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Ugwu GO, Iyoke CA, Nnagbo JE. The feasibility of introducing early pregnancy assessment unit in Nigerian hospitals: A pilot study from a private hospital in Enugu, Southeast Nigeria. Niger J Clin Pract 2023; 26:1036-1039. [PMID: 37635592 DOI: 10.4103/njcp.njcp_172_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Early pregnancy assessment unit (EPAU) is a dedicated unit that provides specialist care such as definitive ultrasonographic and biochemical assessment to women who have or have had vaginal bleeding or pain before 16 weeks of pregnancy. Such patients usually have a positive pregnancy test with a scan showing pregnancy of an unknown location, previous ectopic pregnancy, recurrent miscarriages, or previous molar pregnancy. Such a holistic and prompt approach leads to better outcome in the management of women with early pregnancy and other complications. Aim This study aimed to describe the diagnosis and outcome of early pregnancy pain and bleeding, managed by rapid ultrasonographic and biochemical assessments by a dedicated gynecological team in a private hospital to determine the feasibility of establishing early pregnancy assessment units (EPAUs) in Nigeria. Materials and Methods This is a cross-sectional study of eligible cases of early pregnancy bleeding and pain in a private gynecological hospital in Enugu, Nigeria. Results During the 9-year study period, 160 women with early pregnancy pain or bleeding were analyzed. The mean age of the participants was 32.3 ± 7.2 years, and they were mostly multipara (68.7%) and Christians and of the Igbo tribe (91.3%). The final diagnosis after clinical and radiological evaluations showed that the majority had miscarriages (82.5%), while 17.5% had ectopic gestations. All the participants had their definitive diagnosis and treatment within 24 hours of presentation. There was no recorded case of maternal death. Conclusion EPAUs are feasible in a Nigerian setting provided that trained, dedicated staff and equipment are provided.
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Affiliation(s)
- G O Ugwu
- Department of Obstetrics and Gynaecology, University of Nigeria, Enugu, Nigeria
| | - C A Iyoke
- Department of Obstetrics and Gynaecology, University of Nigeria, Enugu, Nigeria
| | - J E Nnagbo
- Department of Obstetrics and Gynaecology, University of Nigeria, Enugu, Nigeria
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Creeper KJ, Stafford AC, Choudhuri S, Tumian R, Breen K, Cohen AT. Bleeding related hospitalizations and mortality in England 2014-2019. J Thromb Thrombolysis 2023:10.1007/s11239-023-02849-z. [PMID: 37338712 DOI: 10.1007/s11239-023-02849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 06/21/2023]
Abstract
Acute bleeding is common and associated with increased morbidity and mortality. Epidemiological studies evaluating trends in bleeding-related hospitalisations and mortality are important as they have potential to guide resource allocation and service provision, however, despite this literature evaluating the national burden and annual trends are lacking. Our objective was to report the national burden and incidence of bleeding-related hospitalisation and mortality.This was a population-based review of all people in England between 2014 and 2019 either admitted to an acute care ward of a National Health Service (NHS) English hospital, or who died. Admissions and deaths were required to have a primary diagnosis of significant bleeding.There was a total of 3,238,427 hospitalisations with a mean of 539,738 ± 6033 per year and 81,264 deaths with a mean of 13,544 ± 331 per year attributable to bleeding. The mean annual incident rate for bleeding-related hospitalisations was 975 per 100,000 patient years and for mortality was 24.45. Over the study period there was a significant 8.2% reduction in bleeding related deaths (χ2 test for trend 91.4, p < 0.001). A direct relationship between increasing age and incidence of bleeding-related hospitalisation and mortality was seen.Bleeding remains a common cause of hospitalisation and death. The reduction in bleeding related mortality requires further investigation. This data may serve to guide future interventions designed to reduce bleeding-related morbidity and mortality.
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Affiliation(s)
- Katherine J Creeper
- Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK.
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia.
| | | | | | - Rafeah Tumian
- Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
- Haematology Unit, Dept of Medicine, UKM Medical Centre, Kuala Lumpur, 56000, Malaysia
| | - Karen Breen
- Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
| | - Alexander T Cohen
- Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
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Memtsa M, Goodhart V, Ambler G, Brocklehurst P, Keeney E, Silverio SA, Anastasiou Z, Round J, Khan N, Hall J, Barrett G, Bender-Atik R, Stephenson J, Jurkovic D. Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: Findings from the VESPA Study. PLoS One 2021; 16:e0260534. [PMID: 34847201 PMCID: PMC8631630 DOI: 10.1371/journal.pone.0260534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions. DESIGN Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the "Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes". SETTING 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata. PARTICIPANTS 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017. EXPOSURES Planned and actual senior clinician presence, unit size, and weekend opening. MAIN OUTCOME MEASURES Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs. RESULTS 205/6397 (3.2%; 95% CI 2.8-3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED. CONCLUSIONS Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.
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Affiliation(s)
- Maria Memtsa
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Venetia Goodhart
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, United Kingdom
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sergio A Silverio
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom.,Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Zacharias Anastasiou
- Department of Statistical Science, University College London, London, United Kingdom
| | - Jeff Round
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Institute of Health Economics, Edmonton, Canada
| | - Nazim Khan
- Modelling and Analytical Systems Solutions (MASS) Ltd, Edinburgh, United Kingdom
| | - Jennifer Hall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | | | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Davor Jurkovic
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
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Coomarasamy A, Gallos ID, Papadopoulou A, Dhillon-Smith RK, Al-Memar M, Brewin J, Christiansen OB, Stephenson MD, Oladapo OT, Wijeyaratne CN, Small R, Bennett PR, Regan L, Goddijn M, Devall AJ, Bourne T, Brosens JJ, Quenby S. Sporadic miscarriage: evidence to provide effective care. Lancet 2021; 397:1668-1674. [PMID: 33915095 DOI: 10.1016/s0140-6736(21)00683-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/19/2022]
Abstract
The physical and psychological effect of miscarriage is commonly underappreciated. The journey from diagnosis of miscarriage, through clinical management, to supportive aftercare can be challenging for women, their partners, and caregivers. Diagnostic challenges can lead to delayed or ineffective care and increased anxiety. Inaccurate diagnosis of a miscarriage can result in the unintended termination of a wanted pregnancy. Uncertainty about the therapeutic effects of interventions can lead to suboptimal care, with variations across facilities and countries. For this Series paper, we have developed recommendations for practice from a literature review, appraisal of guidelines, and expert group discussions. The recommendations are grouped into three categories: (1) diagnosis of miscarriage, (2) prevention of miscarriage in women with early pregnancy bleeding, and (3) management of miscarriage. We recommend that every country reports annual aggregate miscarriage data, similarly to the reporting of stillbirth. Early pregnancy services need to focus on providing an effective ultrasound service, as it is central to the diagnosis of miscarriage, and be able to provide expectant management of miscarriage, medical management with mifepristone and misoprostol, and surgical management with manual vacuum aspiration. Women with the dual risk factors of early pregnancy bleeding and a history of previous miscarriage can be recommended vaginal micronised progesterone to improve the prospects of livebirth. We urge health-care funders and providers to invest in early pregnancy care, with specific focus on training for clinical nurse specialists and doctors to provide comprehensive miscarriage care within the setting of dedicated early pregnancy units.
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Affiliation(s)
- Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Ioannis D Gallos
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
| | - Argyro Papadopoulou
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Rima K Dhillon-Smith
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Maya Al-Memar
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Jane Brewin
- Tommy's Charity, Laurence Pountney Hill, London, UK
| | - Ole B Christiansen
- Centre for Recurrent Pregnancy Loss of Western Denmark, Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | - Mary D Stephenson
- University of Illinois Recurrent Pregnancy Loss Program, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Rachel Small
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Phillip R Bennett
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Lesley Regan
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Mariëtte Goddijn
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Adam J Devall
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK; KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Jan J Brosens
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, UK; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Siobhan Quenby
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, UK; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Memtsa M, Goodhart V, Ambler G, Brocklehurst P, Keeney E, Silverio S, Anastasiou Z, Round J, Khan N, Hall J, Barrett G, Bender-Atik R, Stephenson J, Jurkovic D. Variations in the organisation of and outcomes from Early Pregnancy Assessment Units: the VESPA mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background
Early pregnancy complications are common and account for the largest proportion of emergency work in gynaecology. Although early pregnancy assessment units operate in most UK acute hospitals, recent National Institute of Health and Care Excellence guidance emphasised the need for more research to identify configurations that provide the optimal balance between cost-effectiveness, clinical effectiveness and service- and patient-centred outcomes [National Institute for Health and Care Excellence (NICE). Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management. URL: http://guidance.nice.org.uk/CG154 (accessed 23 March 2016)].
Objectives
The primary aim was to test the hypothesis that the rate of hospital admissions for early pregnancy complications is lower in early pregnancy assessment units with high consultant presence than in units with low consultant presence. The key secondary objectives were to assess the effect of increased consultant presence on other clinical outcomes, to explore patient satisfaction with the quality of care and to make evidence-based recommendations about the future configuration of UK early pregnancy assessment units.
Design
The Variations in the organisations of Early Pregnancy Assessment Units in the UK and their effects on clinical, Service and PAtient-centred outcomes (VESPA) study employed a multimethods approach and included a prospective cohort study of women attending early pregnancy assessment units to measure clinical outcomes, an economic evaluation, a patient satisfaction survey, qualitative interviews with service users, an early pregnancy assessment unit staff survey and a hospital emergency care audit.
Setting
The study was conducted in 44 early pregnancy assessment units across the UK.
Participants
Participants were pregnant women (aged ≥ 16 years) attending the early pregnancy assessment units or other hospital emergency services because of suspected early pregnancy complications. Staff members directly involved in providing early pregnancy care completed the staff survey.
Main outcome measure
Emergency hospital admissions as a proportion of women attending the participating early pregnancy assessment units.
Methods
Data sources – demographic and routine clinical data were collected from all women attending the early pregnancy assessment units. For women who provided consent to complete the questionnaires, clinical data and questionnaires were linked using the women’s study number. Data analysis and results reporting – the relationships between clinical outcomes and consultant presence, unit volume and weekend opening hours were investigated using appropriate regression models. Qualitative interviews with women, and patient and staff satisfaction, health economic and workforce analyses were also undertaken, accounting for consultant presence, unit volume and weekend opening hours.
Results
We collected clinical data from 6606 women. There was no evidence of an association between admission rate and consultant presence (p = 0.497). Health economic evaluation and workforce analysis data strands indicated that lower-volume units with no consultant presence were associated with lower costs than their alternatives.
Limitations
The relatively low level of direct consultant involvement could explain the lack of significant impact on quality of care. We were also unable to estimate the potential impact of factors such as scanning practices, level of supervision, quality of ultrasound equipment and clinical care pathway protocols.
Conclusions
We have shown that consultant presence in the early pregnancy assessment unit has no significant impact on key outcomes, such as the proportion of women admitted to hospital as an emergency, pregnancy of unknown location rates, ratio of new to follow-up visits, negative laparoscopy rate and patient satisfaction. All data strands indicate that low-volume units run by senior or specialist nurses and supported by sonographers and consultants may represent the optimal early pregnancy assessment unit configuration.
Future work
Our results show that further research is needed to assess the potential impact of enhanced clinical and ultrasound training on the performance of all disciplines working in early pregnancy assessment units.
Trial registration
Current Controlled Trials ISRCTN10728897.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Memtsa
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Venetia Goodhart
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sergio Silverio
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, London, UK
| | | | - Jeff Round
- Institute of Health Economics, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nazim Khan
- Modelling and Analytical Systems Solutions Ltd, Edinburgh, UK
| | - Jennifer Hall
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | | | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Davor Jurkovic
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
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Abstract
Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care. OBJECTIVE: To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments. METHODS: We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case–cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients. RESULTS: Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1–2.7) or outpatient (OR 14.7, 95% CI 8.1–26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9–70.7). CONCLUSIONS: Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.
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Daoun C, Isoul M, Pourcelot AG, Fernandez H, Capmas P. Guidelines for minimal report in gynaecologic sonography: Are they useful for emergency department resident physicians? J Gynecol Obstet Hum Reprod 2020; 50:101887. [PMID: 32814160 DOI: 10.1016/j.jogoh.2020.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to evaluate the impact of Collège National des Gynécologues et Obstétriciens Français (CNGOF) guidelines on the minimal sonographic reports generated by emergency department resident physicians. MATERIAL AND METHODS This prospective observational study was conducted in the gynaecologic emergency unit of a teaching hospital from November 2016 to May 2017. We analysed sonographic reports generated by residents during gynaecological emergencies before and after training on the minimal report standards. An analysis of the evaluated items was carried out. We also compared residents according to their specialities and seniority. RESULTS A total of 240 reports were analysed, 120 before and 120 after the training. Half of the reports concerned women with an early pregnancy while the others concerned women with negative hCG. All residents significantly improved their practice after the training, as shown by the increase in ratings of the evaluated items (38 % before training vs 44.8 % after, p < 0.01). General practitioners had greater improvement (48.1 % of evaluated items), whereas older residents reported fewer items before or after the training (43.5 %) than younger residents. Finally, all residents improved their practice with a conclusion that followed the guidelines in 92.5 % of cases (versus 68.3 % before the training; p < 0.01). CONCLUSION Training on the CNGOF minimal sonographic report guidelines significantly improved the emergency sonographic reports generated by residents. Wider dissemination of this training, particularly to young residents, would probably improve the quality of sonographic reports performed at gynaecological emergencies.
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Affiliation(s)
- Cecile Daoun
- CHU Bicêtre, Service Gynécologie Obstétrique, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Marion Isoul
- CHU Bicêtre, Service Gynécologie Obstétrique, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Anne-Gaëlle Pourcelot
- CHU Bicêtre, Service Gynécologie Obstétrique, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Hervé Fernandez
- CHU Bicêtre, Service Gynécologie Obstétrique, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Perrine Capmas
- CHU Bicêtre, Service Gynécologie Obstétrique, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
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Cox R, Khalid S, Brierly G, Forsyth A, McNamara R, Heppell V, Granne I. Implementing a community model of early pregnancy care. BMC Health Serv Res 2020; 20:664. [PMID: 32680503 PMCID: PMC7367246 DOI: 10.1186/s12913-020-05524-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 07/08/2020] [Indexed: 11/25/2022] Open
Abstract
Background In the UK Early Pregnancy Assessment Units (EPAUs) are usually situated alongside hospital maternity and gynaecology services. In June 2018, the Oxford EPAU relocated from the John Radcliffe Hospital to a community clinic. This is to our knowledge, the UK’s first community-based EPAU. This change was inspired by our patient feedback describing the co-location of the EPAU with maternity services as distressing. Methods Following the introduction of the community EPAU we developed a database to capture information on the patients seen in the clinic. This is a retrospective observational study of a single cohort of patients attending the clinic over an 8 month period. Data was collected from 1st July 2018 to 28th February 2019. This data included clinical, safety and patient experience outcomes. Results Two thousand nine hundred and twenty patient episodes were recorded, 1,932 were new patients. Mean waiting time to be seen in clinic was 1.3 days. When miscarriage was confirmed 48.6% chose conservative management, 19.9% chose medical management, and 31.5% chose surgical management. The mean rate of ambulance transfers to hospital was 3.1 per month. Of all patients seen in EPAU 32 had unplanned admissions, which accounted for 2.7% of all patients seen in EPAU. Patient feedback questionnaires have been consistently positive. Conclusion The development of a community EPAU has improved services to allow care closer to home in an environment separate from maternity care. Our data shows that a community EPAU can deliver timely, good quality patient care, is safe, and a service valued by patients. Further research is indicated to evaluate the cost-effectiveness of community EPAUs and the long term safety and effectiveness of care.
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Affiliation(s)
- Rebecca Cox
- Nuffield Department of Primary Care Health Science, Oxford, UK.
| | - Somia Khalid
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gemma Brierly
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Annie Forsyth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth McNamara
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Ingrid Granne
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Okada A, Okada Y, Fujita H, Iiduka R. Development of the "POP" scoring system for predicting obstetric and gynecological diseases in the emergency department: a retrospective cohort study. BMC Emerg Med 2020; 20:35. [PMID: 32375643 PMCID: PMC7203896 DOI: 10.1186/s12873-020-00332-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/29/2020] [Indexed: 02/04/2023] Open
Abstract
Background Obstetric and gynecological (OBGY) diseases are among the most important differential diagnoses for young women with acute abdominal pain. However, there are few established clinical prediction rules for screening OBGY diseases in emergency departments (EDs). This study aimed to develop a prediction model for diagnosing OBGY diseases in the ED. Methods This single-center retrospective cohort study included female patients with acute abdominal pain who presented to our ED. We developed a logistic regression model for predicting OBGY diseases and assessed its diagnostic ability. This study included young female patients aged between 16 and 49 years who had abdominal pain and were examined at the ED between April 2017 and March 2018. Trauma patients and patients who were referred from other hospitals or from the OBGY department of our hospital were excluded. Results Out of 27,991 patients, 740 were included. Sixty-five patients were diagnosed with OBGY diseases (8.8%). The “POP” scoring system (past history of OBGY diseases + 1, no other symptoms + 1, and peritoneal irritation signs + 1) was developed. Cut-off values set between 0 and 1 points, sensitivity at 0.97, specificity at 0.39, and negative likelihood ratio (LR-) of 0.1 (95% CI: 0.02–0.31) were considered to rule-out, while cut-off values set between 2 and 3 points, sensitivity at 0.23 (95% CI 0.13–0.33), specificity at 0.99 (95% CI 0.98–1.00), and positive likelihood ratio (LR+) of 17.30 (95% CI: 7.88–37.99) were considered to rule-in. Conclusions Our “POP” scoring system may be useful for screening OBGY diseases in the ED. Further research is necessary to assess the predictive performance and external validity of different data sets.
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Affiliation(s)
- Asami Okada
- Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, 602-8026, Haruobicho 355-5, Kamigyo, Kyoto, Japan. .,Department of Obstetrics and Gynecology, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan.
| | - Yohei Okada
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.,Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Fujita
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan
| | - Ryoji Iiduka
- Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, 602-8026, Haruobicho 355-5, Kamigyo, Kyoto, Japan
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Blavier F, Cosyns S, Dony N, Faron G, Parra J, Gucciardo L. Perception and knowledge of early pregnancy assessment units among perinatal practitioners in Europe. Int J Gynaecol Obstet 2018; 143:289-299. [PMID: 30182449 DOI: 10.1002/ijgo.12661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/30/2018] [Accepted: 09/03/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate perceptions of early pregnancy assessment units (EPAUs) among perinatal practitioners working in Belgium, France, and Switzerland. METHODS A prospective multinational survey was conducted between September 1, 2015, and May 21, 2016. Obstetricians, gynecologists, medical doctors, radiologists, and midwives were recruited during meetings, via e-mail invitations, or through the websites of regional obstetrics and gynecology scientific societies. The survey comprised 17 questions that assessed the participants' knowledge, interest, and management of early pregnancy. RESULTS Of the 871 individuals invited to participate in the survey, 306 (35.1%) responded. Most of the participants were gynecologists and/or obstetricians (225 [73.5%]). A total of 258 (84.3%) participants had no or limited knowledge about EPAUs. Furthermore, 211 (69.0%) participants reported incorrect management when they visualized a gestational sac without embryo and 265 (86.6%) misinterpreted changes in serum levels of chorionic gonadotropin during early pregnancy. In all, 201 (65.7%) participants were interested in collaboration with an EPAU; however, only 125 (40.8%) had sufficient time and resources available to support a patient's psychological distress after early pregnancy loss or salpingectomy. CONCLUSION Knowledge about early management of pregnancy was limited among the perinatal practitioners surveyed; however, the concept of EPAUs was welcomed by many.
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Affiliation(s)
- Frédéric Blavier
- Department of Obstetrics and Prenatal Medicine, Univeritair Ziekenhuis Brussel, Vrij Universiteit Brussel, Brussels, Belgium
| | - Stefan Cosyns
- Department of Gynecology, Univeritair Ziekenhuis Brussel, Vrij Universiteit Brussel, Brussels, Belgium
| | - Noëlie Dony
- Department of Gynecology, Univeritair Ziekenhuis Brussel, Vrij Universiteit Brussel, Brussels, Belgium
| | - Gilles Faron
- Department of Obstetrics and Prenatal Medicine, Univeritair Ziekenhuis Brussel, Vrij Universiteit Brussel, Brussels, Belgium
| | - José Parra
- Faculty of Medicine, Univeritair Ziekenhuis Brussel, Vrij Universiteit Brussel, Brussels, Belgium
| | - Leonardo Gucciardo
- Department of Obstetrics and Prenatal Medicine, Univeritair Ziekenhuis Brussel, Vrij Universiteit Brussel, Brussels, Belgium
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Varas C, Ravit M, Mimoun C, Panel P, Huchon C, Fauconnier A. Optimal Combination of Non-Invasive Tools for the Early Detection of Potentially Life-Threatening Emergencies in Gynecology. PLoS One 2016; 11:e0162301. [PMID: 27583697 PMCID: PMC5008751 DOI: 10.1371/journal.pone.0162301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/20/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives Potentially life-threatening gynecological emergencies (G-PLEs) are acute pelvic conditions that may spontaneously evolve into a life-threatening situation, or those for which there is a risk of sequelae or death in the absence of prompt diagnosis and treatment. The objective of this study was to identify the best combination of non-invasive diagnostic tools to ensure an accurate diagnosis and timely response when faced with G-PLEs for patients arriving with acute pelvic pain at the Gynecological Emergency Department (ED). Methods The data on non-invasive diagnostic tools were sourced from the records of patients presenting at the ED of two hospitals in the Parisian suburbs (France) with acute pelvic pain between September 2006 and April 2008. The medical history of the patients was obtained through a standardized questionnaire completed for a prospective observational study, and missing information was completed with data sourced from the medical forms. Diagnostic tool categories were predefined as a collection of signs or symptoms. We analyzed the association of each sign/symptom with G-PLEs using Pearson’s Chi-Square or Fischer’s exact tests. Symptoms and signs associated with G-PLEs (p-value < 0.20) were subjected to logistic regression to evaluate the diagnostic value of each of the predefined diagnostic tools and in various combinations. Results The data of 365 patients with acute pelvic pain were analyzed, of whom 103 were confirmed to have a PLE. We analyzed five diagnostic tools by logistic regression: Triage Process, History-Taking, Physical Examination, Ultrasonography, and Biological Exams. The combination of History-Taking and Ultrasonography had a C-index of 0.83, the highest for a model combining two tools. Conclusions The use of a standardized self-assessment questionnaire for history-taking and focal ultrasound examination were found to be the most successful tool combination for the diagnosis of gynecological emergencies in a Gynecological ED. Additional tools, such as physical examination, do not add substantial diagnostic value.
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Affiliation(s)
- Catalina Varas
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Marion Ravit
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Camille Mimoun
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Mignot Hospital, Le Chesnay, France
| | - Cyrille Huchon
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
- * E-mail:
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12
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Popowski T, Huchon C, Fathallah K, Falissard B, Dumont A, Fauconnier A. Impact of accreditation training for residents on sonographic quality in gynecologic emergencies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:829-835. [PMID: 25911716 DOI: 10.7863/ultra.34.5.829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the impact of an educational intervention based on an original accreditation training program on the quality of emergency sonography performed by obstetrics and gynecology (Ob/Gyn) residents. METHODS We conducted a prospective before-after study on residents who performed bedside standardized sonographic examinations as first-line investigations in patients seen at our gynecologic emergency department. In both periods, the residents followed a 1-hour class taught by a board-certified Ob/Gyn sonography expert (opinion leader) and received a written standardized imaging protocol. An accreditation training process was implemented for the new residents at the beginning of the second period: 5 complete sonographic examinations were required for each resident, and facilitated feedback from the opinion leader was performed using a dedicated sonographic quality score. During both periods, all consecutive sonograms were collected and stored. The primary outcome was the sonographic quality score. A mixed model for repeated measures was used to compare scores in both periods from 20 consecutive sonographic examinations performed by 5 residents who were different in each period. RESULTS The mixed model analysis showed an increase in quality scores in the post-accreditation training compared to the pre-accreditation training period (estimated coefficient ± SD, 4.13 ± 0.51; t = 8.16). The sonographic examination order also had a significant effect in both periods (estimated coefficient ± SD, 0.11 ± 0.03; t = 3.99). CONCLUSIONS An accreditation training process including facilitated feedback from a local opinion leader improved the quality of sonographic examinations performed by Ob/Gyn residents in women presenting to a gynecologic emergency department.
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Affiliation(s)
- Thomas Popowski
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France (T.P., C.H., K.F., A.F.); University Versailles Saint-Quentin-en-Yvelines, Versailles, France (T.P., C.H., K.F., A.F.); Research Unit EA 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles Saint-Quentin, Montigny-le-Bretonneux, France (T.P., C.H., A.D., A.F.); Institut National de la Santé et de la Recherche Médicale Unité 669, University Paris-Sud and University Paris-Descartes, Paris, France (B.F.); and Unité Mixte de Recherche 216, Institut de Recherche Pour le Développement Paris Descartes, Université Paris Descartes, Paris, France (A.D.)
| | - Cyrille Huchon
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France (T.P., C.H., K.F., A.F.); University Versailles Saint-Quentin-en-Yvelines, Versailles, France (T.P., C.H., K.F., A.F.); Research Unit EA 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles Saint-Quentin, Montigny-le-Bretonneux, France (T.P., C.H., A.D., A.F.); Institut National de la Santé et de la Recherche Médicale Unité 669, University Paris-Sud and University Paris-Descartes, Paris, France (B.F.); and Unité Mixte de Recherche 216, Institut de Recherche Pour le Développement Paris Descartes, Université Paris Descartes, Paris, France (A.D.)
| | - Khadija Fathallah
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France (T.P., C.H., K.F., A.F.); University Versailles Saint-Quentin-en-Yvelines, Versailles, France (T.P., C.H., K.F., A.F.); Research Unit EA 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles Saint-Quentin, Montigny-le-Bretonneux, France (T.P., C.H., A.D., A.F.); Institut National de la Santé et de la Recherche Médicale Unité 669, University Paris-Sud and University Paris-Descartes, Paris, France (B.F.); and Unité Mixte de Recherche 216, Institut de Recherche Pour le Développement Paris Descartes, Université Paris Descartes, Paris, France (A.D.)
| | - Bruno Falissard
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France (T.P., C.H., K.F., A.F.); University Versailles Saint-Quentin-en-Yvelines, Versailles, France (T.P., C.H., K.F., A.F.); Research Unit EA 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles Saint-Quentin, Montigny-le-Bretonneux, France (T.P., C.H., A.D., A.F.); Institut National de la Santé et de la Recherche Médicale Unité 669, University Paris-Sud and University Paris-Descartes, Paris, France (B.F.); and Unité Mixte de Recherche 216, Institut de Recherche Pour le Développement Paris Descartes, Université Paris Descartes, Paris, France (A.D.)
| | - Alexandre Dumont
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France (T.P., C.H., K.F., A.F.); University Versailles Saint-Quentin-en-Yvelines, Versailles, France (T.P., C.H., K.F., A.F.); Research Unit EA 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles Saint-Quentin, Montigny-le-Bretonneux, France (T.P., C.H., A.D., A.F.); Institut National de la Santé et de la Recherche Médicale Unité 669, University Paris-Sud and University Paris-Descartes, Paris, France (B.F.); and Unité Mixte de Recherche 216, Institut de Recherche Pour le Développement Paris Descartes, Université Paris Descartes, Paris, France (A.D.)
| | - Arnaud Fauconnier
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France (T.P., C.H., K.F., A.F.); University Versailles Saint-Quentin-en-Yvelines, Versailles, France (T.P., C.H., K.F., A.F.); Research Unit EA 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles Saint-Quentin, Montigny-le-Bretonneux, France (T.P., C.H., A.D., A.F.); Institut National de la Santé et de la Recherche Médicale Unité 669, University Paris-Sud and University Paris-Descartes, Paris, France (B.F.); and Unité Mixte de Recherche 216, Institut de Recherche Pour le Développement Paris Descartes, Université Paris Descartes, Paris, France (A.D.)
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Abstract
Ultrasound scan (USS) is an important tool for assessing and diagnosing early pregnancy and gynaecological emergencies. Providing an ultrasound scanning service at all hours would enable and ease prompt diagnosis and appropriate management. It would also help hospitals in reducing costs secondary to unnecessary admissions due to lack of ultrasound out of hours. We have conducted a retrospective observational study that looked into the out of hours admissions to a busy early pregnancy unit in a general district hospital, over a 3-month period. Our results highlight the important role and possible benefits of using ultrasound out of hours and prove it is a cost-effective approach. However, providing ultrasound scanning out of hours is affected by limitations of staff and resources at each unit. This could be avoided by following a multidisciplinary approach in acute services and providing more training for medical staff in ultrasound scanning.
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Affiliation(s)
- B H Al Wattar
- Department of Obstetrics and Gynaecology, Heart of England NHS Foundation Trust, Heartlands Hospital
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14
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Polena V, Huchon C, Varas Ramos C, Rouzier R, Dumont A, Fauconnier A. Non-invasive tools for the diagnosis of potentially life-threatening gynaecological emergencies: a systematic review. PLoS One 2015; 10:e0114189. [PMID: 25723401 PMCID: PMC4344336 DOI: 10.1371/journal.pone.0114189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/05/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To identify non-invasive tools for diagnosis of the major potentially life-threatening gynaecological emergencies (G-PLEs) reported in previous studies, and to assess their diagnostic accuracy. METHODS MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library) were searched to identify all eligible studies published in English or French between January 1990 and December 2012. Studies were considered eligible if they were primary diagnostic studies of any designs, with a gold standard and with sufficient information for construction of a 2 × 2 contingency table, concerning at least one of the following G-PLEs: complicated ectopic pregnancy, complicated pelvic inflammatory disease, adnexal torsion and haemoperitoneum of any gynaecological origin. Extraction of data and assessment of study quality were conducted by two independent reviewers. We set the thresholds for the diagnostic value of signs retrieved at Sensibility ≥ 95% and LR-≤ 0.25, or Specificity ≥ 90% and LR+ ≥ 4. RESULTS We identified 8288 reports of diagnostic studies for the selected G-PLEs, 45 of which met the inclusion criteria. The methodological quality of the included studies was generally low. The most common diagnostic tools evaluated were transvaginal ultrasound (20/45), followed by medical history (18/45), clinical examination (15/45) and laboratory tests (14/45). Standardised questioning about symptoms, systolic blood pressure<110 mmHg, shock index>0.85, identification of a mass by abdominal palpation or vaginal examination, haemoglobin concentration <10 g/dl and six ultrasound and Doppler signs presented high performances for the diagnosis of G-PLEs. Transvaginal ultrasound was the diagnostic tool with the best individual performance for the diagnosis of all G-PLEs. CONCLUSION This systematic review suggests that blood pressure measurement, haemoglobin tests and transvaginal ultrasound are cornerstone examinations for the diagnosis of G-PLEs that should be available in all gynaecological emergency care services. Standardised questioning about symptoms could be used for triage of patients.
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Affiliation(s)
- Viola Polena
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
| | - Cyrille Huchon
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
| | - Catalina Varas Ramos
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
| | - Roman Rouzier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, 35 rue Dailly, 92210, Saint-Cloud, France
| | - Alexandre Dumont
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Institut de Recherche pour le Développement, UMR 216, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
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15
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Huchon C, Dumont A, Chantry A, Falissard B, Fauconnier A. Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology. World J Emerg Surg 2014; 9:46. [PMID: 25180047 PMCID: PMC4150681 DOI: 10.1186/1749-7922-9-46] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/07/2014] [Indexed: 11/22/2022] Open
Abstract
Objective Acute pelvic pain is a common reason for emergency room visits that can indicate a potentially life-threatening emergency (PLTE). Our objective here was to develop a triage process for PLTE based on a self-assessment questionnaire for gynecologic emergencies (SAQ-GE) in patients experiencing acute pelvic pain. Methods In this multicenter prospective observational study, all gynecological emergency room patients seen for acute pelvic pain between September 2006 and April 2008 completed the SAQ-GE after receiving appropriate analgesics. Diagnostic procedures were ordered without knowledge of questionnaire replies. Laparoscopy was the reference standard for diagnosing PLTE; other diagnoses were based on algorithms. In two-thirds of the population, SAQ-GE items significantly associated with PLTEs (P < 0.05) by univariate analysis were used to develop a decision tree by recursive partitioning; the remaining third served for validation. Results Of 344 derivation-set patients and 172 validation-set patients, 96 and 49 had PLTEs, respectively. Items significantly associated with PLTEs were vomiting, sudden onset of pain, and pain to palpation. Sensitivity of the decision tree based on these three features was 87.5% (95% confidence interval (95% CI), 81%-94%) in the derivation set and 83.7% in the validation set. Derivation of the decision tree provided probabilities of PLTE of 13% (95% CI, 6%-19%) in the low-risk group, 27% (95% CI, 20%-33%) in the intermediate-risk group and 62% (95% CI, 48%-76%) in the high-risk group, ruling out PLTE with a specificity of 92.3%; (95% CI, 89%-96%). In the validation dataset, PLTE probabilities were 16.3% in the low-risk group, 30.6% in the intermediate-risk group, and 44% in the high-risk group, ruling out the diagnosis of PLTE with a specificity of 88.6%. Conclusion A simple triage model based on a standardized questionnaire may assist in the early identification of patients with PLTEs among patients seen in the gynecology emergency room for acute pelvic pain.
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Affiliation(s)
- Cyrille Huchon
- Service de gynécologie & obstétrique, CHI Poissy-St-Germain, 10 rue du champ Gaillard, BP 3082 78303, Poissy CEDEX, France ; Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France
| | - Alexandre Dumont
- Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France ; UMR 216, IRD Paris Descartes, 4 Avenue de l'Observatoire, Paris - Université, 75 006 Paris Descartes, France
| | - Anne Chantry
- INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Cochin, Paris, France
| | | | - Arnaud Fauconnier
- Service de gynécologie & obstétrique, CHI Poissy-St-Germain, 10 rue du champ Gaillard, BP 3082 78303, Poissy CEDEX, France ; Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France
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Bika OH, Edozien LC. Delivering quality care: What can emergency gynaecology learn from acute obstetrics? J OBSTET GYNAECOL 2014; 34:467-70. [DOI: 10.3109/01443615.2014.902041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Iyoke CA, Lawani OL, Onoh RC. Views of Nigerian gynecologists on the need to establish and implement early pregnancy assessment units (EPAUs) in Nigerian hospitals. Int J Gynaecol Obstet 2014; 126:283-4. [PMID: 24907103 DOI: 10.1016/j.ijgo.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 03/29/2014] [Accepted: 05/08/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Chukwuemeka A Iyoke
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
| | - Osaheni L Lawani
- Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Robinson C Onoh
- Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria
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Menakaya UA, Adno A, Burnet S, Trivedi A, Smoleniec J, Condous G. Acute gynaecological services in Australia--time for a change. Aust N Z J Obstet Gynaecol 2014; 54:195-7. [PMID: 24888593 DOI: 10.1111/ajo.12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Uchefuna A Menakaya
- Acute Gynaecology, Early Pregnancy Unit and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, Sydney, NSW, Australia.
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Coutin AS, Vaucel E. [Evolution of waiting time and length of stay between 2005 and 2012 in an obstetric and gynaecologic emergency unit in a French teaching hospital]. J Gynecol Obstet Hum Reprod 2014; 43:371-378. [PMID: 24120295 DOI: 10.1016/j.jgyn.2013.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/11/2013] [Accepted: 08/13/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To compare and analyze waiting time and length of stay between 2005 and 2012 in the obstetric and gynaecologic emergency unit of Nantes teaching hospital, new unit opened in 2004. METHODS Descriptive study from the registers over 2months' periods in 2005 and 2012. RESULTS Despite an increase of the daily average number of visits from 28 to 39 (P<0.0001), the waiting time increased in obstetrics from 15minutes to 18 in 2012, P<0.03. In gynaecology, waiting time decreased in 2012 on daytime weekdays (37minutes versus 44) and increased on weekend (41minutes versus 28) and at night (37minutes versus 23) P<0.01. The length of stay was similar in obstetrics (108minutes versus 104) but reduced on daytime weekdays (124minutes in 2005, 109 in 2012, P<0.05). In gynaecology duration was similar (108minutes versus 105), but decreased on daytime weekdays (110minutes in 2005, 101 in 2012) and increased on overnight weekend (94minutes in 2005, 121 in 2012) (P<0.05). CONCLUSION Our organization enabled to improve some lengths of time despite an increased activity. Those lengths of time should be monitored as they reflect our organizations and are indicators of efficiency.
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Affiliation(s)
- A-S Coutin
- Pôle femme-enfant-adolescent, centre hospitalier universitaire, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France.
| | - E Vaucel
- Pôle femme-enfant-adolescent, centre hospitalier universitaire, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France
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20
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Toret-Labeeuw F, Huchon C, Popowski T, Chantry AA, Dumont A, Fauconnier A. Routine ultrasound examination by OB/GYN residents increase the accuracy of diagnosis for emergency surgery in gynecology. World J Emerg Surg 2013; 8:16. [PMID: 23631837 PMCID: PMC3651717 DOI: 10.1186/1749-7922-8-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/19/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Diagnostic accuracy of first-line sonographic evaluation by obstetrics/gynecology residents in determining the need for emergency surgery in women with acute pelvic pain is unknown. Aim of this study was to evaluate the diagnostic accuracy of routine ultrasound evaluation by obstetrics/gynecology residents, available 24 hours a day, in patients with acute pelvic pain. Methods A cross-sectional retrospective study included consecutive patients who underwent emergency laparoscopy for acute pelvic pain at a teaching hospital gynecologic emergency unit, between January 1, 2004, and December 31, 2006. The laparoscopic diagnosis was the reference standard. Gynecologic and nongynecologic conditions requiring immediate surgery to avoid severe morbidity or death were defined as surgical emergencies. In all patients, obstetrics/gynecology residents routinely performed clinical examination and standardized ultrasonography was routinely recorded. Sonograms were re-interpreted for the study, blinded to physical examination and laparoscopic findings, according to evidence-based predetermined criteria. Sensitivity, specificity, and likelihood ratios were computed for clinical data alone, sonographic data alone, and the combination of both. Results Emergency laparoscopy was performed in 234 patients, diagnosing 139 (59%) surgical emergencies. Clinical and sonographic examinations performed by the residents each independently predicted a need for emergency surgery. Combining both examinations was superior over each examination alone and had an acceptable false-negative rate of 1%. Conclusions First-line combined clinical and sonographic examination by obstetrics/gynecology residents is effective in ruling out surgical emergencies in patients with acute pelvic pain.
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Affiliation(s)
- Flavie Toret-Labeeuw
- Department of Gynecology & Obstetrics, Centre Hospitalier Intercommunal de Poissy - Saint-Germain, University of Versailles Saint-Quentin (UVSQ), Poissy, 78103, France.
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Huchon C, Panel P, Kayem G, Schmitz T, Nguyen T, Fauconnier A. Does this woman have adnexal torsion? Hum Reprod 2012; 27:2359-64. [DOI: 10.1093/humrep/des186] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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El-Sayed MM, Mohamed SA, Jones MH. Cost-effectiveness of ultrasound use by on-call registrars in an acute gynaecology setting. J OBSTET GYNAECOL 2012; 31:743-5. [PMID: 22085067 DOI: 10.3109/01443615.2011.614973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ultrasound, and in particular transvaginal sonography (TVS), plays an important role in the management of women with acute gynaecology conditions. This study compared the cost-effectiveness of two models of out-of-hours care for women in an acute gynaecology setting. In the ultrasound-based model, the on-call registrar with ultrasound experience managed such patients after performing pelvic ultrasound as a part of the initial assessment. On the other hand, in the traditional model of care the on-call registrar managed the patients without the use of ultrasound. The conclusion is that the use of ultrasound by the on-call registrars has significant cost implications through reduced hospital admissions. It leads to improved outcomes of such patients through timely diagnosis and treatment.
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Popowski T, Huchon C, Fathallah K, Bouhanna P, Bernard JP, Fauconnier A. Standardisation de l’échographie aux urgences gynécologiques. ACTA ACUST UNITED AC 2012; 40:182-8. [DOI: 10.1016/j.gyobfe.2011.08.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 07/29/2011] [Indexed: 11/28/2022]
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Peled Y, Ben-Haroush A, Eitan R, Eiger M, Pardo J, Krissi H. The accuracy of the preoperative diagnosis in women undergoing emergent gynecological laparoscopy for acute abdominal pain. Arch Gynecol Obstet 2011; 284:1439-42. [PMID: 21234759 DOI: 10.1007/s00404-010-1835-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 12/31/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the accuracy of the working diagnosis in emergent laparoscopies and identify variables associated with an accurate or faulty preoperative diagnosis. METHODS A retrospective cohort study including 217 consecutive women who underwent emergent laparoscopy for acute abdominal pain in 2000-2007. Each case was designated a preoperative-postoperative diagnostic match or mismatch by file review. The agreement between the clinical and preoperative ultrasound findings was analyzed according to the circumstances of imaging tests (Doppler-ultrasound examination performed by a specialist or ultrasound performed by the on-call physician without Doppler examination). RESULTS On multivariate logistic stepwise regression analysis, the significant independent variables for prediction of preoperative-postoperative diagnostic match (n = 63, 29%) were pregnant state, preoperative clinical-ultrasound match, and duration of symptoms. The circumstances of imaging tests were not a significant predictor for accurate preoperative diagnosis. CONCLUSIONS In this retrospective analysis, Doppler-ultrasound examination performed by a specialist was not associated with higher accuracy of the preoperative diagnosis in women undergoing emergent laparoscopy for acute abdominal pain. These data should be further validated in future prospective cohorts. Doppler-ultrasound examination performed by a specialist does not add to the accuracy of the preoperative diagnosis in women undergoing emergent gynecological laparoscopy for acute abdominal pain.
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Affiliation(s)
- Yoav Peled
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, 49100 Petach Tikva, Israel
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