Pregnancy of Unknown Location, Early Pregnancy Loss, Ectopic Pregnancy, and Cesarean Scar Pregnancy

2018 ◽  
pp. 236-246.e1
Author(s):  
Anna Katerina Sfakianaki ◽  
Ana Monteagudo ◽  
Ilan E. Timor-Tritsch
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Early Pregnancy Loss ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Pregnancy Of Unknown Location

scholarly journals P074: Emergency department utilization and outcomes for patients with early pregnancy complications

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S91-S91
Author(s):  
R. Glicksman ◽  
D. Little ◽  
C. Thompson ◽  
S. McLeod ◽  
C. Varner
Keyword(s):  
Emergency Department ◽  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Pregnancy Loss ◽  
Hospital Admissions ◽  
Emergency Department Utilization ◽  
Early Pregnancy Loss ◽  
Surgical Interventions ◽  
Ed Visits

Introduction: Affecting roughly 1 in 5 pregnancies, early pregnancy loss is a common experience for reproductive-aged women. In Canada, most women do not establish care with an obstetrical provider until the second trimester of pregnancy. Consequently, pregnant patients experiencing symptoms of early pregnancy loss frequently access care in the emergency department (ED). The objective of this study was to describe the resource utilization and outcomes of women presenting to two Ontario EDs for early pregnancy loss or threatened early pregnancy loss. Methods: This was a retrospective cohort study of pregnant (≤20 weeks), adult (≥18 years) women in two EDs (one community hospital with 110,000 annual ED visits; one academic hospital with 65,000 annual ED visits) between January 2010 and December 2017. Patients were identified by diagnostic codes indicating early pregnancy loss or threatened early pregnancy loss. Results: A total of 16,091 patients were included, with a mean (SD) age of 32.8 (5.6) years. Patients had a total of 22,410 ED visits for early pregnancy complications, accounting for 1.6% of the EDs’ combined visits during the study period. Threatened abortion (n = 11,265, 50.3%) was the most common ED diagnosis, followed by spontaneous abortion (n = 5,652, 25.2%), ectopic pregnancy (n = 3,242, 14.5%), missed abortion (n = 1,541, 6.9%), and other diagnoses (n = 710, 3.2%). 8,000 (44.8%) patients had a radiologist-interpreted ultrasound performed during the initial ED visit. Median (IQR) ED length of stay was 3.4 (2.3 to 5.1) hours. There were 4,561 (25.6%) return ED visits within 30 days, of which 2,317 (50.8%) occurred less than 24 hours of index visit, and 481 (10.6%) were for scheduled, next day ultrasound. The total number of hospital admissions was 1,793 (8.0%), and the majority were for ectopic pregnancy (n = 1,052, 58.7%). Of admitted patients, 1,320 (73.6%) underwent surgical interventions related to early pregnancy. There were 474 (10.4%) patients admitted to hospital during return ED visits. Conclusion: Pregnant patients experiencing symptoms of early pregnancy loss in the ED frequently had radiologist-interpreted US and low rates of hospital admission, yet had high rates of return ED visits. This study highlights the heavy reliance on Ontario EDs to care for patients experiencing complications of early pregnancy.

scholarly journals Diagnostic Methods of Ectopic Pregnancy and Early Pregnancy Loss: a Review of the Literature

2016 ◽  
Vol 76 (04) ◽  
pp. 377-382 ◽  
Author(s):  
A. Hamza ◽  
G. Meyberg-Solomayer ◽  
I. Juhasz-Böss ◽  
R. Joukhadar ◽  
Z. Takacs ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Diagnostic Methods ◽  
Early Pregnancy Loss ◽  
Review Of The Literature

scholarly journals P120: A survey of Ontario Family Health Teams: Family physicians are reliant on emergency services for complicated early pregnancy loss

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S108-S108
Author(s):  
J. Cirone ◽  
C. Thompson ◽  
S. McLeod ◽  
C. Varner
Keyword(s):  
Ectopic Pregnancy ◽  
Family Physician ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Family Health ◽  
Family Physicians ◽  
First Trimester ◽  
Early Pregnancy Loss ◽  
Missed Abortion ◽  
Obstetrical Care

Introduction: The majority of first trimester pregnancy care in Canada is provided by family physicians and emergency departments (EDs). Early pregnancy loss occurs in approximately 30% of pregnancies, and the majority take place in first trimester when many patients do not yet have an obstetrical care provider. In Ontario, nearly 70% of patients are rostered to a family physician, many of whom practice in Family Health Teams (FHTs). The objective of this study was to determine how Ontario family physicians manage early pregnancy complications and explore the services available for patients experiencing early pregnancy loss or threatened early pregnancy loss. Methods: Family physician leads from 104 Ontario FHTs were contacted by email and invited to complete a 19-item, online questionnaire using modified Dillman methodology. The survey was developed by investigators based on a review of relevant literature and consultation with clinical experts. Prior to distribution, the questionnaire was peer reviewed and tested for face and construct validity, as well as ease of comprehension. Results: Respondents from 50 FHTs across Ontario completed the survey (response rate 48.1%). Of the respondents, 45 (90.0%) reported access to an ED in their community, 45 (90.0%) had access to an obstetrician/gynecologist, 33 (66.0%) had access to an early pregnancy clinic, and 18 (36.0%) reported comprehensive obstetrical care from first trimester to delivery within their FHT. The following services were only accessible through the ED: administration of RhoGAM (n = 28; 56.0%); surgical management of spontaneous or missed abortion (n = 22; 44.0%); same day serum quantitative beta human chorionic gonadotropin (n = 21; 42.0%); same day radiologist-interpreted ultrasound assessment (n = 15; 30.0%); and medical management of spontaneous or missed abortion (n = 12; 24.0%). Forty (80.0%) respondents stated physicians in their practice would provide urgent follow-up care for patients with spontaneous abortion, 35 (70.0%) would provide care for threatened abortion, and 26 (52.0%) would provide urgent care for missed abortion. For patients with a stable ectopic pregnancy, 37 (74.0%) respondents would refer to the ED. Conclusion: This study suggests FHTs in Ontario provide comprehensive care to patients with uncomplicated early pregnancy loss such as spontaneous abortion, yet rely on the ED for management of complicated early pregnancy loss, when medical or surgical management is indicated or for ectopic pregnancy.

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

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