MISS hELEN BAYLISS FRCOG CONSULTANT LEAD rACHEL GILMORE LEAD NURSE AND sonographer cWM TAF MORGANNWG UNIVERSITY HEALTH BOARD Introduction Since the end of March of this year we introduced a Covid 19 pathway for Abortion care to ensure continuation of services in our area of South Wales ID: 932316
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Slide1
CORNUAL ECTOPIC PREGNANCY DIAGNOSED AFTER EARLY MEDICAL ABORTION
MISS hELEN BAYLISS FRCOG (CONSULTANT LEAD), rACHEL GILMORE (LEAD NURSE AND
sonographer
)
cWM TAF MORGANNWG UNIVERSITY HEALTH BOARD
Slide2Introduction
Since the end of March of this year, we introduced a Covid 19 pathway for Abortion care to ensure continuation of services in our area of South Wales.
This meant that the majority of our women who had no risk factors identified at their telephone consultations did not have an Ultrasound scan.
Concerns were raised as to the safety of this practice especially regarding the prompt diagnosis and management of Ectopic pregnancy.
The patient has given us consent to share her story.
Slide3Case Report
A 25 year old accessed our Abortion care pathway in September of this year.
She had one child born by normal delivery and had had one previous surgical termination.
During her telephone consultation there were no risks for ectopic pregnancy identified using the RCOG decision aid for early medical abortion without ultrasound.
In good faith she was dated at 5 weeks gestation and given treatment for an early medical abortion.
Slide4POST EMA
The patient contacted our department shortly after her treatment and advised us that she had experienced no bleeding or pain and was still symptomatic of pregnancy
She was asked to attend and an ultrasound showed a live right sided
Cornual
or Interstitial ectopic pregnancy. The patient was still asymptomatic at this time, and was sent directly to Prince Charles Hospital, where she had surgery the same day.
The operation notes describe a
Cornual
ectopic, with no evidence of rupture.
Slide5Interstitial pREGNANCY
The term interstitial pregnancy is sometimes interchangeably used with
Cornual
pregnancy, but the latter specifically refers to the presence of a gestational sac within a rudimentary uterine horn, a
unicornuate
uterus,
cornua
of a
bicornuate
uterus or
septate
uterus.
It accounts for 2 – 4% of all ectopics and the incidence is thought to be rising
Early diagnosis and management is important as there is a 15 x increase in morbidity and mortality due to later presentation and increased complications.
The main risk factor is a history of prior intrauterine instrumentation.
Slide6Discussion
We have spoken with this patient recently and she is recovered and grateful for the management she received. Her perception is that she was lucky to have been medically assessed so early in her pregnancy.
This case helps to show that asymptomatic ectopic pregnancy should of course always be considered in our patients. But it may also help strengthen the argument that abortion without ultrasound is safe as long as we have an accessible follow up system in place.
We have since added any patients who have had surgical termination of pregnancy to our ultrasound trigger list, in light of this case.