A United Kingdom national survey of trends in ectopic pregnancy management

Dear Sir,

We read with interest the article: A United Kingdom national survey of trends in ectopic pregnancy management by Taheri et al. (2014).

It is commendable that the authors have been able to carry out a national survey of management of ectopic pregnancy, the first since the original publications (Saidi et al. 1999; Tooz-hobson et al. 2000). The paper by Saidi and colleagues reported on clinician's opinions, with a response rate of 55%. A possible limitation of the study was that it relied on the recall of the respondents. The study by Tooz-Hobson and colleagues had a response rate of 75% and relied on the responses of clinical tutors in the units surveyed. Both of these early surveys, however, gave insight into the state of minimal access surgery for the management of ectopic pregnancy in the UK in the 1990s. Unfortunately this publication by Taheri and colleagues appears to be plagued by the low response rate to questionnaire surveys, with a response rate of 37% well below the average response rate for medical questionnaires (Asch 1997). However, we would argue that the actual response rate was lower at 28%, if the total number of eligible units to participate in the survey was 157. Also only 124 ectopic pregnancies were included in the cohort, which is low considering that 11,000 women present with ectopic pregnancies in the UK annually. By the authors’ estimation if the mean number of ectopic pregnancies in the responding units was 5 per week, this figure would represent 1.08% of potential ectopic pregnancies in the year of study. Whilst the authors recognise the low response rate and the low number ectopic pregnancies analysed as a potential limitation of the study, this unfortunately compromises the purpose of a national survey. In understanding the difficulties in conducting a national survey, we carried out a prospective multi-centre observational regional survey of the management of ectopic pregnancy in 2010. We looked at the management of ectopic pregnancy over a 6-month period in 7 centres in the south east of the UK (Odejinmi et al. 2010); there was an average operative laparoscopy rate of 84%. We also highlighted potential barriers to the laparoscopic management of ectopic pregnancy. The operative laparoscopy rate was 92% in this paper by Taheri et al. This would imply that the operative laparoscopy rate for the management of ectopic pregnancy in the UK is somewhere between 84% and 92%, but an accurate rate of operative laparoscopy for the management of ectopic pregnancy is still unknown. It is unfortunate that this remains the case, considering it is an auditable standard for all early pregnancy assessment units and should be a benchmark for quality of care. There have also been issues regarding training of junior doctors in emergency minimal access skills and training facilities as highlighted once again in this survey. In our study the rate of operative laparoscopy was 62% by trainees in the region with more than 40% of the procedures undertaken by juniors independently. Appropriate laparoscopic management would also increase training opportunity for junior doctors, so that they may improve their competencies.

Until there are advocates for the “proper” management of women with ectopic pregnancy, to highlight the importance of provision of quality care, the state of affairs will remain the same.

Declaration of interest: On behalf of all the co-authors we declare that we have no conflicts of interest and have nothing to declare. We do not have any affiliation with any organization with a financial interest, direct or indirect, in the subject matter or materials discussed in the manuscript. We further state that we did not receive any funding or medical writing/editorial assistance with the preparation of the article. We confirm that all the co-authors qualify for authorship.