The diagnosis of ectopic pregnancy

The Royal College of Emergency Medicine (RCEM) is happy to accept the safety recommendation made by HSIB. The RCEM will be developing a patient leaflet template to be made available on the RCEM website. The template will form the basis for a discharge advice leaflet. Clinicians can offer the leaflet to women who have been discharged from emergency departments after experiencing a problem in early pregnancy and who need to attend an early pregnancy service at a later date. Clinicians can adapt the template to reflect their local service arrangements and include relevant details of their local departments. In addition to the leaflet template, the RCEM will be releasing a safety flash that will reference the event from the HSIB investigation as well as a link to the HSIB report. The safety flash will also include a link to the RCEM leaflet template and RCEM recommendations on important information to be included in the discharge leaflet. Response received on 6 January 2021.

We were very concerned to hear about any missed ectopic pregnancy as the complications are very serious and can be life threatening. Early diagnosis and treatment is crucial, and more could be done to improve early detection methods and raise awareness of the symptoms so women and their clinicians can recognise that something is wrong as soon as possible. It is also essential that information between health professionals is shared in a streamlined and efficient fashion during referral to early pregnancy units so action can be taken swiftly. We acknowledge HSIB’s safety recommendation in the report and we will include it in the next update of our guidance which is currently underway. We will also work with the Royal College of Emergency Medicine to ensure consistency of approach across all acute settings. Symptoms of ectopic pregnancy can include vaginal bleeding, abdominal pain, shoulder tip pain and discomfort going to the toilet. Women presenting with these symptoms and a positive pregnancy test should be offered referral to a local early pregnancy unit for ongoing care. We have information for women and their families about ectopic pregnancy on our website, including symptoms, when to seek advice, risks and diagnosis and treatment options. The information is also available in a print and audio leaflet. We are updating the RCOG Green-top Guideline (no 21) on the Diagnosis and Management of Ectopic Pregnancy to include the information that should be provided during referral to early pregnancy units. This information standardises and improves the flow of information required to identify those most at risk from ectopic pregnancy and any consequent deterioration. It is expected the guideline will be published during 2023. Response received on 16 December 2021.

CQC fully supports HSIB’s safety recommendations. Implementation was planned for April 2020. This work has been delayed by the impact of the Covid-19 but this important recommendation will be brought into our future framework. Response received on 10 September 2020.