ruptured ectopic pregnancy with p = 0.019 and OR 4.333 (1.185 - 15.856). Table 6 . Association between two categorical variables (N = 94). Categorical variables Level of significance; p-value (<0.05) Risk estimates values 95%CI Lower upper History of PID * Pelvic adhesions 0.015 Odds ratio for history of PID Yes/No; 2.833 1.217 6.599 Abdominal pain * Ruptured ectopic pregnancy <0.001 For cohort ruptured = No; 0.088 0.045 0.170 Tenderness * Ruptured ectopic pregnancy 0.019 Odds ratio for tenderness Yes/No; 4.333 1.185 15.856 4. Discussion The prevalence of ectopic pregnancy (EP) observed at Ndola Teaching Hospital (NTH) was marginally higher than the one documented in different studies. For instance, Chisha [ 9] reported a prevalence of 0.05% at the University Teaching Hospital (UTH) in Lusaka, while Sefogah et al. [15] found a rate of 0.08% at Lekma Hospital in Ghana. Berhe et al. [16] reported a higher prevalence of 0.5%. How- ever, it remains below the global range of 1% - 2% [15]. Notably, higher prevalence rates have been recorded in other settings, such as 2.1% in Ghana’s Volta Region [17], 2% at Bashair Teaching Hospital in Sudan [8], and 1.43% in Cameroon [18]. Such variability in prevalence rates may stem from disparities in diagnostic capa- bilities, differences in clinical reporting practices, variations in health-seeking be- haviour, patient’s load in these hospitals and unequal access to healthcare services. These findings underscore the importance of enhanced surveillance mechanisms, like involving referring centres in Ndola district to be vigilant in the recognition of ectopic pregnancy through signs and symptoms and refer them to NTH for further management, and systematic case documentation to more accurately cap- H. Chungu et al. DOI: 10.4236/ojog.2026.162040 409 Open Journal of Obstetrics and Gynecology ture the epidemiological landscape of ectopic pregnancy, particularly in referral institutions like NTH. Accurate capturing of epidemiological data for ectopic pregnancy can be achieved by creating an early pregnancy unit (EPU) at NTH. Sociodemographic analysis revealed that 79.8% of the women diagnosed with EP resided in low-income areas, 84% were married, 51.1% had attained secondary education, and 47.9% were unemployed. These characteristics are consistent with those reported by Chish a [9], who found 62.2% of affected women from low -in- come areas, 81.1% married, and 51.1% with secondary-level education. One study [19] also reported a significant proportion (74%) of EP cases among women from low-income backgrounds, with only 26% from higher-income brackets compared to 7.4% in the current study. The consistent association across studies suggests a relationship between socioeconomic disadvantage and increased EP risk. The mean age in this cohort was 28 ± 5.82 years, ranging from 17 to 43 years, consistent with findings by multiple other studies [ 9] [16] [18], who all reported peak incidence among women aged 26 - 30 years. Njingu et al. [18] similarly ob- served that the majority of EPs in Cameroon occurred in women aged 20 - 34 years. This reproductive age group is generally more sexually active, which in- creases their vulnerability to sexually transmitted infections (STIs) and pelvic in- flammatory disease (PID), both of which are established risk factors for EP [ 16] [20]. Obstetric history showed that 31.9% of patients were para one, 22.3% para 2, and 20.2% were primigravida. These findings contrast slightly with Santoso [ 21], who found the highest EP incidence between second pregnancies (34.3%), fol- lowed by primigravida (32.2%), suggesting that EP is not confined to higher -par- ity women. The mean gestational age at presentation (5.98 ± 1.15 weeks) was similar to that reported by Khan et al. [20]. However, Njingu et al. [18] reported a later presen- tation at 8.42 ± 3.25 weeks, while Suliman et al. [8] observed most presentations between 6 and 9 weeks. These differences may reflect variations in diagnostic awareness and healthcare access across settings. Analysis of gynaecological history revealed that 57.4% of participants had a prior history of PID, confirming its established role in EP pathogenesis [18] [22]- [25]. A statistically significant association was found between PID and pelvic ad- hesion (p = 0.015) whose OR was 2.833 (1.217 - 6.599), suggesting environmental or socioeconomic contributors to infection risk for majority of these patient came from low social income areas (79.8%). These findings support the need for pre- ventative public health interventions. About 3.2% of participants had history of previous EP, consistent with recur- rence trends noted in previous studies. Prasanna et al. [26] reported a 6% recur- rence, while Wang et al. [27] highlighted an increased risk due to pelvic and perit- ubular adhesions. American College of Obstetricians and Gynaecologists esti- mates that the recurrence risk may range from 10% to 27%, underscoring the crit- ical need for close surveillance and early diagn ostic evaluation in women with H. Chungu et al. DOI: 10.4236/ojog.2026.162040 410 Open Journal of Obstetrics and Gynecology such a history [28]. In the present study, 11.7% of the women had a documented history of pelvic surgery. This observation reinforces the widely acknowledged understanding that previous pelvic or abdominal surgical interventions can pre- dispose women to ectopic pregnancy by d isrupting normal tubal anatomy and function [29]. Regarding contraceptive use, 33% of women had used Levonorgestrel emer- gency contraceptive pills and 2.1% had IUCD. Tarafdari et al. [30] identified a significant association between EP and use of intrauterine devices (IUCDs) or emergency contraception (p < 0.001), underscoring the need for tailored contra- ceptive counselling, particularly in high -risk populations. Additionally, Mahajan et al. [6] has acknowledged the increased risk of ectopic gestation following con- traceptive failure, particularly among women with existing predisposing factors such as a history of pelvic inflammatory disease, tubal surgery, or prior ectopic pregnancy [6]. The predominance of abdominal pain (96.8%), amenorrhea (74.5%), and vagi- nal bleeding (62.8%) aligns with the classic symptom triad described in the litera- ture [1] [8] [12] [31]. These features remain the cornerstone of early clinical sus- picion, particularly in settings where laboratory and imaging support may be lim- ited. Noticed similar trends in studies from Tanzania, reinforcing the universality of these symptoms even in varie d clinical environments [ 32]. Given diagnostic

in many low -resource settings, awareness of these symptom patterns is critical for early detection and management as this study reviewed the associa- tion between abdominal pain and abdominal tenderness with ruptured ectopic pregnancy p-values of 0.001 and 0.019 (4.33 [1.185 - 15.856]) respectively. In the current study, among women who underwent additional clinical diagno- sis, 27.7% demonstrated a positive Culdocentesis while 14.9% had a positive pa- racentesis. The identification of blood during Culdocentesis was a significant in- dicator of ruptured ectopic pregnancy, underscoring the strong correlation be- tween hemoperitoneum and tubal compromise [33] [34]. Outcomes at NTH indicated that 57.4% of patients had favourable clinical courses. This aligns with Berhe et al. [16] who reported a 62% favourable outcome rate [17]. However, 41.5% developed haemorrhagic shock and 1.1% of cases re- sulted in mortality similar to the rate reported in Zambia [9]. By contrast, several other studies reported no EP -related deaths [8] [15] [31]. At NTH, 77.7% of pa- tients were managed in general gynaecological bays, reflecting constraints in ac- cess to high- dependency or ICU care. As Suresh et al. [35] also notes, delayed diagnosis often results in severe outcomes such as salpingectomy, blood transfu- sions, or hypovolemic shock procedures associated with increased morbidity and health system burden [35]. Ruptured ectopic pregnancy is a serious gynaecological emergency associated with significant maternal morbidity, primarily due to intra- abdominal bleeding which was a key finding of this study was the notably high incidence of ruptured ectopic pregnancies, observed in 88.3% of the cases. Delayed presentation remains H. Chungu et al. DOI: 10.4236/ojog.2026.162040 411 Open Journal of Obstetrics and Gynecology a critical contributing factor. In the current study, a large proportion of women were either referred from peripheral facilities or self -presented only after severe symptoms had developed. This mirrors the findings of Andola and Desai [ 25], who reported that approximately 80% of patients presented after the EP ruptured. Contributing factors to delayed presentation in this current study include poor awareness of being pregnant (gestational age) where 23.4% of participants were unsure of thei r last menstrual period and ongoing vaginal bleeding reported in 62.8% of cases, which likely masked the early signs of pregnancy. Moreover, ab- dominal pain, which was reported by 96.8% of participants, typically only prompted hospital visits once the condition had progressed. 5. Public Health Implications The observed strong association between ectopic pregnancy (EP) and low-income residential areas highlights the urgent need for targeted public health interven- tions in underserved communities. These should include comprehensive repro- ductive health education and robust strategies for the prevention and management of sexually transmitted infections (STIs). With more than half of EP cases linked to a prior history of pelvic inflammatory disease (PID), there is a critical need to expand access to STI screening, treatment, and health education— particularly in low-income and high-burden settings. Additionally, the considerable use of emer- gency contraception among affected individuals underscores the importance of in- formed contraceptive counselling. Healthcare providers should ensure that women, especially those at elevated risk, are adequately informed about the potential risks associated with methods such as Levonorgestrel emergency contraception (LNG- EC) and intrauterine contraceptive devices (IUCDs), including the possibility of ectopic implantation. The high incidence of haemorrhagic shock further indicates the necessity of improving emergency triage systems and increasing the availabil- ity of high-dependency or intensive care units for gynaecological emergencies. Fi- nally, ongoing surveillance and the collection of region- specific epidemiological data are vital to inform effective policy development and the design of targeted programs aimed at reducing the burden of ectopic pregnancy. 6. Strengths and Limitations A key strength of this study lies in its prospective design, which allowed for sys- tematic data collection across multiple domains— sociodemographic, clinical, im- aging, and surgical — minimizing recall bias and improving data completeness. The relatively large sample size (n = 94) for a single-centre study also contributed. Being a cross-sectional study led to study limitations: • It did not determine the cause-effect of independent and dependent variables. • Generalization of results is not statistically right to the entire population in Ndola district for the research was hospital based (NTH). • It only focused on the immediate outcomes of ectopic pregnancy leaving out the long-term outcomes like fertility issues. H. Chungu et al. DOI: 10.4236/ojog.2026.162040 412 Open Journal of Obstetrics and Gynecology 7. Conclusions This study provides critical insight into the epidemiology, clinical presentation, and outcomes of ectopic pregnancy (EP) at Ndola Teaching Hospital, highlighting both consistencies and disparities when compared to national, regional, and in- ternational data. The slightly elevated prevalence, combined with sociodemographic findings such as a predominance of cases among low-income, unemployed, and rel- atively young women, underscores the intersection between socioeconomic vulner- ability and reproductive health outcomes. The high proportion of cases associated with pelvic inflammatory disease, early gestational presentation, and use of emer- gency contraception points to identifiable and, in many cases, preventable risk factors. The significant incidence of haemorrhagic shock and the constraints in access- ing high-dependency care further illustrate the challenges faced in resource- lim- ited settings, where delayed diagnosis and limited emergency capacity contribute to maternal morbidity and mortality. These findings reinforce the urgent need for public health strategies that prioritize early diagnosis, improve access to care, en- hance sexual and reproductive health education, and strengthen emergency re- sponse systems. Overall, the results of this study emphasize the importance of routine surveil- lance, context-specific health education, and health system strengthening to re- duce the burden of ectopic pregnancy and improve maternal health outcomes in Zambia and similar settings. Conflicts of Interest The authors declare no conflict of interest related to the publication of this work.

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