Negative Laparoscopies for Ectopic Pregnancy | RCOG World Congress 2013 - ePostersOnline
TINA KAPOOR 1, LUCINDA RYAN 1, TAN TOH LICK 1,2Department of Obstetrics Gynaecology, 1 Ealing Hospital NHS Trust, London, United Kingdom; and 2 K K Women’ s and Children’ s Hospital, Singapore
Ectopic pregnancy (EP) remains an important cause of morbidity and mortality in women of reproductive age despite the mortality rate at 16.9 per 100,000 EP, the lowest since they were first monitored in the United Kingdom. In developed healthcare system, using a combination of high resolution transvaginal ultrasonography supported by serum βhCG and progesterone, early pregnancy units (EPU) have achieved good diagnostic capability for managing EP. Nevertheless, laparoscopy remains the gold standard for diagnosing EP as ultrasound has its limitations (figure 1). However, laparoscopy itself carries a morality risk of 3-8 per 100,000 and therefore should not be undertaken without due consideration.
There is no established standard for negative laparoscopy for EP. Most published data comes from tertiary centres where the EPU are staffed by consultants and research fellows. The majority of EPU however are based in district hospitals where the staffing model differs. In order to determine the negative laparoscopy rate for EP in our hospital, we undertook a retrospective cohort study.
To determine the rate of true negative laparoscopy rates for suspected EP in our hospital, a retrospective cohort study was undertaken of all women undergoing surgical procedure for suspected EP from 01 January 2009 to 31 December 2011 in a London district hospital with consultant- led EPU. Cases were identified using the coding terms ‘diagnostic laparoscopy’ and ‘laparoscopy for tubal or ectopic pregnancy’. Laparoscopy for non-pregnant woman were excluded. The absence of chorionic villi on histology was taken as lack of confirmation of the ectopic pregnancy, and these case notes were reviewed to determine if there was an explanation for the apparent negative laparoscopy in order to obtain the true negative laparoscopy rate (figure 2).
In the 3 year period, there were 374 laparoscopies identified of which 125 (33.4%) were performed in pregnant women. 90.4% (n = 113) of these had histological confirmation of chorionic villi to confirm an EP. In the remaining 12 cases, 3 were wrongly coded as having had laparoscopy when they were managed expectantly or medically, and 1 had the histology report in the notes confirming chorionic villi.
Of the potential 8 cases of negative laparoscopy, 3 were excluded as they were either ruptured tubal or interstitial pregnancies where the chorionic villi specimen may have been lost during the evacuation of the haemaperitoneum. Another case was excluded as an interstitial EP was diagnosed subsequent to the initial negative laparoscopy (figure 2).
The remaining 4 cases were considered true negative laparoscopies. The 3 known gestational age were based on last menstrual period and were 4, 5 and 16 weeks.
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