Woo Lawrence, Shirley Jenna, Wellman Emilie, Karreman Erwin, Jabs Corrine
Department of Obstetrics and Gynaecology, University of Saskatchewan, Regina, SK.
College of Medicine, University of Saskatchewan, Regina, SK.
J Obstet Gynaecol Can. 2020 Sep;42(9):1086-1092. doi: 10.1016/j.jogc.2020.02.126. Epub 2020 Apr 17.
Patients who experience spontaneous abortion often present to the emergency department (ED), which may restrict the physician's recommendations for and the patient's choice of therapy. With support provided by an early pregnancy assessment clinic (EPAC), expectant and medical management may become more feasible options for spontaneous abortion. This study aimed to compare the therapeutic choices before and after the establishment of an EPAC and hypothesized that the proportion of miscarriages treated expectantly or medically would increase.
We conducted a retrospective cohort study that compared patients presenting to the ED and the EPAC with spontaneous abortion. We excluded patients with hemodynamic instability, complete abortions, ectopic pregnancies, and molar pregnancies. The primary outcome was the initial chosen treatment. The retrospective chart review included demographics, type of spontaneous abortion and management, procedural dictations, ED notes, and EPAC clinic documentation. Secondary end points included wait times, repeat visits, and success rates for the initial treatment option.
We reviewed 103 ED and 92 EPAC patient records. Patients in the ED were 1.52 times more likely to choose surgery over expectant or medical management (P = 0.004). Patients in the ED were 1.41 times more likely to have surgery as their final treatment compared with patients in the EPAC (P = 0.006). There were no significant differences in length of stay, number of visits required, or adverse outcomes.
Our study demonstrates that an EPAC results in more patients choosing and successfully being treated by expectant or medical management for spontaneous abortion.
经历自然流产的患者常前往急诊科（ED），这可能会限制医生的治疗建议以及患者的治疗选择。在早期妊娠评估诊所（EPAC）的支持下，期待疗法和药物治疗可能会成为自然流产更可行的选择。本研究旨在比较EPAC设立前后的治疗选择，并假设采用期待疗法或药物治疗的流产患者比例会增加。
我们进行了一项回顾性队列研究，比较前往ED和EPAC的自然流产患者。我们排除了血流动力学不稳定、完全流产、异位妊娠和葡萄胎妊娠的患者。主要结局是最初选择的治疗方法。回顾性病历审查包括人口统计学、自然流产类型和治疗、手术记录、ED记录以及EPAC诊所文档。次要终点包括等待时间、复诊次数和初始治疗方案的成功率。
我们审查了103份ED患者记录和92份EPAC患者记录。与期待疗法或药物治疗相比，ED患者选择手术的可能性高1.52倍（P = 0.004）。与EPAC患者相比，ED患者最终接受手术治疗的可能性高1.41倍（P = 0.006）。住院时间、所需就诊次数或不良结局方面无显著差异。
我们的研究表明，EPAC使更多患者选择期待疗法或药物治疗自然流产并获得成功治疗。
