Case Number 4607
Request Date 03/02/2016
Completion Date  

 

Details of the Request

In relation to the last 12 months:

 

Do you offer systemic methotrexate as a first-line treatment to women who are able to return for follow-up and who have all of the following:

  • no significant pain, andan unruptured ectopic pregnancy with an adnexal mass smaller than 35 mm with no visible heartbeat
  • a serum hCG level less than 1500 IU/litre?

 

Do you offer the choice of either methotrexate or surgical management to women with an ectopic pregnancy who have a serum hCG level of at least 1500 IU/litre and less than 5000 IU/litre, who are able to return for follow-up and who meet all of the following criteria:

  • no significant pain and an unruptured ectopic pregnancy with an adnexal mass smaller than 35 mm with no visible heartbeat?

 

What percentage of women have surgical treatment of their ectopic pregnancy performed by laparotomy?

What percentage of women have surgical treatment of their ectopic pregnancy completed laparoscopically?

What percentage of women have surgical treatment of their ectopic pregnancy initiated laparoscopically and converted to laparotomy?

Do you always have the correct equipment available to allow the laparoscopic treatment of ectopic pregnancy?

Do you perform salpingectomy for women with an ectopic pregnancy and no clear risk factors for infertility?

Do you perform salpingotomy for women with risk factors for infertility?

Please estimate the % of surgeons operating on ectopic pregnancies who you think can competently and confidently perform a salpingotomy?

What equipment / organizational / training issues could improve the laparoscopic treatment of your patients with an ectopic pregnancy?

 

Details of the Response

In relation to the last 12 months: Yes/No/% Comments / explanation
Do you offer systemic methotrexate as a first-line treatment to women who are able to return for follow-up and who have all of the following:
  • no significant pain, and an unruptured ectopic pregnancy with an adnexal mass smaller than 35 mm with no visible heartbeat
  • a serum hCG level less than 1500 IU/litre?
No Usually conservative or surgical option offered first, methotrexate offered for non tubal ectopics or at patients request
Do you offer the choice of either methotrexate or surgical management to women with an ectopic pregnancy who have a serum hCG level of at least 1500 IU/litre and less than 5000 IU/litre, who are able to return for follow-up and who meet all of the following criteria:
  • no significant pain and an unruptured ectopic pregnancy with an adnexal mass smaller than 35 mm with no visible heartbeat?
Yes Routinely offer option of surgical or conservative management.
What percentage of women have surgical treatment of their ectopic pregnancy performed by laparotomy? 2% Estimated from experience over the last year
What percentage of women have surgical treatment of their ectopic pregnancy completed laparoscopically? 96%  
What percentage of women have surgical treatment of their ectopic pregnancy initiated laparoscopically and converted to laparotomy? 2%  
Do you always have the correct equipment available to allow the laparoscopic treatment of ectopic pregnancy? Yes  
Do you perform salpingectomy for women with an ectopic pregnancy and no clear risk factors for infertility? Yes As per RCOG guidance
Do you perform salpingotomy for women with risk factors for infertility? Yes As per RCOG guidance
Please estimate the % of surgeons operating on ectopic pregnancies who you think can competently and confidently perform a salpingotomy? 50% laparoscopically
100% by laparotomy
If a surgeon is unable to perform salpingotomy there is cross over cover and an alternative Consultant will take over the procedure.
What equipment / organizational / training issues could improve the laparoscopic treatment of your patients with an ectopic pregnancy?   Improving access to early pregnancy scanning to reduce incidence factors of women with large haemo peritoneums