Determination of the Leading Clinical Features of Ruptured Ectopic Pregnancy and the Formulation of Scoring System for the Early Presumptive Diagnosis in a Tertiary Health Institution in Edo State, Nigeria

Background: Ectopic pregnancy is a life-threatening gynecological emergency and a significant cause of maternal morbidity and mortality in the first trimester of pregnancy.  Objective The aim of this study is to formulate a simple scoring system for the early presumptive diagnosis of ruptured ectopic pregnancy to minimize delay in recognizing the condition to reduce the associated maternal morbidity and mortality especially in the poorly resourced and low-income settings.  Methods A retrospective study of all cases of ruptured ectopic pregnancies at Central Hospital Benin City, Edo State, Nigeria from January 2021 to December 2023 were analyzed. Participants’ medical records were used to extract socio-demographic characteristics, clinical presentation and management outcome data. An acronym known as “PAPPA” was formulated from ‘pain’, the leading clinical features ‘pulse rate’, ‘adnexal tenderness’, ‘palor’ and ‘amenorrhea’ in order from the highest frequencies, with two points given to each clinical feature with a cumulative maximum score of 10. On the application of the PAPPA scoring parameter to the disease conditions that mimic ruptured ectopic pregnancy, in respect to their common clinical features, the maximum score obtained was found to be 6 points each. This meant that seven points could be taken as ‘discriminatory zone’ against these clinical differentials for early presumptive diagnosis of ruptured ectopic pregnancy.  Results There were sixty-nine (69) cases of ruptured ectopic pregnancies with an incidence of 3.4% of all gynecological admissions and 0.65% of total number of deliveries. The mean age of occurrence was 27.3 years and 49.3% of these cases were nulliparous. Five leading clinical features found to be present in the participants were identified: lower abdominal pain, adnexal tenderness, fast pulse rate, pallor and amenorrhea in frequencies of 100.0%, 100.0% 94.2%, 89.9% and 75.4% respectively.  Conclusion PAPPA scoring system is a useful tool which can increase the level of index of suspicion of ruptured ectopic pregnancy with a pelvic ultrasound scan backup for definitive diagnosis when available. This will aid escalation of cases in order to trigger early intervention and prevent maternal morbidities and mortalities.