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Compliance With Follow-Up Among Patients Treated With Methotrexate for Suspected Ectopic Pregnancy in an Urban Community Setting
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
hours at the same day. At step three they have reached the preset proficiency levels for the five tasks. Step four is the performance of a laparoscopic supracervical hysterectomy in the operating room. The surgical procedure is video-recorded and stored on a memory-stick. Measurements and Main Results: The surgical performance is evaluated using two assessment tools; Global Operating Assessment in Laparoscopic skills (GOALS) and Competence Assessment Tool for Laparoscopic supracervical hysterectomy (CAT-LSH). Two observers, blinded for the registrars identity, evaluate the video-taped procedures. The results from the GOALS and CAT-LSH score are compared with the same score for residents with the same surgical experience but no training on the simulator, demonstrated in a previous study. The participants evaluate themselves with the same assessment tools before leaving the operation room and the surgical performance is assessed by the assisting consultant. The study inclusion was started on March 17th 2015, and six registrars have been included so far. According to the power calculations, 12 study participants is needed. Results will be presented and discussed. Conclusion: Will be presented and discussed. 575 Accurate Identification of Anatomical Structures in a Normal Female Pelvis During Laparoscopic Surgery: A Survey Amongst Trainees and Consultants in Obstetrics and Gynaecology Jones AS, Thomas CM, Griffiths A, Nargund A. Women’s Health, University Hospital of Wales, Cardiff, Wales, United Kingdom Study Objective: The study objective is to assess accuracy of identification of pelvic anatomical structures in a normal female pelvis during laparoscopic surgery, according to level of experience and competence. Design: An observational study was conducted using anonymised photographs taken at laparoscopy, labelled to indicate 19 anatomical structures. Anterior abdominal wall, right pelvic side wall and panoramic anteverted and retroverted uterus views of the pelvis were included. Photographs were shown on large computer screens to demonstrate images as displayed in theatre. Each participant was guided through the orientation of the images and encouraged to record their responses in one sitting. None of the participants were aware of an anatomy survey being conducted in the department prior to the study commencing. All 28 participants were recruited during one day. Setting: Doctors of varying grades and special interest working at University Hospital of Wales Department of Women’s Health, were asked at random to complete the study, which was done under supervision to ensure completion without influence of others or resources. Each was asked to identify labelled structures and anonymously record answers on a standardised free text grid. Patients: Measurements and Main Results: Preliminary results are available due to extension of this study to include other groups. Accuracy of identification of structures improved with level of experience. Second year junior doctors scored a range between 26% - 53% with consultants scoring 53% - 100%. 100% correctly identified the uterus, ovaries and fallopian tubes. The least accurately labelled structures were the urachus (43%) and obliterated umbilical arteries (25% - 43%) which were also mistaken for the inferior epigastric vessels in 14% of responses. Conclusion: In conclusion, accuracy of identification of anatomy during laparoscopy improves with level of experience and continued competence. To maximise patient safety, competency at laparoscopic surgery should include assessment of correct identification of normal anatomy in addition to pathology. 576 Pattern of Congenital Uterine Anomalies Among Infertile Women in Southwest Nigeria Ajayi A,1 Ajayi V,1 Biobaku O,1 Oyetunji I,1 Aikhuele H,1 Adejuwon O,1 Afolabi B.2 1Nordica Fertility Centre, Ikoyi, Lagos, Nigeria; 2Health, Environment and Development Foundation, Yaba, Lagos, Nigeria
Study Objective: To determine the prevalence and pattern of congenital uterine anomalies (CUA)detected at hysteroscopy among infertile women (IW) in Southwest Nigeria. Design: Clinical retrospective cohort study. Setting: Nordica Fertility Center, a private establishment in, Lagos, Nigeria. Patients: One thousand one hundred and eighteen consecutive infertile women. Intervention: Hysteroscopy. Measurements and Main Results: Of the 1118 IW examined, 26 (2.3%) had CUA, majority of which were subseptate uterus (19/26; 73.1%); others were bicornuate (3, 11.5%), arcuate (2, 7.7%), unicornuate (1, 3.8%) and intracervical septum (1, 3.8%).The means (SD) of age (years), BMI (Kg/m2) and duration of subfertility (years)among IW with CUA were 38.7 (6.6), 27.4 (5.9) and 7.5 (6.9) respectively. CUA was more prevalent among IW in the age group of 35-39 years (9/26; 34.6%), in overweight (15/26, 57.7%). 24 (92.3%) had secondary infertility and 9 (34.6%) gave a history of spontaneous miscarriage. The mean uterine cavity depth of IW with CUA (7.811.01; 95% CI= 7.4, 8.2) was significantly smaller (t= -2.26, df=27.7, P-value=0.015) than that of IW without CUA (8.271.50; 95% CI= 8.2, 8.4). Among IW with CUA, 1 (3.8%) had obliterated right ostium while 2 (7.7%) had obliterated left ostium. Conclusion: The 2.3% CUA prevalence among IW was comparable to other studies. Subseptate uterus was the most frequent CUA. Majority of the IW with CUA had secondary infertility and significantly smaller uterine cavity depth.
577 Compliance With Follow-Up Among Patients Treated With Methotrexate for Suspected Ectopic Pregnancy in an Urban Community Setting Fridman D, Chong W, Rotenberg O, Chudnoff S, Hawkins E, Mehta S, Levie M. Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center, Bronx, New York Study Objective: To describe follow-up compliance rate among patients treated with single dose methotrexate for suspected ectopic pregnancy in typical clinical care. Design: A retrospective cohort, descriptive study. Setting: Inner city academic medical center. Patients: All patients presenting to the medical center emergency department who were treated for suspected ectopic pregnancy with methotrexate from January 2000 to January 2014. Intervention: Manual review of medical records to retrieve demographic and clinical information. Specifically, follow-up compliance in this patient population. Measurements and Main Results: There were a total of 633 patients who received treatment with methotrexate for suspected ectopic pregnancies. Of them, 396 (62.6%) completed follow-up (study group) – 293 (74%) had eventual undetectable levels of b-hcg, 91 (23%) subsequently underwent salpingectomy and 12 (3%) subsequently underwent D&C with products of conception found on pathological exam. The average visit number which the patient received methotrexate was the 2nd visit. There was no statistically significant difference in demographics, clinical presentation, sonographic and laboratory findings between the study group and patients who did not complete follow up. On average patients who completed follow up had 2 more visits than those who did not (7.03.0 vs 5.32.9, p \ 0.01). Of 237 patients who failed to follow-up 118 (49.8%) had last b-hcg level below 200 mIU/mL; 156 (65.8%) were on a downwards trend (consecutive decrease of b-hcg level by at least 15%); 42 (17.7%) did not come for a single visit after methotrexate administration. Conclusion: A high rate of non-compliance during typical clinical care in a high-volume urban setting should be taken into consideration when developing a management algorithm for patients with suspected ectopic pregnancy.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
hours at the same day. At step three they have reached the preset proficiency levels for the five tasks. Step four is the performance of a laparoscopic supracervical hysterectomy in the operating room. The surgical procedure is video-recorded and stored on a memory-stick. Measurements and Main Results: The surgical performance is evaluated using two assessment tools; Global Operating Assessment in Laparoscopic skills (GOALS) and Competence Assessment Tool for Laparoscopic supracervical hysterectomy (CAT-LSH). Two observers, blinded for the registrars identity, evaluate the video-taped procedures. The results from the GOALS and CAT-LSH score are compared with the same score for residents with the same surgical experience but no training on the simulator, demonstrated in a previous study. The participants evaluate themselves with the same assessment tools before leaving the operation room and the surgical performance is assessed by the assisting consultant. The study inclusion was started on March 17th 2015, and six registrars have been included so far. According to the power calculations, 12 study participants is needed. Results will be presented and discussed. Conclusion: Will be presented and discussed. 575 Accurate Identification of Anatomical Structures in a Normal Female Pelvis During Laparoscopic Surgery: A Survey Amongst Trainees and Consultants in Obstetrics and Gynaecology Jones AS, Thomas CM, Griffiths A, Nargund A. Women’s Health, University Hospital of Wales, Cardiff, Wales, United Kingdom Study Objective: The study objective is to assess accuracy of identification of pelvic anatomical structures in a normal female pelvis during laparoscopic surgery, according to level of experience and competence. Design: An observational study was conducted using anonymised photographs taken at laparoscopy, labelled to indicate 19 anatomical structures. Anterior abdominal wall, right pelvic side wall and panoramic anteverted and retroverted uterus views of the pelvis were included. Photographs were shown on large computer screens to demonstrate images as displayed in theatre. Each participant was guided through the orientation of the images and encouraged to record their responses in one sitting. None of the participants were aware of an anatomy survey being conducted in the department prior to the study commencing. All 28 participants were recruited during one day. Setting: Doctors of varying grades and special interest working at University Hospital of Wales Department of Women’s Health, were asked at random to complete the study, which was done under supervision to ensure completion without influence of others or resources. Each was asked to identify labelled structures and anonymously record answers on a standardised free text grid. Patients: Measurements and Main Results: Preliminary results are available due to extension of this study to include other groups. Accuracy of identification of structures improved with level of experience. Second year junior doctors scored a range between 26% - 53% with consultants scoring 53% - 100%. 100% correctly identified the uterus, ovaries and fallopian tubes. The least accurately labelled structures were the urachus (43%) and obliterated umbilical arteries (25% - 43%) which were also mistaken for the inferior epigastric vessels in 14% of responses. Conclusion: In conclusion, accuracy of identification of anatomy during laparoscopy improves with level of experience and continued competence. To maximise patient safety, competency at laparoscopic surgery should include assessment of correct identification of normal anatomy in addition to pathology. 576 Pattern of Congenital Uterine Anomalies Among Infertile Women in Southwest Nigeria Ajayi A,1 Ajayi V,1 Biobaku O,1 Oyetunji I,1 Aikhuele H,1 Adejuwon O,1 Afolabi B.2 1Nordica Fertility Centre, Ikoyi, Lagos, Nigeria; 2Health, Environment and Development Foundation, Yaba, Lagos, Nigeria
Study Objective: To determine the prevalence and pattern of congenital uterine anomalies (CUA)detected at hysteroscopy among infertile women (IW) in Southwest Nigeria. Design: Clinical retrospective cohort study. Setting: Nordica Fertility Center, a private establishment in, Lagos, Nigeria. Patients: One thousand one hundred and eighteen consecutive infertile women. Intervention: Hysteroscopy. Measurements and Main Results: Of the 1118 IW examined, 26 (2.3%) had CUA, majority of which were subseptate uterus (19/26; 73.1%); others were bicornuate (3, 11.5%), arcuate (2, 7.7%), unicornuate (1, 3.8%) and intracervical septum (1, 3.8%).The means (SD) of age (years), BMI (Kg/m2) and duration of subfertility (years)among IW with CUA were 38.7 (6.6), 27.4 (5.9) and 7.5 (6.9) respectively. CUA was more prevalent among IW in the age group of 35-39 years (9/26; 34.6%), in overweight (15/26, 57.7%). 24 (92.3%) had secondary infertility and 9 (34.6%) gave a history of spontaneous miscarriage. The mean uterine cavity depth of IW with CUA (7.811.01; 95% CI= 7.4, 8.2) was significantly smaller (t= -2.26, df=27.7, P-value=0.015) than that of IW without CUA (8.271.50; 95% CI= 8.2, 8.4). Among IW with CUA, 1 (3.8%) had obliterated right ostium while 2 (7.7%) had obliterated left ostium. Conclusion: The 2.3% CUA prevalence among IW was comparable to other studies. Subseptate uterus was the most frequent CUA. Majority of the IW with CUA had secondary infertility and significantly smaller uterine cavity depth.
577 Compliance With Follow-Up Among Patients Treated With Methotrexate for Suspected Ectopic Pregnancy in an Urban Community Setting Fridman D, Chong W, Rotenberg O, Chudnoff S, Hawkins E, Mehta S, Levie M. Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center, Bronx, New York Study Objective: To describe follow-up compliance rate among patients treated with single dose methotrexate for suspected ectopic pregnancy in typical clinical care. Design: A retrospective cohort, descriptive study. Setting: Inner city academic medical center. Patients: All patients presenting to the medical center emergency department who were treated for suspected ectopic pregnancy with methotrexate from January 2000 to January 2014. Intervention: Manual review of medical records to retrieve demographic and clinical information. Specifically, follow-up compliance in this patient population. Measurements and Main Results: There were a total of 633 patients who received treatment with methotrexate for suspected ectopic pregnancies. Of them, 396 (62.6%) completed follow-up (study group) – 293 (74%) had eventual undetectable levels of b-hcg, 91 (23%) subsequently underwent salpingectomy and 12 (3%) subsequently underwent D&C with products of conception found on pathological exam. The average visit number which the patient received methotrexate was the 2nd visit. There was no statistically significant difference in demographics, clinical presentation, sonographic and laboratory findings between the study group and patients who did not complete follow up. On average patients who completed follow up had 2 more visits than those who did not (7.03.0 vs 5.32.9, p \ 0.01). Of 237 patients who failed to follow-up 118 (49.8%) had last b-hcg level below 200 mIU/mL; 156 (65.8%) were on a downwards trend (consecutive decrease of b-hcg level by at least 15%); 42 (17.7%) did not come for a single visit after methotrexate administration. Conclusion: A high rate of non-compliance during typical clinical care in a high-volume urban setting should be taken into consideration when developing a management algorithm for patients with suspected ectopic pregnancy.