Oyelese K O, Shehata H, Hussain S, Manyonda I
Department of Obstetrics and Gynaecology, St George's Hosptial, London, UK.
J Obstet Gynaecol. 1999 May;19(3):276-9. doi: 10.1080/01443619965066.
We carried out a complete audit cycle of the management of ectopic pregnancy at a London teaching hospital over 2 years. Case notes of women presenting to St George's Hospital, London in 1995 with ectopic pregnancy were examined and management was assessed. The targets were low rates of rupture, high rates of sonographic diagnosis of ectopic pregnancy, acceptable rates of tubal conservation and laparoscopic surgery. We also considered levels of training of junior doctors in laparoscopic surgery for ectopic pregnancy and the acceptable duration of hospital stay for patients. Recommendations were made, the standards were modified, and the audit repeated for the year 1996. A substantial improvement in the quality of care of women with ectopic pregnancy was achieved. The main improvement was in the ultrasonographic diagnosis of ectopic pregnancy. There was also a reduction in ectopic pregnancies which were ruptured, possibly due to earlier diagnosis. The percentage of cases treated laparoscopically remained stable. More junior doctors performed laparoscopic surgery for the condition. Finally, we confirmed that laparoscopic management of ectopic pregnancy significantly reduces duration of hospital stay, conferring advantages to both patient and hospital.
我们在一家伦敦教学医院对异位妊娠的管理进行了为期两年的完整审核周期。检查了1995年在伦敦圣乔治医院就诊的异位妊娠女性的病历，并对管理情况进行了评估。目标是降低破裂率、提高异位妊娠的超声诊断率、使输卵管保留率和腹腔镜手术率达到可接受水平。我们还考虑了初级医生在异位妊娠腹腔镜手术方面的培训水平以及患者可接受的住院时间。提出了建议，修改了标准，并对1996年进行了重复审核。异位妊娠女性的护理质量有了显著提高。主要的改善在于异位妊娠的超声诊断。破裂的异位妊娠数量也有所减少，这可能是由于早期诊断。腹腔镜治疗的病例百分比保持稳定。更多的初级医生进行了针对该病症的腹腔镜手术。最后，我们证实异位妊娠的腹腔镜管理显著缩短了住院时间，对患者和医院都有好处。
