A six-year audit of the management of ectopic pregnancy.
OBJECTIVE
To audit the management of ectopic pregnancy at National Women's Hospital over a six-year period to monitor changes in practice and assess adherence to hospital protocols.


METHODS
A retrospective audit of the management of women with a discharge diagnosis of ectopic pregnancy from 1996-2001 at National Women's Hospital, Auckland, New Zealand. Information was collected regarding the demographics, risk factors for ectopic pregnancy, delay in diagnosis, management undertaken and failure and complications of initial treatment.


RESULTS
Over a six-year period a total of 673 women had a discharge diagnosis of ectopic pregnancy. Surgery was the most frequent method of management but there was increasing utilisation of systemic methotrexate. The proportion of women who met the criteria for methotrexate varied from 27-54% over the six year period although the highest proportion who received methotrexate in any given year was only 24% (2001). The proportion of women who met the criteria for receiving methotrexate and had the option of methotrexate discussed with them increased from 12% in 1996 to 91% in 2001. Over the six year period 74 women received methotrexate and 14 (18.9%) failed and required surgical management. Surgical management was performed in 537 women and 30 (5.6%) required either further surgery or methotrexate or a combination of both. A laparoscopic procedure was performed in 86.5% (465/533) and 10.9% (51/465) converted to laparotomy


CONCLUSIONS
Although there is evidence that methotrexate is an effective and safe option for a proportion of women with ectopic pregnancy, the majority of women still undergo surgical management.
Cooray
Hashira
H
Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Harilall
Mahesh
M
Farquhar
C M
CM
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D019983:Guideline Adherence; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008485:Medical Audit; D008727:Methotrexate / Q000627:therapeutic use*; D009520:New Zealand; D018579:Patient Selection; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate