Ectopic Pregnancy: When life grows outside the womb

Nancy Akinyi, 30, with her baby at Bondo Sub-County Hospital. Akinyi delivered the baby following an ectopic pregnancy.[Marann Muganda, Standard]

At Bondo Sub-County Hospital, the maternity ward is a place of new beginnings. This afternoon, the cries of newborns fill the large ward as mothers rest beside their babies.

Among them is 30-year-old Nancy Akinyi, cradling a child whose arrival was anything but ordinary. Her pregnancy had not been growing inside her womb. The fertilised egg had implanted in her abdomen, a rare form of ectopic pregnancy that can become life-threatening when diagnosis and treatment are delayed.

“When I first started feeling sick, I was diagnosed with malaria, now and then. I continued being sickly until I decided to go back to the hospital for treatment,” Nancy says.

She had been experiencing abdominal pain, but it was only after further tests that she learnt she was five months pregnant. The next revelation left her confused. “I was pregnant and told that my child was growing outside the womb. I did not know what that meant,” she says.

She spent about a week at home trying to make sense of the diagnosis before returning to hospital, where she was reviewed and referred to a gynaecologist.

“The doctors sat me down, explained, and told me that the baby was growing outside the womb, and that meant it was dangerous for me,” Nancy recalls.

Evelyne Mwalo, the nutritionist-in-charge at Bondo Sub-County Hospital.[Maryann Muganda,Standard]

The following morning, at about 9am, she was wheeled into theatre. What doctors found was an abdominal pregnancy, one of the rarer forms of ectopic pregnancy.

According to Dr Evans Ogoti a medical superintendent and consultant obstetrician-gynaecologist at Bondo Sub-County Hospital, in a normal pregnancy the fertilised egg implants in the lining of the uterus. An ectopic pregnancy occurs when it implants somewhere outside the uterine cavity.

“The fallopian tube is the most common site, but implantation can occur elsewhere, including the abdomen,” Dr Ogoti says.

The condition can quickly become a medical emergency. “If it undergoes rupture, it could lead to catastrophic bleeding,” he says. A ruptured ectopic pregnancy can cause severe internal bleeding, leading to shock, severe anaemia, collapse and death if treatment is not provided quickly.

Some carefully selected early ectopic pregnancies can be managed medically or through close monitoring, depending on factors such as the woman’s stability, the size and location of the pregnancy and beta-hCG levels. A suspected rupture, however, requires urgent intervention.

Nancy’s pregnancy had progressed unusually far. She arrived at about 28 weeks’ gestation with abdominal pain, and an ultrasound revealed the abdominal pregnancy. “We moved in swiftly, rushed her to theatre,” Ogoti says.

The baby was delivered weighing about one kilogram and admitted to the newborn unit, where the infant would remain for nearly three months. Two days after surgery, Nancy was called to see her child.

“When I got there, the baby was not something I was impressed with; it didn’t look like a baby. I was shocked it was tiny,” she says.

George Ombwak, a reproductive health clinician at the hospital, says the cause of Nancy’s ectopic pregnancy could not be established. Some cases are linked to conditions that affect the fallopian tubes; others occur without any identifiable risk factor.

“Part of the reasons why she got an ectopic pregnancy we cannot establish,” Ombwak says. “Some of the predisposing factors include factors that affect the tube, tubal blockage, previous history of ectopic pregnancy and infections of the pelvis, which is a major risk factor.”

Other abnormalities of the reproductive system, including fibroids depending on their location, can also raise the risk. “Some are unexplained. They just walk out of the ordinary. You’re not able to pick a risk factor for the same,” he says.

The premature newborn required specialised care as health workers worked to keep the baby stable and help it gain weight. The child was eventually discharged weighing about 1.7 kilogrammes.

But when Nancy returned for a routine review about three months later, health workers noticed the baby was not gaining weight as expected. At about 1.845 kilogrammes, the child was readmitted.

This time, the problem was not only medical. The hospital’s multidisciplinary team found that social and economic circumstances were affecting Nancy’s ability to provide the nutrition and care a premature baby needs. She was living alone and working to provide for herself and her child.

Evelyne Mwalo, the nutritionist-in-charge at Bondo Sub-County Hospital, says the child was placed on therapeutic feeds alongside breastfeeding, with the weight eventually rising to 2.4 kilogrammes.

“We still want to do inpatient management for some time as we also tackle socio-economic issues back at home,” Mwalo says.

The baby is currently receiving F-100 therapeutic milk, breastfeeding on demand and being introduced to complementary foods under nutritional supervision. Premature babies can have additional nutritional and developmental needs compared with babies born at term. “They are not the same as the term babies,” Mwalo says. Some struggle to suck effectively and require expressed breast milk given through a cup or feeding tube until they can breastfeed directly.

Nutrition, however, cannot be separated from the circumstances in which a mother and child live. A breastfeeding mother also requires adequate food and support, particularly where poverty, stress and limited family support make it difficult to maintain regular feeding. “Nutrition is important for both the mother, the baby, the household at large,” Mwalo says.

For health workers, the challenge is not simply helping a baby gain weight in hospital, but ensuring that the progress is sustained after discharge.

Ogoti says the facility sees an average of five to six ectopic pregnancies every month. The figure is significant because ectopic pregnancy remains uncommon compared with normal pregnancies, yet its complications can be severe. Most women arrive too late.

“Most of them come to us already complicated in terms of having ruptured already,” he says.

Delayed diagnosis is one of the challenges. Some women do not have an ultrasound early enough in pregnancy to establish where it is developing, yet determining the location of a pregnancy is an important part of early assessment, particularly when a woman has symptoms or risk factors.

“We want to confirm, is this pregnancy actually in the uterus or is it out of the uterus?” Ogoti says.

A 2026 study from Aga Khan University Hospital in Nairobi identified 347 surgically managed ectopic pregnancies between 2011 and 2020, representing 1.78 ectopic pregnancies per 100 live births at that facility.

The consequences of delayed diagnosis form part of a much wider maternal-health challenge. The World Health Organisation estimates that about 260,000 women died during and following pregnancy and childbirth globally in 2023, with sub-Saharan Africa accounting for about 70 per cent of those deaths. Although maternal mortality in the African region has declined since 2000, WHO says progress remains too slow to meet the global target of fewer than 70 maternal deaths per 100,000 live births by 2030.

Ectopic pregnancy is only one part of that burden. For health workers, the message is straightforward: pregnancy should be followed early, and concerning symptoms should not be ignored. Ogoti advises women to begin antenatal care early, undergo recommended examinations and ultrasound when indicated, and seek medical attention promptly when warning signs appear. “Come to hospital very early,” he says.

Maternal and newborn outcomes are also shaped by what happens outside the consultation room. Medical social workers at Bondo are dealing with another layer of vulnerability, mothers who lack financial, emotional and family support.

Auma Okello, a medical social worker at the hospital, works with teenage mothers as well as mothers generally. She says the facility receives a significant number of teenage mothers, including girls as young as 14. At one point, she says, the hospital received a 13-year-old mother.

The support offered goes beyond counselling. “We do psychosocial counselling,” Okello says. For mothers unable to settle hospital bills, social workers may help secure waivers while mobilising support for basic items such as diapers and wipes. “Most of them are never prepared,” she says.

Poverty repeatedly emerges when the social circumstances surrounding teenage pregnancy are examined. “Poverty is a major contributor to teenage mothers being here,” she says.

George Ombwak, a reproductive health clinician at Bondo Sub County Hospital, Siaya County.[Maryann Muganda, Standard]

For some mothers, the difficulty continues after delivery. A mother caring for a premature or sick newborn may need help with feeding, transport, household chores, and other basic needs. Teenage mothers may face additional challenges because they are still dependent on parents or guardians and may have little control over household finances.

Even a visit can make a difference. “When you come here, when you are visited, you feel good. It’s therapeutic,” Okello says. The absence of such support has the opposite effect. “You come here, nobody visits you, it demoralises you,” she says.

Some mothers spend long periods in hospital without their partners or other family members. Okello says some women report that their partners disappear when they learn about hospital bills or the responsibilities associated with a new baby.

“Most of these women that complain, ‘I’ve not been visited, nobody’s coming,’ if you look at it carefully, men are just around here,” she says.

She believes greater involvement of men is necessary, particularly in providing financial and emotional support to mothers and newborns.