Management of suspected ectopic pregnancy: An audit from East Kent NHS Hospital Trust.

This is a retrospective case note analysis of 105 suspected cases of ectopic pregnancies that underwent laparoscopy within a stipulated 12-month period, September 2001 to August 2002. The management and care of these women was reviewed using the Royal College of Obstetricians and Gynaecologists' (RCOG) guidelines on management of ectopic pregnancies as well as local guidelines developed from the RCOG guidance. Other criteria used to review patient care were derived from the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD). A large number of procedures (51.13%) which include laparoscopy, laparotomy and combined procedure were performed by the consultant. Approximately 90.19% of all procedures were performed during official working hours, which is in keeping with the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommendation. Other standards and criteria used were the use of anti-D immunoglobulin and the use of thromboprophylaxis. A total of 86.7% of non-sensitised Rhesus negative women received anti-D immunoglobulin; 96% of suspected ectopic pregnancies were diagnosed within 96 h of initial presentation. In 80% of cases, betahCG results were available within 24 h of request. Only 26% of ectopic pregnancies were successfully treated using laparoscopy, indicating that even though operative laparoscopy is the preferred approach, operative complications and haemoperitoneum, can lead to changes in surgical approach. The results of the audit identified areas for improvement and offers a practical solution through recommendations based on the audit process.

Microwave endometrial ablation: patients' experiences in the first 3 months following treatment.

The aim of this study was to investigate patients' experiences in the first 3 months following microwave endometrial ablation (MEA) for menorrhagia as well as the suitability of local anaesthesia (LA) versus general anaesthesia (GA) for these procedures. We carried out a cross-sectional questionnaire survey of 173 patients at 3 months after treatment with MEA. All were treated between September 1997 and December 1999. The setting was a small free-standing hospital day unit equipped with a minor operating theatre. Interventions were pretreatment with danazol or goserelin, followed by endometrial ablation with microwaves under GA or LA. Of the 173 patients, 98 (57%) were treated under GA, and 75(43%) under LA. The return of questionnaires was high in both groups (90% for GA and 84% for LA) and all procedures were completed with the planned anaesthetic. Commonly reported symptoms were immediate postoperative pain (61%), abdominal pain in the following weeks (75%), vaginal discharge (87%), vaginal bleeding (74%) and vaginal dryness. Reported symptoms were usually mild and not requiring medical intervention, e.g. in 124 patients (71%), postoperative pain was either absent or mild with no analgesics required. Only 4% had severe pain requiring a single dose of opiate analgesia. The results were similar in both groups. Sixty-nine per cent (104 patients) had no pain 1 week after treatment. This increased to over 90% by the end of the third week. Results were similar in those treated under LA (83% and 96%, respectively). There was early return to normal daily activity (70% by 1 week and 95% by 3 weeks). Reported symptoms were usually mild and not severe enough to warrant consultation of their doctor or the hospital. There were no blood transfusions or hysterectomy within the first 3 months of treatment. We conclude that MEA is well tolerated by patients. Reported side effects are usually minor. LA is comparable to GA and seems to have potential benefits.

Microwave endometrial ablation for menorrhagia.

Sixteen women requesting surgical treatment of menorrhagia were recruited for a study on microwave endometrial ablation. The mean age at treatment was 41.4 years and all patients had completed their family and were pre-menopausal. Average treatment time was 2 minutes 6 seconds. All patients reported a reduction in their menstrual loss and 87.5% were satisfied with their treatment after 1 year follow-up. One patient required overnight admission for analgesia while 15 patients were treated on a day case basis using light general anaesthesia. Sixty-seven per cent of patients reported a reduction in dysmenorrhoea scores at 1 year, two patients reported no change in symptoms and one patient reported a modest increase. One patient had a hysterectomy 10 months after treatment despite being amenorrhoeic. The indication for hysterectomy was pelvic pain (which was present before endometrial ablation). There were few minor complications but no uterine perforation or emergency hysterectomies.

The effect of maternal exercise on uterine artery velocimetry waveforms.

One hundred and two subjects in the second half of pregnancy were subject to an acute exercise test lasting 5 minutes on an upright bicycle ergometer. The pulsatility index (using Doppler ultrasound) of the right uterine artery was analysed before exercise and at 2, 4, 6, 8, 10, 12, 16, 20, 24 and 30 minutes after exercise. The mean exercise intensity achieved was 67.2% of sub-maximal exercise (range 51-90%). At 2 minutes post-exercise, the mean uterine artery pulsatility index was increased from the baseline value, reaching a maximum of 0.64 at 8 minutes (baseline 0.583). After 8 minutes there was a gradual decrease in the pulsatility index, and at 24 and 30 minutes the values were significantly lower (P < 0.001 and P < 0.001 respectively). Smokers had significantly higher pulsatility index values than non-smokers (P < 0.004). Primigravidae also had lower resistance indices compared with multigravidae (P < 0.001). We conclude that exercise in the second half of pregnancy appears to cause a transient increase in the maternal uterine artery pulsatility index. We also believe that at this level of exercise intensity there was no evidence of harmful effects on maternal uterine blood flow.