Management of ectopic pregnancy in a Scottish teaching hospital: implications for training

An audit was undertaken to assess the management of 50 consecutive women with an ectopic pregnancy at a teaching hospital in Scotland. The ectopic pregnancy was removed laparoscopically in 62% and of these women 80% were discharged home on the first postoperative day. In a minority of patients, elements of substandard care were identified including failure to operate when the ectopic pregnancy had been visualised on ultrasound or in the presence of static hCG levels in patients with an empty uterus and adnexal pain. Fewer than 50% of consultants and no junior registrar reported competency in the laparoscopic management of these patients. We suggest that the management of ectopic pregnancy could be improved by following published algorithms with high diagnostic accuracy. In addition, either skilled endoscopic teams should be developed to take on the responsibility of the management of these patients or universal consultant competency in laparascopic surgery is required if we are to offer laparoscopy to all women with ectopic pregnancy.