The diagnosis and management of ectopic pregnancy presenting to Mater Dei Hospital between June 2019 and June 2020

Abstract

The incidence of ectopic pregnancies has steadily increased over recent years and despite advances in treatment it still remains a major cause of maternal morbidity and mortality. The objective of this audit was to assess whether diagnosis and management is occurring as per international suggested guidance and practice. This study is a retrospective one using data collected from June 2019 to June 2020. All data were password protected and kept anonymous. No patient contact occurred. The standard cross referenced was the ‘April 2019 NICE Guideline on the Management of Ectopic Pregnancy’. Thirty-one ectopic pregnancies occurred between June 2019 and June 2020. Twenty-nine underwent surgical management and two medical. Six out of the 29 surgically managed patients were managed incorrectly. Twenty-four of the surgical cases were managed laparoscopically. Presence of a foetal heart rate remained undocumented in 21 out of 31 of cases. The results highlight the ease of access to emergency gynaecological services at Malta’s national hospital. However, this audit did highlight the discrepancy that can occur in examination in association with ectopic pregnancy. An inconsistency was noted in documentation. Additionally, a number of cases could have been offered and benefitted from different modes of management.

Impact Statement

• What is already known on this subject? Ectopic pregnancy (EP) is an important cause of morbidity and mortality in mothers of childbearing age. The diagnostic method and appropriate management for EP has been extensively studied. Concrete- and evidence-based guidelines guide clinical management and improve morbidity and mortality. Local guidelines improve clinical outcome.

• What do the results of this study add? This study shows the impact of clinical outcome without a national guideline to guide management on a national level. Malta has one national hospital in which the local obstetrics and gynaecology department is run. The results of this study thus comprise of nationwide statistics on EP and its management. Ectopic pregnancies are managed without a local guideline in place. It also reflects the ease of access to health care in smaller countries.

• What are the implications of these findings for clinical practice and/or further research? The findings of this study have resulted in the production of a local guideline for the management of EP, as well as the introduction of a protocol for obtaining methotrexate for medical management. It has introduced new ultrasound machines and staff training to aid diagnostics. Further re-auditing will be carried out to analyse the impact a local guideline has on clinical practice at a national level.

Keywords:

• Ectopic pregnancy
• pregnancy of unknown origin
• methotrexate
• laparoscopy
• ultrasound

Acknowledgements

We would like to acknowledge the Obstetrics and Gynaecology Department at Mater Dei Hospital Malta for their great efforts at providing optimal care to their patients.

Ethical approval: Ethical approval was not necessary as no patient contact occurred at any point. Data protection approval was sought from Mater Dei Hospital data protection officer.

Disclosure statement

No potential conflict of interest was reported by the author(s).