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A multicenter cohort study analyzing the implementation of a new guideline for diagnosis and treatment of women with pregnancy of unknown location or ectopic pregnancy in the Netherlands
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  • lisa madder,
  • Elke Stark,
  • Paul van der Linden,
  • jorien woolderink,
  • Jeroen Dijkstra,
  • marjan keizer,
  • Laurens van boven,
  • Marco Versluis,
  • Karin van der Tuuk
lisa madder
University Medical Centre Groningen
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Elke Stark
University Medical Centre Groningen
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Paul van der Linden
Deventer Ziekenhuis
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jorien woolderink
Martini Ziekenhuis
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Jeroen Dijkstra
Isala Zwolle
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marjan keizer
Medical Centre Leeuwarden
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Laurens van boven
Medical Centre Twente
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Marco Versluis
University Medical Centre Groningen
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Karin van der Tuuk
University Medical Centre Groningen
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Abstract

Objective: Evaluation of the implementation of a new guideline for diagnosis and treatment of women with pregnancy of unknown location (PUL) or ectopic pregnancy (EP). Design: Multicenter retrospective cohort study Setting: Six hospitals in the Northern part of the Netherlands Population and methods: Women above 18-years old with a final diagnosis of PUL or EP between January 2012 to April 2020. Main outcome measures: Diagnostic findings, type of treatment and outcomes, before and after implementation of the guideline. User interpretation of the guidelines. Results: 1306 women with PUL or EP were included. The amount of women diagnosed with PUL has significantly increased between the guideline cohorts (28.4%;174/693 versus 16.6%;115/613 P<0.001). A significantly lower percentage of women using the new guideline underwent surgical management versus treatment with MTX (odds ratio [OR] =0.516, 95% confidence interval [CI] 0.399 – 0.668 P<0.001). Among women treated with MTX, the overall success rate was significantly lower compared to surgery (80.5%;103/128 versus 95.2%; 943/991 P=0.007). There was no observed difference in adverse events or guideline adherence between the guidelines. Conclusion: The implementation of the new guideline contributes to an increase in women diagnosed with PUL and treated with MTX. Treatment with MTX caused more complications and a lower treatment success compared to women undergoing surgery. This did not lead to an increase in adverse events between the guidelines. The overall adherence to the guidelines was equal.
14 Jun 2022Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
20 Jun 2022Assigned to Editor
20 Jun 2022Submission Checks Completed
21 Jun 2022Reviewer(s) Assigned
29 Jun 2022Review(s) Completed, Editorial Evaluation Pending