Socioeconomic Analysis of the Surgical Management of Ectopic Pregnancies: An Analysis of the National Inpatient Sample

Background Older data indicate that less patients undergo surgery for complicated peptic ulcer disease (PUD). We evaluated contemporary trends in the surgical management and outcomes of patients with complicated PUD. Methods The National Inpatient Sample (2005-2014) was queried for patients with complicated PUD (hemorrhage, perforation, or obstruction). Trend analyses were used to evaluate changes in management and outcomes. Results There were 1 570 696 admissions for complicated PUD during the study period. Majority (87.0%) presented with hemorrhage, 10.6% presented with perforation, and 2.4% had an obstruction. The average age was 67 years. Overall, admissions with complicated PUD decreased from 180 054 in 2005 to 150 335 in 2014. The proportion of patients managed operatively decreased from 2.5% to 1.9% in the hemorrhage group, 75.0% to 67.4% in the perforation group, and 26.0% to 20.2% in the obstruction group (all P-trend < .05). Overall, among patients managed operatively, the use of acid-reducing procedures decreased from 25.9% to 13.9%, mortality decreased from 11.9% to 9.4% (both P-trend < .001), while complications remained stable (10.4% to 10.3%, P-trend = .830). Conclusions There are fewer admissions with complicated PUD and more patients are treated nonoperatively. Despite subtle improvements, significant proportions of patients still die from complicated PUD indicating the need for improved preoperative optimization and postoperative care among these patients.

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Surgical intervention in ectopic pregnancies

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.06.3587 ◽

2019 ◽

Vol 26 (06) ◽

Author(s):

Fouzia Rasool Memon ◽

Mini Poothavelil ◽

Samreen Memon

Keyword(s):

Ectopic Pregnancy ◽

Surgical Management ◽

Surgical Intervention ◽

University Hospital ◽

Time Interval ◽

Presenting Symptoms ◽

Beta Hcg ◽

Ultrasound Findings ◽

Ectopic Pregnancies ◽

Study Setting

Objectives: To find out the negative laparoscopy rate for suspected ectopic pregnancy. Study Design: Retrospective cohort study. Setting: Electronic medical record databases in North Cumbria University Hospital, Carlisle, United Kingdom. Period: August 2014 to August 2018. Material and Methods: The data of total 150 laparoscopies performed for ectopic pregnancy management was collected for gestational age at presentation, symptoms, serial beta human chorionic gonadotrophic hormone (HCG) levels, ultrasound findings, time interval for diagnosis, time to surgery and histology. Results: One hundred and fifty patients (52 under 5 weeks and 98 over 5 weeks’ gestation) were incorporated into this study. The primary presenting symptoms were pain and vaginal bleeding. Suboptimal rise in serial beta HCG (performed 48 hours apart) was seen in 69 patients (46%) while other 81 patients (54%) had confirmed ectopic on USS and were offered surgical management after the scan. One hundred forty for women (96%) went for surgical management and one patient had conservative management as she was asymptomatic with low HCG(less than 1000IU) at the first visit and rapid drop in serial BHG results. Fifty three women (35%) had surgery on the same day when they had ectopic pregnancies seen on USS, 63 (42%) went to theatre for surgery between 0-6 days, while 34 patients (23%) had surgery between 7-14 days of USS. All women were operated through laparoscopic route and tubal ectopic pregnancies were confirmed at laparoscopy. There was no negative laparoscopy in our study period. Conclusion: Judicious and timely surgical intervention made it possible to treat every case through laparoscopic route with zero negative laparoscopy rate.

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Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/906825 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Mara Clapp ◽

Jaou-Chen Huang

Keyword(s):

Ectopic Pregnancy ◽

Surgical Management ◽

Thermal Injury ◽

Tubal Pregnancy ◽

Effective Alternative ◽

Intrauterine Pregnancy ◽

Tubal Ectopic Pregnancy ◽

Tubal Patency ◽

Ectopic Pregnancies

Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue.Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG) confirmed tubal patency. The patient subsequently had an intrauterine pregnancy.Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.

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An audit on surgical management of Tubal ectopic pregnancies and patients’ preferences survey

Sri Lanka Journal of Obstetrics and Gynaecology ◽

10.4038/sljog.v37i2.7749 ◽

2015 ◽

Vol 37 (2) ◽

pp. 19

Author(s):

R. P. Pathiraja ◽

M. A. M. M. Jayawardane ◽

K. C. D. P. Silva ◽

S. Srisanjeevan

Keyword(s):

Surgical Management ◽

Ectopic Pregnancies

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Impact of SARS-Cov-2 on ectopic pregnancies management in the United Kingdom: a multicentre paired observational study

10.22541/au.160642275.57561401/v1 ◽

2020 ◽

Author(s):

Sophie Platts ◽

Jeewantha Ranawakagedon ◽

Reeba Oliver ◽

Sayantana Das ◽

Phalguni Kotabagi ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Surgical Management ◽

Expectant Management ◽

Complication Rates ◽

University Hospitals ◽

Length Of Treatment ◽

Hospital Visits ◽

Ectopic Pregnancies ◽

The Impact ◽

Pregnancy Registry

Objective: to describe the impact of COVID-19 on the management of patients with ectopic pregnancy. Design: a multicentre study comparing outcomes from a prospective cohort during the pandemic [Covid-ectopic pregnancy registry (CEPR)] compared to an historical pre-pandemic cohort [non-Covid ectopic pregnancy registry (NCEPR)]. Setting: five London university hospitals. Population and Methods: consecutive patients diagnosed clinically and/or radiologically with ectopic pregnancy (March/2020-Aug/2020) were entered into the CEPR and an exploratory matched analysis was performed comparing results to NCEPR patients (January/2019-June/2019). Main outcome measures: patient demographics, management (expectant, medical and surgical), length of treatment, number of hospital visits (non-surgical management), length of stay (surgical management) and 30-day complications. Results: 341 patients met inclusion: 162 CEPR and 179 NCEPR. A significantly higher percentage of women underwent non-surgical management versus surgical management in the CEPR versus NCEPR (58.6% [95/162] vs 72.6% [130/179]; p= 0.0084]. Amongst patients managed with expectant management the CEPR had a significantly lower mean number of hospital visits compared to NCEPR [3.6 [SD 1.4] vs 13.7 [SD 13.4], p= 0.0053]. Amongst patients managed with medical management, the CEPR had a significantly lower mean number of hospital visits [NCEPR 6.4 [SD 2.3] vs 8.8 [SD 3.9], p= 0.0014]. There was no observed difference in complication rates between cohorts. Conclusion: women were found to undergo significantly higher rates of non-surgical management during COVID-19 first wave vs NCEPR cohort. Women managed non-surgically in CPER cohort were also managed with fewer hospital attendances. This did not lead to an increase in observed complications rates.

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An Audit of Management of Ectopic Pregnancy in a Major Tertiary Healthcare Service

Fertility & Reproduction ◽

10.1142/s266131822150002x ◽

2021 ◽

pp. 1-5

Author(s):

Krystle Y. Chong ◽

Yee K. Mak ◽

Beverley Vollenhoven ◽

Ben W. Mol

Keyword(s):

Ectopic Pregnancy ◽

Surgical Management ◽

Medical Management ◽

Expectant Management ◽

Tertiary Hospital ◽

Management Options ◽

Local Hospital ◽

Retrospective Audit ◽

Tertiary Healthcare ◽

Ectopic Pregnancies

Background: Ectopic pregnancy remains the most common cause of early pregnancy mortality, with management options differing according to clinical presentation and investigations. This audit aims to investigate the indications for medical and surgical management of ectopic pregnancy at a tertiary hospital network, in order to assess variances in practice and adherence to local hospital protocols. Methods: A retrospective audit of the management of women with a diagnosis of ectopic pregnancy was performed over 12 months from July 2018 to June 2019, at three hospitals in the largest healthcare network in Victoria, Australia. Information collected included patient demographics, risk factors for ectopic pregnancy, pathology and radiology results, documented indication for surgery, and any complications of treatment. A subgroup analysis of data was done to investigate changes and deficiency in management of ectopic pregnancy compared to local hospital protocol. Results: Over a 12-month period, 138 women were diagnosed with an ectopic pregnancy, of which 99 (72%) received surgical management and 39 (28%) received medical management. Four women within the medical group were excluded from analysis, one due to loss of follow-up and three patients who were diagnosed with nontubal ectopic pregnancies. About 94% (33/35) of women who received methotrexate were within hospital guidelines for medical management and 91% (32/35) were successfully managed without surgery. All women who received surgical management underwent a salpingectomy and 97% (96/99) had clear indications documented for surgery within local protocol. Conclusion: Overall, the majority of women with ectopic pregnancy were treated according to local guidelines. Expectant management and the option of salpingostomy as a surgical alternative could be considered in the local guidelines. The dissemination of this clinical audit data is aimed at continuing clinical governance and improvements in outcomes.

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