Frequency of utilisation of ultrasound in the diagnosis of ectopic pregnancy in Sub-Saharan Africa countries: A systematic review

Ectopic pregnancy (EP) is a common diagnosis, frequently misdiagnosed early in its presentation and a leading cause of first trimester mortality. Ultrasound (US) is a key component of evidence-based diagnostic algorithms. We present a systematic review on the frequency of the use of US in the diagnosis of EP in Sub-Saharan Africa. Methods: A librarian-assisted search of PUBMED, EMBASE, Cochrane, Web of Science, and POPLINE databases was performed. Inclusion criteria were original research studies that reported the proportion of patients receiving US as part of a workup for EP in a Sub-Saharan African country. Abstracts were reviewed and those potentially meeting criteria had a formal survey of the manuscript. Results: The initial search revealed 784 original publications. Manual review of abstracts narrowed this to 91 papers with potential relevance, and 12 studies were included in the final analysis. A total of 6055 patients diagnosed with EP were included. 8.7% received a pregnancy test. 92.3% were ruptured at the time of presentation. 42.9% were in shock and 75.8% received red blood cell transfusion. 73.7% were unaware of the pregnancy and 24.9% were seen by a healthcare worker prior to presentation, 1.1% of patients died. Overall, 12.6% received US to aid in the diagnosis. Conclusion: In this study, overall utilisation of US in the diagnosis of EP was found to be low. In this population, patients presented late and critically ill, obviating the need for US in many cases. However, studies in Sub-Saharan Africa in populations of patients with similar rates of late presentations have shown a substantial increase in the diagnosis of unruptured EP with the routine use of US