Research exposes deadly gaps in care for ectopic pregnancies

When Nontando* developed abdominal pain followed by spotting, she assumed she was about to start her period. But when the pain became unbearable, her boyfriend rushed her to Khayelitsha Hospital.

There, she received the shock of her life: she had an ectopic pregnancy .

“I was not even aware that I was pregnant . I was shocked and scared when the doctors told me that I had lost my pregnancy. I could not hear anything after that. My mind went blank,” she said.

Nontando’s experience highlights the often subtle and easily overlooked symptoms of ectopic pregnancy, a potentially life-threatening condition that requires urgent diagnosis and treatment.

Research by Dr Maria Mmaphefo Maluleka, a registrar in Family and Primary Health Care at Sefako Makgatho Health Sciences University, found that delays in recognising and treating ectopic pregnancies continue to cost women their lives.

According to the Saving Mothers 2020–23 report, 103 women died from ectopic pregnancy-related causes during the reporting period. Of these deaths, 82% involved some form of suboptimal care, while 45% were considered clearly avoidable.

Maluleka said the findings showed that many deaths could potentially have been prevented through earlier diagnosis and timely intervention.

“South Africa needs a dependable health system that recognises ectopic pregnancy at the first consultation, confirms pregnancy promptly, provides urgent ultrasound for stable women, transfers patients safely and ensures immediate surgery for women with ruptured ectopic pregnancies or haemorrhagic shock,” she said.

Ultrasound is valuable, but its absence must never delay referral of a clinically unstable woman. A woman with a positive pregnancy test and acute abdominal findings needs urgent surgical assessment and haemorrhage control, not prolonged diagnostic delays.

“The finding that 45% of deaths were clearly avoidable means that timely and competent care could save many of these women.”

She said ectopic pregnancy should not only be viewed as a clinical emergency, but also as an indicator of the quality and responsiveness of the country’s primary and district healthcare systems.

The World Health Organization similarly emphasises that early diagnosis and timely intervention are essential to reducing maternal illness and deaths from ectopic pregnancy.

Maluleka said ectopic pregnancy often presents with non-specific symptoms that can mimic other conditions. In resource-limited settings, delays in accessing ultrasound or beta-human chorionic gonadotropin (β-hCG) testing can become life-threatening.

Patient-related factors can also contribute to delays, including delayed health-seeking behaviour, poor recognition of warning signs and uncertainty about pregnancy status.