A randomised controlled trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy

Letter by Odejinmi and Oliver on article by Snyman et al. (Snyman LC, Makulana T, Makin JD. A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy. S Afr Med J 2017;107(3):258-263. https://doi.org/10.7196/SAMJ.2017.v107i3.11447); and response by Snyman et al

Severe morbidity with ectopic pregnancy is associated with late presentation

This article investigates if severe morbidity associated with ectopic pregnancy (EP) is related to patient characteristics or the quality of patient care after presentation. This is a retrospective study of women who had surgical management of tubal EP between 2008 and 2012. Severe maternal morbidity was defined as a blood loss ≥800 mL. Women of a white ethnicity were statistically more likely to have a blood loss of <800 mL (p = .0228). The patient related risk factors were significantly higher in the women with a blood loss of <800 mL (p = .0139). The incidence of substandard care was low in both groups although a substandard care due to a misdiagnosis of EP was significantly higher in the patients with a blood loss ≥800 mL (p = .0150). We found that a severe morbidity from EP is multifactorial involving patient awareness of risk factors and timely diagnosis by healthcare professionals.IMPACT STATEMENT What is already known on the subject? Ectopic pregnancy (EP) can be associated with severe maternal morbidity with up to a third of women with EP being managed after the pregnancy has ruptured. To try and reduce severe maternal morbidity and improve management for these women it is vital to identify the important risk factors associated with severe maternal morbidity. What do the results of this study add? We found ethnicity to be a predictive factor of severe maternal morbidity, with women of white ethnicity significantly more likely to have reduced severe maternal morbidity compared to other ethnicities. We also found multiple risk factors for an EP were statistically protective of severe maternal morbidity. We found the rate of substandard care to be low in our study but identified that where there was substandard care it was associated with diagnostic and therapeutic delays. Our findings lead us to conclude that a severe maternal morbidity from EP is multifactorial, and an improvement will involve both a patient awareness of risk factors and a timely diagnosis by health care professionals. What are the implications of these findings for clinical practice and/or further research? We believe that this to be an important article as it identifies the importance of the increasing knowledge both of women in the community but also educating health care professionals on the signs and symptoms of EP. These steps are vital to improve severe maternal morbidity associated with EP

Correspondence: A randomised controlled trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy

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