Current approaches for assessment and treatment of women with early miscarriage or ectopic pregnancy in Nigeria: A case for dedicated early pregnancy services

Abstract

Context: It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient.

Aims: To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by  Nigerian Gynecologists, and determine if dedicated early pregnancy  services such as Early Pregnancy Assessment Units could be introduced to improve care.

Settings and Design: A cross.sectional survey of Nigerian Gynecologists  attending the 46th Annual Scientific Conference of the Society of  Gynaecology and Obstetrics of Nigeria.

Materials and Methods: This was a questionnaire.based study.

Statistical Analysis: Data analysis was by descriptive statistics using Statistical Package for the Social Sciences software, version 17.0 for Windows (IBM Corporation, Armonk, NY, USA).

Results: A total of 232 gynecologists working in 52 different secondary and tertiary health facilities participated in the survey. The mean age of the respondents was 42.6 } 9.1 years (range 28-70 years). The proportion of gynecologists reporting that women with early miscarriage or ectopic  pregnancy were first managed within the hospital general emergency room was 92%. The mean reported interval between arrival in hospital and first ultrasound scan was 4.9 } 1.4 hours (range .-8 hours). Transvaginal scan was stated as the routine initial imaging investigation by only 17.2% of respondents. Approximately 94.8% of respondents felt that dedicated early pregnancy services were feasible and should be introduced to improve the care of women with early miscarriage and ectopic pregnancy.

Conclusions: Reported protocols for managing early miscarriage or ectopic pregnancy in many health facilities in Nigeria appear to engender  unnecessary delays and avoidable costs, and dedicated early pregnancy services could be both useful and feasible in addressing these  shortcomings in the way women with such conditions are currently  managed.

Key words: Early pregnancy assessment units, ectopic pregnancy,  gynaecological ultrasonography, miscarriage,ultrasonography