A retrospective analysis of the management of ectopic pregnancy was undertaken at Billinge Hospital, Wigan from June 1999 to June 2002. A total of 114 cases of ectopic pregnancy were identified. Diagnosis was usually confirmed by laparoscopy (89.4%) and 102 cases (82.4%) were managed by laparoscopic salpingectomy. A total of 7.08% of patients needed a laparotomy after the initial laparoscopy and two (1.75%) had laparotomy performed as the primary approach. Medical treatment was given to eight women (7.0%). All the consultants were competent in performing laparoscopic surgery and 71.3% of cases were performed laparoscopically by a consultant. The diagnostic accuracy was high using a combination of urine pregnancy tests, serum beta-hCG and transvaginal scan.

RESULTS: There were 118 patients identified (55% class A1). 58% were African-American and 52% had medical assistance insurance. 83% attended the postpartum visit. Screening was discussed at 68% of postpartum visits, but a screening test was only ordered at 55% of visits. 77% of these were 2H-OGTTs. 38% of 2H-OGTTs ordered were completed, of which 38% were abnormal. In multivariate analyses, patients with A2 GDM were more likely to be screened (odds ratio [OR] 2.8 [95% CI: 1.1-7.3]). Attendance at resident clinic was significantly associated with performance of the 2H-OGTT (OR 11.7, 95% CI: 1.6-84.8).CONCLUSION: Rates of postpartum screening for GDM patients are low, both because providers are not ordering screening and because patients do not complete the test. Further efforts must be made to improve follow-up for these vulnerable patients.