A clinical study of ectopic pregnancy: a five-year institutional experience

Background: Ectopic pregnancy contributes significantly to maternal morbidity and mortality. There is a steady increase in the incidence of ectopic pregnancy over the past few decades, owing to rise in sexually transmitted infections, subfertility and its treatment with ART techniques. Objective of present work was to study the rate of ectopic pregnancy, associated risk factors, clinical course and management at SSIMS and RC.Methods: This is a retrospective study carried out at SSIMS and RC, Davangere from 01st January 2012 to 30th April 2017. A detailed analysis of case sheets done and all parameters analyzed. Institutional ectopic rate was calculated per 1000 deliveries.Results: Out of 43 women with ectopic gestation, 40 (93.02%) were tubal ectopic and 3 (6.98%) were ovarian ectopic. Institutional rate of ectopic is 11.54 per 1000 deliveries. STI’s are the commonest risk factor followed by subfertility. Diagnostic aid commonly used was pelvic ultrasound. There were no maternal deaths due to ectopic pregnancy. One third of the women presented with shock. 52.5% tubal and 66.6% ovarian ectopics were ruptured. All women with tubal ectopic were managed by salpingectomy either by open or laparoscopic method and ovarian ectopics managed by ipsilateral oophorectomy. Two-thirds of the women received blood transfusion and 5-7 days were required for post-operative recovery.Conclusions: Ectopic pregnancy is one of the commonest gynecological emergency and there is a yearly increase in the rate of ectopic. STI’s and subfertility are important risk factors. Prevention, early detection and treatment of STI’s may play an important role in reducing the rate of ectopic pregnancy.

Changing trends in the usage of copper intrauterine contraceptive device: a five year institutional study

Background: Intrauterine contraceptive device is one of the commonest form of long acting contraceptive method (LARC) adapted by reproductive aged women all over the world today. It can be used for 5 to 10 years depending on the type of the device. Aim of the study was to study the institutional rate of copper IUCD usage, rate of removal, side effect profile, indications for removal among women seeking contraception.Methods: The data regarding the usage of various temporary contraceptive methods were obtained from the family planning unit at our institution SSIMS&RC, Davangere from the records between Jan 1, 2012 to Dec 31, 2016 (5 years). A careful detailed study of records was done on the usage of Cu-IUCD.Results: During the five year study period, 3,767 women were provided with various forms of contraceptive methods. Cu-IUCD was the commonest method used by women accounting for 42.11% (1586 users). There was a decline in the rate of usage of Cu-IUCD in 2015-16, with increase in the usage of injectables. 179 women requested for removal in the study period, main reason being desire to become pregnant in 73.18% (131) users. Failure rate in the study period was 0.55%.Conclusions: Cu-IUCD is a safe and effective method of contraception adapted by women of reproductive age. The rate of removal is also low in our study. The decline in the usage of Cu-IUCD during our study period could be attributed to increasing awareness of other methods of LARC.

Preoperative Laboratory Investigations

Background Increasing attention has been focused on low-value healthcare services. Through Choosing Wisely campaigns, routine laboratory testing before low-risk surgery has been discouraged in the absence of clinical indications. The authors investigated rates, determinants, and institutional variation in laboratory testing before low-risk procedures. Methods Patients who underwent ophthalmologic surgeries or predefined low-risk surgeries in Ontario, Canada, between April 1, 2008, and March 31, 2013, were identified from population-based administrative databases. Preoperative blood work was defined as a complete blood count, prothrombin time, partial thromboplastin, or basic metabolic panel within 60 days before an index procedure. Adjusted associations between patient and institutional factors and preoperative testing were assessed with hierarchical multivariable logistic regression. Institutional variation was characterized using the median odds ratio. Results The cohort included 906,902 patients who underwent 1,330,466 procedures (57.1% ophthalmologic and 42.9% low-risk surgery) at 119 institutions. Preoperative blood work preceded 400,058 (30.1%) procedures. The unadjusted institutional rate of preoperative blood work varied widely (0.0 to 98.1%). In regression modeling, significant predictors of preoperative testing included atrial fibrillation (adjusted odds ratio [AOR], 2.58; 95% CI, 2.51 to 2.66), preoperative medical consultation (AOR, 1.68; 95% CI, 1.65 to 1.71), previous mitral valve replacement (AOR, 2.33; 95% CI, 2.10 to 2.58), and liver disease (AOR, 1.69; 95% CI, 1.55 to 1.84). The median odds ratio for interinstitutional variation was 2.43. Conclusions Results of this study suggest that testing is associated with a range of clinical covariates. However, an association was similarly identified with preoperative consultation, and significant variation between institutions exists across the jurisdiction.

Point-of-Care Glucose Critical Values: A Q-Probes Study Involving 50 Health Care Facilities and 2349 Critical Results

Context Accuracy of blood glucose measurements in the critical value range is important for properly treating patients with severe hypoglycemia and hyperglycemia. Objective To evaluate the performance and reliability of point-of-care glucose (POCG) results in the critical value range among multiple facilities. Design Q-Probes participants retrospectively collected data from up to 50 POCG results in their critical value range including patient location, type of testing operator, repeat glucose results, and caregiver notification. A repeat measurement at 10 minutes or less that was within 15 mg/dL of initial critical low or 20% of initial critical high value was considered a confirmed result. Results Fifty facilities submitted data. Of 2349 critical POCG measurements, 1386 (59.0%) were retested. The median institutional retest rate was 56%. The retest rate was significantly higher when initial results were in the critical low range, P < .001. Although 30 of 50 facilities (60%) had written procedures for retesting, this was not associated with higher retest rates (P = .34). Among 35 facilities that routinely retested critical POCG results, 23 (65.7%) had criteria defined for interpreting results. The median institutional confirmation rate for retested specimens was 81.7%. The median institutional rate for caregiver notification of critical POCG results was 85.7%. Five hundred eighty-six of 1488 critical POCG notifications (39.4%) were done on patients in whom specimens were not retested. Conclusions This study shows that POCG results in the critical range may be unreliable because of testing errors that are not recognized from lack of confirmatory testing. In addition, notification of critical POCG results is not consistently performed.