The diagnosis and management of ectopic pregnancy & pregnancy of unknown location

▪️  Diagnosis & Early Detection

QS.1

A urinary beta-human chorionic gonadotrophin (β-hCG) test should be performed in all women of reproductive age presenting to a maternity or adult general hospital/unit with abdominal pain, vaginal bleeding, gastrointestinal symptoms, dizziness, or collapse

QM.1

Numerator: Number of women who performed β-hCG

Denominator: all women of reproductive age presenting to a maternity or adult general hospital/unit with abdominal pain, vaginal bleeding, gastrointestinal symptoms, dizziness, or collapse

QS.2

Offer women who attend an early pregnancy a transvaginal ultrasound scan to identify the location of the pregnancy and whether there is a fetal pole and heartbeat. If a transvaginal ultrasound scan is unavailable or unacceptable to the woman, offer a transabdominal ultrasound scan and explain the limitations of this method of scanning

QM.2

Numerator: number of women who performed early pregnancy ultrasound

Denominator: number of women attending antenatal care

▪️  Treatment

QS.1

Offer expectant management as an option to women who are clinically stable and pain-free and have a tubal ectopic pregnancy measuring <35 mm with no visible heartbeat on transvaginal ultrasound scan and have serum hCG levels of ≤1000 IU/L and are able to return for follow-up

QM.1

Numerator: Number of women who were treated expectantly

Denominator: all women diagnosed with ectopic pregnancy with indications of expectant management

QS.2

Offer systemic methotrexate to women who have no significant pain and have an unruptured tubal ectopic pregnancy with an adnexal mass smaller than 35 mm with no visible heartbeat and have a serum hCG level less than 1,500 IU/litre and do not have an intrauterine pregnancy (as confirmed on an ultrasound scan) and are able to return for follow-up

QM.2

Numerator: number of women were treated with methotrexate

Denominator: Total number of women with indications of methotrexate treatment

QS.3

Offer surgery as a first-line treatment to women who are unable to return for follow-up after methotrexate treatment or who have an ectopic pregnancy and significant pain, with an adnexal mass of 35 mm or larger, with a fetal heartbeat visible on an ultrasound scan, with a serum hCG level of 5,000 IU/litre or more

QM.3

Numerator: number of women were treated surgically

Denominator: Total number of women with indications of surgical treatment