scholarly journals Efficacy of transabdominal ultrasound examination in the diagnosis of early pregnancy complications in an emergency department.

1998 ◽  
Vol 15 (3) ◽  
pp. 155-158 ◽  
Author(s):  
T W Wong ◽  
C C Lau ◽  
A Yeung ◽  
L Lo ◽  
C M Tai
Keyword(s):  
Emergency Department ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Ultrasound Examination ◽  
Transabdominal Ultrasound

scholarly journals P024: Obtaining consensus on optimal management and follow-up of patients presenting to the emergency department with early pregnancy complications – a modified Delphi study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S71-S72
Author(s):  
A. Cornelis ◽  
R. Clouston ◽  
P. Atkinson
Keyword(s):  
Emergency Department ◽  
Family Medicine ◽  
Nurse Practitioners ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Delphi Study ◽  
Pregnancy Loss ◽  
Early Pregnancy Loss ◽  
Modified Delphi

Introduction: Complications in early pregnancy are common and have many physical and emotional consequences. Locally, there is no early pregnancy loss clinic or standardized guide in the emergency department (ED) for referral and follow-up decisions, and both initial management of patients and follow up can be inconsistent. This study aimed to obtain consensus on the best approach to initial work-up, management, and follow up for patients who present to the ED with early pregnancy complications, with the goal of using this consensus to produce a standardized guide for emergency provider use. Methods: A literature review was completed to produce evidence-based recommendations which were used to initiate a modified Delphi consensus process. A survey was distributed, with three rounds completed. Participants included emergency providers, obstetrician-gynecologists, a radiologist, a sample of family medicine physicians including some involved in primary care obstetrics, and nurse practitioners. An obstetric specialist from outside the local region was also involved. Results: Consensus was reached on several key recommendations, however some areas remained without clear accepted best practice. There was consensus that physical components of early pregnancy complications are addressed well, but that we could improve on patient flow and more consistent follow up. Important investigations to be done for patients were identified. The timing of formal ultrasound, necessity and timing of obstetrician consultation, and safety of discharge was addressed for various patient scenarios including stable and unstable patients, with and without adnexal pain, with intrauterine pregnancy of uncertain viability, and with pregnancy of unknown location. Management of confirmed early pregnancy loss in the ED and family medicine clinics was addressed. Barriers to an early pregnancy loss clinic included lack of funding, space, and staffing as well as lack of resources and uncertain patient volumes. A feasible alternative to an early pregnancy loss clinic was for willing providers to keep appointment times available to facilitate confirmation of follow-up prior to discharge. Other suggested alternatives included an early pregnancy loss clinic, a nurse educator, and having a standardized guideline in the ED. Conclusion: Through a consensus approach, several recommendations were agreed upon for improving care for patients presenting to the ED with early pregnancy complications.

scholarly journals LO40: Services for emergency department patients experiencing early pregnancy complications: a survey of Ontario hospitals

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S21-S22
Author(s):  
R. Glicksman ◽  
S. McLeod ◽  
J. Thomas ◽  
C. Varner
Keyword(s):  
Emergency Department ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Pregnancy Loss ◽  
Transvaginal Ultrasound ◽  
Point Of Care Ultrasound ◽  
Early Pregnancy Loss ◽  
Online Questionnaire ◽  
Follow Up Care

Introduction: Women experiencing complications of early pregnancy frequently seek care in the emergency department (ED), as most have not yet established care with an obstetrical provider. The primary objective of this study was to explore the services available (ED management, ultrasound access, and follow-up care) for ED patients experiencing early pregnancy loss or threatened early pregnancy loss in Ontario hospitals. Methods: The emergency medicine chiefs of 71 Ontario hospital EDs with an annual census of more than 30,000 ED patient visits in 2017 were invited to complete a 30-item, online questionnaire using modified Dillman methodology. These hospitals constitute greater than 85% of the annual ED visits in Ontario, creating a sample reflective of the services available to most women older than 18 years old seeking care for early pregnancy complications in the province. Results: Respondents from 63 EDs across Ontario completed the survey (response rate 88.7%). Of the EDs surveyed, 34 (54.0%) reported they did not have access to early pregnancy clinic services for women who presented to the ED with early pregnancy complications that were safe to discharge home. At these hospitals, it was found that patients were followed up in 14 (41.2%) EDs for the same complications including pregnancy of unknown location and threatened abortion. Respondents also stated that radiologist-interpreted ultrasound was only available to 22 (34.9%) of hospital sites 24 hours a day, 7 days per week for women with early pregnancy complications. Of hospital site respondents, 55 (87.3%) reported point-of-care ultrasound (POCUS) use in the ED for patients with early pregnancy complications, and 27 (49.1%) reported the ED had access to transvaginal ultrasound probes for POCUS assessment by emergency physicians. Additionally, the proportion of ED physicians who were certified as Canadian Emergency Ultrasound independent practitioners ranged from 10% to 100%. Conclusion: The results of this study highlight the reliance of some hospitals on the ED to provide ongoing follow-up care to patients experiencing complications of early pregnancy. The lack of clinical resources and specialized personnel in Ontario hospital EDs makes supporting these women longitudinally unrealistic, exposing them to undue risk and complications.

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 P133: Why the emergency department is the wrong place for patients with early pregnancy complications: A qualitative study of patient experience

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S112
Author(s):  
V. Rojas-Luengas ◽  
B. Seaton ◽  
K. Dainty ◽  
S. McLeod ◽  
C. Varner
Keyword(s):  
Emergency Department ◽  
Qualitative Study ◽  
Lived Experience ◽  
Patient Experience ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Tertiary Care ◽  
Care Hospital ◽  
Telephone Interviews ◽  
Current Health Care System

Introduction: Women experiencing complications of early pregnancy frequently seek care in the emergency department (ED), as most have not yet established care with an obstetrical provider. The objective of this study was to explore the lived experiences and perceptions of care of women treated for early pregnancy complications in the ED and early pregnancy clinic (EPC). Methods: We conducted an interpretive phenomenological qualitative study of women who presented to the ED or EPC of an urban tertiary care hospital with early pregnancy loss or threatened loss. We employed purposive sampling to recruit participants for in-depth, one-on-one telephone interviews conducted approximately 6 weeks after the index visit. Data collection and analysis were concurrent and continued until thematic saturation had occurred. Our research team of two qualitative researchers, a clinician, a clinical researcher, and a research student performed a phenomenologically-informed thematic analysis including three phases of coding to identify essential patterns of lived experience and meaning across the sample. Results: Interviews were completed with 30 women between July and August 2018. Participants ranged in age from 22 to 45 years and reflected the diversity of the multicultural city where the study occurred. Four key themes of patient experience were identified: tensions between what is known and unknown by women and ED staff about early pregnancy complications and care in hospital, stigmatization of early pregnancy complications and ED use, normalization of a chaotic experience, and the overwhelm of unexpected outcomes during the ED visit. Conclusion: The perspectives of women attending the ED or EPC for early pregnancy complications highlights the ways in which the current health care system minimizes and medicalizes early pregnancy complications in this setting and fails to adequately support these women. The emotional complexity of this medical situation is often overlooked by ED staff and can produce encounters that are traumatic for patients and families. However, the participants’ negative experiences occurring in the ED were often mitigated with their care in their follow-up with the EPC.

Emergency department utilization and outcomes for patients with early pregnancy complications

2020 ◽  
Vol 42 (5) ◽  
pp. 675
Author(s):  
Robin Glicksman ◽  
Darby Little ◽  
Cameron Thompson ◽  
Shelley McLeod ◽  
Catherine Varner
Keyword(s):  
Emergency Department ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Emergency Department Utilization

Services for emergency department patients experiencing early pregnancy complications: A survey of Ontario hospitals

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 653-658 ◽  
Author(s):  
Robin Glicksman ◽  
Shelley L McLeod ◽  
Jackie Thomas ◽  
Catherine Varner
Keyword(s):  
Emergency Department ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Pregnancy Loss ◽  
Primary Objective ◽  
Early Pregnancy Loss ◽  
Online Questionnaire ◽  
Follow Up Care ◽  
Emergency Department Patients

ABSTRACTObjectivesWomen experiencing complications of early pregnancy frequently seek care in the emergency department (ED), because most have not yet established care with an obstetrical provider. The primary objective of this study was to explore the services available (ED management, ultrasound access, and follow-up care) for ED patients experiencing early pregnancy loss or threatened early pregnancy loss in Ontario hospitals.MethodsThe emergency medicine chiefs of 71 Ontario hospital EDs with an annual census of more than 30,000 ED patient visits in 2017 were invited to complete a 30-item, online questionnaire using modified Dillman methodology.ResultsRespondents from 63 EDs across Ontario completed the survey (response rate 88.7%). Of the EDs surveyed, 34 (54.0%) reported that they did not have access to early pregnancy clinic services for women who presented to the ED with early pregnancy complications that were safe to discharge home. At these hospitals, it was found that patients were followed up in 14 (41.2%) EDs for the same complications, including pregnancy of unknown location and threatened abortion. Respondents also stated that a radiologist-interpreted ultrasound was available to only 22 (34.9%) of hospital sites for 24 hours, 7 days per week for women with early pregnancy complications.ConclusionsThe results of this study highlight the reliance of some hospitals on the ED to provide ongoing follow-up care to patients experiencing complications of early pregnancy. The lack of clinical resources and specialized personnel in Ontario hospital EDs makes supporting these women longitudinally unrealistic, exposing them to undue risk and complications.

scholarly journals The emergency department experience of patients with early pregnancy complications: A qualitative study

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 798-802 ◽  
Author(s):  
Vanessa Rojas-Luengas ◽  
Bianca Seaton ◽  
Katie Dainty ◽  
Shelley McLeod ◽  
Catherine Varner
Keyword(s):  
Emergency Department ◽  
Qualitative Study ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Tertiary Care ◽  
Analysis Data ◽  
Structured Interview ◽  
Care Hospital ◽  
Healthcare Experience ◽  
Interview Guide

ABSTRACTObjectiveThe purpose of this qualitative study was to explore the experiences and perceptions of care of women treated for early pregnancy complications in a Canadian emergency department (ED) and early pregnancy clinic (EPC).MethodsWe conducted a descriptive qualitative study to understand the perceptions, meanings, and perspectives of women of 18 years and older who presented to the ED or EPC of an urban, tertiary care hospital with early pregnancy complications or loss. Using a semi-structured interview guide, a 45- to 60-minute telephone interview was conducted by a trained qualitative interviewer at 4 to 6 weeks after the ED visit. All interviews were digitally recorded and transcribed verbatim for analysis. Data analysis occurred in conjunction with data collection in order to continuously monitor emerging themes and general areas for further exploration. Interviews were conducted until thematic saturation had occurred.ResultsInterviews were completed with 30 women between June and August 2018. Three key themes arose: disconnect of the ED's role in the provision of care, normalization of a chaotic healthcare experience, and finding connection through the institution's EPC.ConclusionsPerspectives of women with early pregnancy complications highlight the ways in which ED care often does not meet the expectations or needs of patients and their families. The emotional complexity of this medical situation is often overlooked by ED staff and can produce encounters that are distressing. However, negative experiences were often mitigated by follow-up care in the institution's EPC.

“The black box” of nonviable pregnancy in early gestation

2017 ◽  
Author(s):  
Å.S. Emelyanenko , A.Yu. Blinov , T.M. Volkovskaya
Keyword(s):  
Early Pregnancy ◽  
Ultrasound Examination ◽  
Black Box ◽  
Safety Regulation ◽  
Intrauterine Pregnancy ◽  
Early Gestation ◽  
Prognostic Criteria

The modern sonographic approach to define miscarriage in early pregnancy was shown in the article. Ultrasound diagnostic and prognostic criteria of nonviable pregnancy in early gestation were introduced. Special attention was paid to the examination`s algorithm and repeatability of ultrasound scans with suspicion of intrauterine pregnancy of uncertain viability. Also the consequences of non-following the stringent ultrasound criteria, which lead to the abortions of potentially normal pregnancies were described. Furthermore, the authors highlighted the importance of safety regulation`s aspects in ultrasound examination in early gestation. The conclusion of the importance and need in following the uniform methodological criteria in diagnostics of nonviable pregnancy has been drawn according to the analysis of world experience.

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