Management of suspected ectopic pregnancy: An audit from East Kent NHS Hospital Trust

Abstract

SummaryThis is a retrospective case note analysis of 105 suspected cases of ectopic pregnancies that underwent laparoscopy within a stipulated 12-month period, September 2001 to August 2002. The management and care of these women was reviewed using the Royal College of Obstetricians and Gynaecologists' (RCOG) guidelines on management of ectopic pregnancies as well as local guidelines developed from the RCOG guidance. Other criteria used to review patient care were derived from the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD). A large number of procedures (51.13%) which include laparoscopy, laparotomy and combined procedure were performed by the consultant. Approximately 90.19% of all procedures were performed during official working hours, which is in keeping with the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommendation. Other standards and criteria used were the use of anti-D immunoglobulin and the use of thromboprophylaxis. A total of 86.7% of non-sensitised Rhesus negative women received anti-D immunoglobulin; 96% of suspected ectopic pregnancies were diagnosed within 96 h of initial presentation. In 80% of cases, βhCG results were available within 24 h of request. Only 26% of ectopic pregnancies were successfully treated using laparoscopy, indicating that even though operative laparoscopy is the preferred approach, operative complications and haemoperitoneum, can lead to changes in surgical approach. The results of the audit identified areas for improvement and offers a practical solution through recommendations based on the audit process.