Quantifying the risk of ectopic pregnancy with a transient diagnosis of pregnancy of unknown location.

OBJECTIVE: To quantify the risk of ectopic pregnancy among a transient diagnosis of pregnancy of unknown location (PUL). METHODS: Retrospective cohort study between August 2016 and November 2020. The final cohort included 244 patients with 255 PULs who presented with vaginal bleeding and/or abdominal pain, positive serum quantitative ß-human chorionic gonadotropin, and negative transvaginal ultrasound, with a subsequent definitive diagnosis. Two-way analysis of variance was used with significance set at P < 0.050. Bonferroni-corrected significance values were used in post hoc analysis. Multinominal logistic regression was used to predict adjusted risk for pregnancy outcome. RESULTS: Definitive diagnosis consisted of 101 (39%) intrauterine pregnancies, 33 (13%) ectopic pregnancies, and 121 (48%) resolved PULs or resolved/treated persisting PULs. A total 68% of the PULs subsequently became nonviable. Vaginal bleeding was associated with increased risk of nonuterine pregnancies. CONCLUSION: A total of 13% of PULs were subsequently diagnosed as ectopic pregnancies, which is higher than the 2% to 3% risk of an ectopic pregnancy in the general reproductive population. A total of 68% of PULs were subsequently nonviable, which is higher than the 31% early pregnancy loss rate in the general reproductive population. This study quantitatively confirms that a transient diagnosis of a PUL increases the odds for ectopic pregnancy and early pregnancy loss.

Development of a Novel, Low-Cost, Low-Fidelity Simulation Model for Pudendal Nerve Block Application.

Background: Pudendal nerve block is an important alternative to neuraxial anesthesia, yet studies demonstrate that 3% to 50% of pudendal nerve blocks are ineffective. Lack of clinician training is the most common cause, and there are no simulation models currently described. Objective: To develop and test a novel, low-cost, low-fidelity simulation model for training residents in the placement of a pudendal nerve block. Methods: A pudendal nerve block model was developed using commonly found supplies, with a cost of $20.57. First-year to fourth-year obstetrics and gynecology (OB/GYN) and family medicine (FM) residents were invited to 1 of 4 pudendal nerve block 1-hour simulation sessions from December 2019 to March 2021 during their required teaching sessions. Expert faculty led a discussion of pudendal nerve blocks, then participants practiced with the described model. A survey about the model was created by the authors and administrated prior to and immediately after the session. Pre- and post-surveys were analyzed by Wilcoxon signed rank tests, and Bonferroni correction was performed. Results: Thirty-four out of a total of 36 eligible residents participated (94%). Residents showed improvement in knowledge (median pre-simulation score 43.99 compared with 70.06 post-simulation, P<.00625) and self-assessed confidence (median pre-simulation score 1.7 compared with 3.2 post-simulation, P<.00625) of a pudendal block placement after simulation training. Conclusions: This new, low-cost, reusable, low-fidelity simulation model for pudendal nerve block placement improved knowledge and confidence in OB/GYN and FM residents after 1 hour of simulation training.