By Simon Wokorach
Gulu
Approximately 50 kilometers West of Paibona Sub County at Ayweri village in Gulu district, Scovia Aciro discovered she was pregnant nearly two months in early February 2023.
The 25-year-old mother of three had gone to seek medical attention for malaria to a nearby private health facility but the medical tests at the facility confirmed that she had malaria and two-month old pregnancy.
“I started experiencing sharp abdominal pain though I had no idea that I was pregnant. This surprised me that I was carrying a two-month old pregnancy” Aciro told this News Agency in an interview.
Whereas her first and second deliveries were normal the yet-to-be-born baby had come with complications through a rare condition she was yet to discover.
With her deteriorating condition, in February 2023, she was referred from Paibona Health Centre III about 45 kilometers from Gulu district to Gulu Regional Referral Hospital for further management.
On arrival, the ultrasound scan machine had broken down. “They requested me to conduct this scan from a private clinic which cost me Shs 80,000 ,” she recounts
The ultrasound at its initial test showed that the pregnancy was normal but the pain continued to worsen.
In July 28, 2023, she returned to the referral hospital and was lucky that the ultrasound machine had been reinstated. It was at that time that she was discovered to have an ectopic pregnancy.
“When I returned for the test, the doctor advised me to drink a lot of water and later told me that my baby was growing outside the uterus. I failed to believe how this could happen” Aciro further explained.
Once her pregnancy was confirmed, surrounded with complications, Dr. Francis Pebalo, a Gynecologist from Gulu University assembled a team of 15 surgeons as she prepared for cesarean operation.
Dr. Pebalo confirmed that, at week 25, which is the sixth month when the second test was conducted, the results could still show that her pregnancy was normal even when they could see a need for consent abortion to save the mother but that would only be subjected with the confirmatory test which showed disparity.
“This is a rare thing and she is very lucky but one thing that saved this baby from termination was the wrong diagnosis that would indicate that it was a normal pregnancy. It’s a miracle and I must be happy that we have this first case in the region where we can see life coming out” Dr Pebalo explained.
According to The American College of Obstetrician and Gynecologists, ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. Almost all ectopic pregnancies, more than 90% occur in a fallopian tube. As the pregnancy grows, it can cause the tube to burst (rupture). A rupture can cause major internal bleeding which is a life-threatening emergency that requires immediate surgery.
This condition happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role, a case likely of Aciro.
Unlike a normal pregnancy, Dr Pebalo disclosed that for Aciro, the fetus just formed a sac in the intestine referred to as ‘omentum’ where the baby survived but there was a possibility that the baby would in this case rapture and blow the sac within two to three weeks but her case was different.
Though there are no clear statistics of ectopic pregnancy in the Country but worldwide it accounts for 1% of all pregnancies and there is no option than to terminate such pregnancy in the interest of saving the mother. “This is a rare case that we have seen the baby come out alive” Dr Pebalo reaffirmed.
While Aciro was successfully saved through surgical procedures, Dr Pebalo disclosed that a similar case was referred from Kitgum General Hospital in 2018 but the baby was discovered dead in the sac.
Separating the baby from the mother
With a team of 15 other surgeons, Dr Pebalo disclosed that they found the baby encased in the intestine and was in a sac which was hanging like a curtain while the placenta was sitting in front of the baby.
In a normal delivery, the baby could have come out through the lining of the uterus but the labor test (vaginal test) discovered that there was no opening of the pelvic which should have prepared the baby for safe passage since the baby had no attachment with the uterus cavity.
“We noticed that this was difficult and what we did was to expand the sac where the baby was hiding in and made way through a surgical process to save this baby and the mother” Dr Pebalo cheerfully explained.
Thankfully, the baby girl weighing 2.5 kilograms was successfully removed from the sac in the history of Gulu regional referral hospital.
Second operation to remove the placenta
Once the baby was removed, the placenta could have come out by itself but this was not possible and the medical team could neither remove it at the time of the first operation.
Removing the placenta immediately would have meant that another second operation be done to the uterus and yet the mother was too weak.
A decision was made to retain the placenta for a week and another successful operation was conducted to remove it.
Mothers need to seek early ANC
While the Ministry of Health requires all expectant mothers to go for Antenatal Care (ANC) visits to health facilities for a minimum of eight times, most of the mothers are yet to embrace it.
Rose Akumu, a midwife at Gulu Regional Referral Hospital noted that most of the deliveries done by the facility are referrals with complications from the lower health facilities arising from late ANC visits by the mothers.
For a mother such as Aciro, Akumu noted that her complication could have been detected much earlier in the first antenatal visit done by the first month.
“Most of these mothers come here when the placenta is saturated with blood clots which makes it difficult for us to save lives” Akumu noted.
The basis for early antenatal visits is to facilitate screening and determine the state of the pregnancy for proper planning.
But it is something the mothers are yet to appreciate as the majority embrace this service between the third to fifth months of their pregnancy.
Experts to study the new phenomenon
Meanwhile, the data on ectopic pregnancy in the Country has remained scanty but in a recent interview with Dr. Richard Mughai, the Assistant Commissioner of Infant and Maternal Health in the Ministry of Health, said the Country has registered a third case of ectopic pregnancy since the beginning of this year.
The first case in the year was registered in Mbarara Regional Referral Hospital in which both the baby and the mother were saved with support from the specialists from Mbarara University.
The second case was a referral from Bundibugyo district to the same hospital but the baby had already died.
“Ectopic pregnancies are becoming more common than before. We are yet to study the new trend and draw conclusions on the new phenomenon” Dr Mughai told GNNA.
The study by Makerere University in 2013 at Mulago Hospital showed an upward trend of ectopic pregnancy of 19 per every 1,000 pregnancies. 57% of the mothers had treated sexually transmitted diseases, 6% had involved in smoking and the frequent use of family planning like intrauterine devices.
