Attached.

Prof. James Ogola Onyango
Laikipia University, Nakuru Campus
PO BOX 16789-20100
Nakuru.
28th August 2017.

The Vice Chancellor
Machakos University 136-90100
Machakos.

Dear Sir,
RE: EXTERNAL EXAMINER’S REPORT
Thank you for appointing me to serve as an External Examiner-August 2017 session- as an
External Examiner. Attached herewith, please find my full report.
Yours faithfully,

Prof. Dr. James Ogola Onyango.

Final copy

ECTOPIC PREGNANCY
Definition:
 Ectopic pregnancy is derived from the Greek word ektopos, meaning out of place,
and it refers to the implantation of a fertilized egg in a location outside of the uterine
cavity, including the fallopian tubes, cervix, ovary, cornual region of the uterus, and
the abdominal cavity.
 This abnormally implanted gestation grows and draws its blood supply from the site
of abnormal implantation.
 As the gestation enlarges, it creates the potential for organ rupture because only the
uterine cavity is designed to expand and accommodate fetal development.
 Ectopic pregnancy can lead to massive hemorrhage, infertility, or death.
 It is the result of a flaw in human reproductive physiology that allows the conceptus
to implant and mature outside the endometrial cavity, which ultimately ends in death
of the fetus.
Epidemiology
 More than 95% of extrauterine pregnancies occur in the fallopian tube.
 Since 1970, the frequency of ectopic pregnancy has increased 6-fold, and it now
occurs in 2% of all pregnancies.
 This may be due, at least in part, to a higher incidence of salpingitis, an increase in
ovulation induction, and more tubal sterilizations.
 Ectopic pregnancy is a significant cause of maternal morbidity and mortality as well
as fetal loss.
 Ectopic pregnancy currently is the leading cause of pregnancy-related death during
the first trimester in the United States, accounting for 9% of all pregnancy-related
deaths.
 In addition to the immediate morbidity caused by ectopic pregnancy, the woman's
future ability to reproduce may be adversely affected as well
Etiology
 Multiple factors contribute to the relative risk of ectopic pregnancy.
 In theory, anything that hampers the migration of the embryo to the endometrial
cavity could predispose women to ectopic gestation
 Several risk factors have been found to be associated with ectopic pregnancy
Pelvic inflammatory disease
 The most common cause is antecedent infection caused by Chlamydia trachomatis.
 Other organisms causing PID, such as Neisseria gonorrhoeae, increase the risk of
ectopic pregnancy.
 A history of salpingitis increases the risk of ectopic pregnancy 4-fold.

 The incidence of tubal damage increases after successive episodes of PID (i.e. 13%
after 1 episode, 35% after 2 episodes, 75% after 3 episodes).
History of prior ectopic pregnancy
 After one ectopic pregnancy, a patient incurs a 7- to 13-fold increase in the likelihood
of another ectopic pregnancy.
 Overall, a patient with prior ectopic pregnancy has a 50-80% chance of having a
subsequent intrauterine gestation, and a 10-25% chance of a future tubal pregnancy.
History of tubal surgery and conception after tubal ligation
 Prior tubal surgery has been demonstrated to increase the risk of developing ectopic
pregnancy.
 The increase depends on the degree of damage and the extent of anatomic alteration.
 Surgeries carrying higher risk of subsequent ectopic pregnancy include
salpingostomy, neosalpingostomy, fimbrioplasty, tubal reanastomosis, and lysis of
peritubal or periovarian adhesions.
 Conception after previous tubal ligation increases a women's risk of developing
ectopic pregnancies.
 Thirty-five to 50% of patients who conceive after a tubal ligation are reported to
experience an ectopic pregnancy.
 Failure after bipolar tubal cautery is more likely to result i...