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.

scholarly journals Role of human chorionic gonadotrophin to prevent repeated early pregnancy loss

2016 ◽  
Vol 48 (1-2) ◽  
pp. 7-10
Author(s):  
Eti Saha ◽  
Fouzia Begum ◽  
Zannatul Ferdous Jesmin
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Loss ◽  
First Trimester ◽  
Additional Treatment ◽  
Chorionic Gonadotrophin ◽  
Human Chorionic Gonadotrophin ◽  
Early Pregnancy Loss ◽  
Significant Difference ◽  
Improve Pregnancy Outcome ◽  
History Of

Early pregnancy loss is a frustrating experience for both the patient and the physician. Approximately 5% of couples trying to conceive have 2 consecutive miscarriages and approximately 1% couples have 3 or more consecutive losses. Objective of this study is to determine whether therapy with dydrogesterone or Human chorionic Gonadotrophin hormone (HCG) in history of repeated pregnancy loss during the first trimester of pregnancy will improve pregnancy outcome. This is a prospective open comparative study.Women having early pregnancy presenting to a private clinic with history of early pregnancy loss, having no medical disorder were included in this study. Eligible subjects were randomised to receive either dydrogesterone 20mg daily or injection Human Chorionic Gonadotrophins (HCG) 5000 iu intramuscularly at 72 hours interval up to fourteen weeks of pregnancy or no additional treatment. Follow up of those patients were done with transabdominal ultrasonography. Hundred women were recruited. There was no statistically significant difference between the three groups with regard to pretreatment status. The continuing pregnancy success rate was higher in women treated with dydrogesterone (79.17%) and highest with Injection Human Chorionic, Gonadotrophin (86.36%) compared with women received no treatment (70%), (p=0.358). Hormonal support with either dydrogesterone or Human Chorionic Gonadotrophin may increase the chances of a successful pregnancy in women with a history of spontaneous abortion.Bang Med J (Khulna) 2015; 48 : 7-10

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 COMPARATIVE STUDY OF MANUAL VACUUM ASPIRATION AND DILATATION & EVACUATION IN TERMS OF THEIRS ACCEPTABILITY AND COMPLICATIONS FOR THE SURGICAL MANAGEMENT OF EARLY PREGNANCY LOSS

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
B S Meena ◽  
Narendra Kumar
Keyword(s):  
Success Rate ◽  
Surgical Management ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Early Pregnancy Loss ◽  
Missed Abortion ◽  
Medical College ◽  
Vacuum Aspiration ◽  
Manual Vacuum Aspiration ◽  
Incomplete Miscarriage

Background: To compare efficacy and complication of manual vacuum aspiration and dilatation and evacuation as the method for early pregnancy loss surgical management. Methods: This study was conducted in the Department of Obstetrics and Gynaecology, SMS Medical College & Associated group of Hospitals, Jaipur during this study, 200 pregnant women with below 12 weeks gestational age having a confirmed diagnosis of incomplete miscarriage and missed abortion were included. All selected cases divided into MVA group and D&E group randomly. Results: MVA group 98% cases were successful and failure was in 2% which required re-procedure. In D&E group 94% cases were successful and failure was in 6% cases which required re-procedure. Success rate was founded more in MVA group than D&E group. Conclusion: On comparison of the two, in our study MVA was seen to be having an edge over D&E, regarding complication and success rate. Keywords: MVA, D&E, Complication, Success rate.

First-trimester maternal dried blood Down syndrome screening marker levels in early pregnancy loss

2006 ◽  
Vol 26 (12) ◽  
pp. 1137-1141 ◽  
Author(s):  
David Krantz ◽  
Terrence Hallahan ◽  
Stephanie Ishack ◽  
V. James Macri ◽  
James N. Macri
Keyword(s):  
Down Syndrome ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
First Trimester ◽  
Early Pregnancy Loss ◽  
Screening Marker ◽  
Down Syndrome Screening

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
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