2.2. Liderazgo Educacional 1 Concepto
2.3.2. Características de un líder:
In this case controlled study, the prevalence of serum antichlamydia antibody in women with ectopic pregnancy was 70.8%, and in women with normal intrauterine pregnancy, it was 37.5%. Thus, the prevalence of serum antichlamydia antibody was high in women with ectopic pregnancy, and significantly higher than the prevalence in women with normal intrauterine pregnancy. This trend is in agreement with reports from studies worldwide in which detection rates of antichlamydia antibodies in patients with ectopic pregnancy of 60 to 85% have been reported20-27
. The study also confirms report of investigations by numerous authors worldwide that
patients with ectopic pregnancy are more likely to have immunoglobulin G (IgG) antibodies against Chlamydia trachomatis when compared with women with normal intrauterine pregnancy20-27. Thus, t
he results confirmed that there is a positive relation between prior Chlamydia trachomatis infection and ectopic pregnancy. The high prevalence of prior Chlamydial infection as evident by presence of antchlamydia antibody among women in this study, and other studies elsewhere in the world20-27, underscores why ectopic pregnancy remains a major challenge to the reproductive health of women worldwide, and why the incidence is increasing in parallel with dramatic rise in the rate of Chlamydial infection30-34.In the study, women with ectopic pregnancy were more likely to be unmarried, of low educational status, of low parity, have sexual debut at younger age, have multiple sexual partners and inconsistent user or non-user of condoms when compared with women with normal intrauterine pregnancy. This finding is in agreement with report from other authors14,21,23. Interestingly, these specific biologic and behavioral characteristics are risk factors for Chlamydia trachomatis infection1,6-8,48. Brunham, RC22 et al in 1992 reported that women with ectopic pregnancy are at increased risk of acquiring a sexually transmitted disease by
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virtue of their sexual behaviour and that such women have high prevalence of serological evidence of Chlamydia trachomatis infection and histologic evidence of plasma cell salpingitis. Thus, this finding in our study adds to the evidence that Chlamydia trachomatis tubal infection producing plasma cell salpingitis commonly underlies ectopic pregnancy. One area in which there was dissimilarity in documented risk factors for Chlamydial infection and identified risk factors for ectopic pregnancy in this study was in the use of oral contraceptive. Oral contraceptive users are said to be more susceptible to infection with Chlamydia trachomatis because of the presence of columnar epithelium on the ectocervix in them7. In this study, patients with ectopic pregnancy were more likely to be non oral contraceptive users. This is understandable as the combined oral contraceptive pills protect against both intrauterine and extrauterine pregnancies19.
There was no statistically significant difference in the prevalence of gynaecological symptoms previously reported by women with ectopic pregnancy compared to those with normal intrauterine pregnancy in our study. These symptoms are features of pelvic inflammatory disease. Several authors have documented that few women with ectopic pregnancy recall having had pelvic infection despite gross evidence of pelvic adhesions and histologic evidence of salpingitis in many, indicating that most of the infections were asymptomatic21-25. Thus, many women in the study group could have had asymptomatic pelvic infection resulting in no difference in the rate of symptoms reported when compared to those with normal intrauterine pregnancy. Genital Chlamydial infection in women is asymptomatic in about 80% of cases, and more likely to be asymptomatic when compared with gonococcal infection1,3,5. It has been documented by several authors that serum data for infection with Chlamydia trachomatis does not correlate with reported inflammatory gynecological diseases undergone in the past, as also evident by this study22-25. Thus, our finding suggests that subclinical Chlamydia trachomatis tubal infection is
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commonly the primary cause of ectopic pregnancy. Additionally, only 6.2% of women with ectopic pregnancy reported symptoms of urethritis in their partner and this was not significantly different from 4.2% of women in the control group.
There were also no symptoms of urethritis in the partners of more than half of women in the study group despite high prevalence of serum antichlamydia antibody. This suggests that infections in their partners could have been mostly asymptomatic.
In the study group, women below age 30 years were more likely to be antichlamydia antibody positive when compared with those above age 30 years.
The prevalence of serum antichlamydia antibody in women below age 30 years was 82.6%, while the prevalence was 60% in women age 30 years and above.
This is similar to the finding by Egger M. et al29 in 1998 that the strongest association between ectopic pregnancy and genital Chlamydial infection is observed among women aged 20-30 years. Falling rates of Chlamydial infection with intervention programmes have been accompanied by an immediate reduction in the rate ofectopic pregnancy among such women. Thus, Chlamydial infection seems to be most commonly the cause of ectopic pregnancy in young women below the age of 30 years. Interestingly, studies in Nigeria have shown that most women with ectopic pregnancy in our environment are in this age group15-18. Although the mechanismsresulting in occlusion of the fallopian tubes has been suggested to be a long term processes, including repeated infections, the series of Egger M. et al29 showed that among young women, a large proportion of ectopic pregnancies are a consequence of recent infections and that damage to tubal function resulting from inflammation and the loss of cilia may be present at an earlystage. Thus a combination of high prevalence of both active and past Chlamydial infection is involved in the occurrence of ectopic pregnancy in these women. Our study is however limited in establishing this because we did not demonstrate the presence of a concomitant active Chlamydial infection at the time of surgery through culture. Combining
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Chlamydial cultures with nonculture techniques may be more beneficial in further attempts to demonstrate such an association. These women represent the age group with the highest incidence of genital Chlamydial infection.
Our study also showed a significantly higher prevalence of serum antichlamydia antibody among women with ectopic pregnancy who had no other identifiable risk factors when compared with women who had IUCD insitu or had previous ectopic pregnancy. Studies by other authors have shown that women with ectopic pregnancy who did not have IUCD insitu or other readily identifiable predisposing factors had a higher prevalence of serum antichlamydia antibody22,23. This group constitutes the largest population of women with ectopic pregnancy, as apparent in this study.22 These findings, and previous epidemiological and biological evidence, suggest that infection of the fallopian tube with Chlamydia trachomatis is a major cause of ectopic pregnancies.