Difficulties and errors in the prehospital diagnosis of ectopic pregnancy
The problem in the prehospital diagnosis of ectopic pregnancy (EP) in women is due to a significant frequency of errors and, as a consequence, delayed hospitalization for surgical treatment. Reducing diagnostic errors mainly in the prehospital stage can improve the quality of care for patients with EP.Manukhin I.B., Ramazanova S.S., Firichenko S.V., Smirnova S.O.
Objective. To analyze the errors of prehospital EP diagnosis and to optimize the latter.
Subjects and methods. The quality of medical care was retrospectively analyzed in 194 patients with EP. By taking into account the identified defects, the authors elaborated an optimized approach to providing outpatient care for patients with EP and evaluated its efficiency in 332 patients with suspected EP.
Results. Unavailability of β-human chorionic gonadotropin (β-hCG) test results at the first visit is a main defect in medical care for patients with EP at the prehospital stage. The laboratory diagnosis of pregnancy, which complies with established standards and is based on serum β-hCG determination, does not meet the requirements for emergency outpatient care since it does not ensure the availability of the result at the same visit. The optimized approach increases the diagnosis of EP from 27.1 to 76.1% at the first visit.
Conclusion. The correct diagnosis made on the day of a patient visit is a significant reserve to reduce severe and complicated cases.
Keywords
ectopic pregnancy
rapid test for β-hCG
outpatient care
References
1. Zhang Y.L., Sun J., Su Y.C., Guo Y.H., Sun Y.P. Study on the incidence and influences on etopic pregnancy from embryo transfer of fresh cycles and frozen-thawed cycles. Zhonghua Fu Chan Ke Za Zhi. 2012; 47(9): 655-8.
2. Lee R., Dupuis C., Chen B., Smith A., Kim Y.H. Diagnosing ectopic pregnancy in the emergency setting. Ultrasonography. 2018; 37(1): 78-87.
3. Радзинский В.Е. Акушерская агрессия v. 2.0. М.: Status Praesens; 2017. [Radzinsky V.E. Obstetric aggression v. 2.0. Moscow: Status Praesens; 2017. (in Russian)]
4. Huancahuari N. Emergencies in early pregnancy. Emerg. Med. Clin. North Am. 2012; 30(4): 837-47.
5. Barnhart K.T. Clinical practice. Ectopic pregnancy. N. Engl. J. Med. 2009; 361(4): 379-87.
6. van Mello N.M., Mol F., Opmeer B.C., Ankum W.M., Barnhart K., Coomarasamy A. et al. Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. Hum. Reprod. Update. 2012; 18(6): 603-17.
7. Berger P., Sturgeon C. Pregnancy testing with hCG--future prospects. Trends Endocrinol. Metab. 2014; 25(12): 637-48.
8. Hochman E., Elami-Suzin M., Soferman H.G., Galil T., Hershkovitz Y., Tzur D. et al. Early pregnancy confirmation--the role of urine pregnancy test in military primary care clinics. Mil. Med. 2012; 177(8): 947-51.
9. Min J., Buckel C., Secura G.M., Peipert J.F., Madden T. Performance of a checklist to exclude pregnancy at the time of contraceptive initiation among women with a negative urine pregnancy test. Contraception. 2015; 91(1): 80-4.
10. Чертовских М.Н., Флоренсова Е.В., Кулинич С.И. Возможные пути улучшения диагностики трубной беременности в плане выполнения органосохраняющих операций. Сибирский медицинский журнал. 2009; 7: 104-7. [Chertovskikh M.N., Florensova E.V., Kulinich S.I. Possible ways to improve the diagnosis of tubal pregnancy in terms of performing organ-saving operations. Siberian Medical Journal. 2009; 7: 104-7. (in Russian)]
11. Каушанская Л.В., Салов И.А. Современные технологии в диагностике внематочной беременности на госпитальном этапе. Саратовский научно-медицинский журнал. 2009; 5(4): 537-40. [Kaushanskaya L.V., Salov I.A. Modern technologies in the diagnosis of ectopic pregnancy at the hospital stage. Saratov Journal of Medical Scientific Research. 2009; 5(4): 537-40. (in Russian)]
12. Приказ Министерства здравоохранения России от 07.11.2012 N 589н „Об утверждении стандарта специализированной медицинской помощи при внематочной (эктопической) беременности”. [Order of the Ministry of Health of Russia from 07.11.2012 N 589n “On the approval of the standard of specialized medical care for ectopic (ectopic) pregnancy.” (in Russian)]
13. Основные показатели здоровья матери и ребенка, деятельность службы охраны детства и родовспоможения в Российской Федерации. М.: МЗ РФ; 2016. [The main indicators of maternal and child health, the activities of child welfare and obstetrics in the Russian Federation. Moscow: Ministry of Health of the Russian Federation; 2016. (in Russian)]
14. Милованов А.П., ред. Анализ причин материнской смертности. Руководство для врачей. М.: МВД; 2008. 228с. [Milovanov A.P., ed. Analysis of the causes of maternal mortality. A guide for doctors. Moscow: Ministry of Internal Affairs; 2008. 228p. (in Russian)]
Received 08.06.2018
Accepted 22.06.2018
About the Authors
Manukhin, Igor B., MD, professor, head of the Department of Obstetrics and Gynecology, Faculty of General Medicine, A.I. EvdokimovMoscow State University of Medicine and Dentistry. 127473, Russia, Moscow, Delegatskaya str. 20/1. Tel.: +74991785971
Ramazanova Sevilla Savelievna, obstetrician-gynecologist of Khimki Central Clinical Hospital, Moscow Region.
141401, Russia, Moscow, Kurkinskoe Highway, 11. Tel.: +79852541616
Firichenko Sergey Viktorovich, MD, associate professor of Department of Obstetrics and Gynecology, Faculty of General Medicine, A.I. Evdokimov Moscow
State University of Medicine and Dentistry. 127473, Russia, Moscow, Delegatskaya str. 20/1. Tel.: +74991785971, +79104400452. E-mail: Firichenko@mail.ru
Smirnova Svetlana Olegovna, MD, associate professor of Department of Obstetrics and Gynecology, Faculty of General Medicine, A.I. Evdokimov
Moscow State University of Medicine and Dentistry. 127473, Russia, Moscow, Delegatskaya str. 20/1. Tel.: +74991785971
For citations: Manukhin I.B., Ramazanova S.S., Firichenko S.V., Smirnova S.O. Difficulties and errors in the prehospital diagnosis of ectopic pregnancy. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (8): 98-104. (in Russian)
https://dx.doi.org/10.18565/aig.2018.8.98-104
Similar Articles
