A Framework Proposal for Quality and Safety Measurement in Gynecologic Emergency Care

Provot, Johan; Creff, Isabelle Le; Boulkedid, Rym; Vendittelli, Françoise; Doret-Dion, Muriel; Sroussi, J.; Giraudet, Géraldine; Jacobs, Romain; Bourret, Antoine; Bauville, Estelle; Carvalho, Solenn; Tourette, Claire; Koskas, Martin; Akladios, Chérif; Nisolle, Michelle; Lejeune, Christophe; Huchon, Cyrille; Alberti, Corinne; Dumont, Alexandre; Bouvier‐Colle, Marie‐Hélène

doi:10.1097/aog.0000000000004132

Cited by 10 publications

(4 citation statements)

References 31 publications

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“…The initial assessment included a complete gynecological examination with hemodynamic variables (heart rate, blood pressure, temperature) recorded to identify women susceptible to hemorrhagic shock in cases of heavy bleeding. Hemodynamic instability was based on the clinical assessment of the investigator, in line with the recommendations (heart rate >120/min and systolic blood pressure lower than 90 mm Hg assessed twice) …”

Section: Methodsmentioning

confidence: 99%

“…Hemodynamic instability was based on the clinical assessment of the investigator, in line with the recommendations (heart rate >120/min and systolic blood pressure lower than 90 mm Hg assessed twice). 18 Incomplete spontaneous abortion was diagnosed by transvaginal ultrasound, performed by a senior obstetriciangynecologist, according to a previously published standard technique for pelvic ultrasound in gynecological emergency settings. 19 Sonogram images were recorded.…”

Section: Key Pointsmentioning

confidence: 99%

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Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion

Huchon

Drioueche

Koskas

et al. 2023

JAMA

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ImportanceVacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility.ObjectiveTo assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy.Design, Setting, and ParticipantsThe HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio.InterventionsSurgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286).Main Outcomes and MeasuresThe primary outcome was a pregnancy of at least 22 weeks’ duration during 2-year follow-up.ResultsThe intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, −4.8% [95% CI, −13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups.Conclusions and RelevanceSurgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases.Trial RegistrationClinicalTrials.gov Identifier: NCT02201732

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Section: Methodsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion

Huchon

Drioueche

Koskas

et al. 2023

JAMA

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“…In total, 44 studies [ 3 , 22 , 24 , 36 – 76 ] provide data on the prevalence of PLTC. The studies were conducted in 17 different countries; in addition, four studies had multiple country sites [ 46 , 67 , 71 , 72 ]. The countries with the largest number of included studies comprised Brazil ( n = 9), India ( n = 7), Ethiopia ( n = 5), the United States ( n = 3), Malaysia ( n = 2), and South Korea ( n = 2).…”

Section: Resultsmentioning

confidence: 99%

“…The remaining studies are one each from 11 countries. All the included studies were observational 32 cross-sectional [ 3 , 22 , 24 , 36 – 58 , 67 , 72 – 76 ], 5 case–control [ 66 , 68 – 71 ], and 7 cohort study designs [ 59 – 65 ]. All the reviewed studies were published between 2012 and 2022.…”

Section: Resultsmentioning

confidence: 99%

Global burden of potentially life-threatening maternal conditions: a systematic review and meta-analysis

Baykemagn,

Abreha,

Zelelow

et al. 2024

BMC Pregnancy Childbirth

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Background Potentially life-threatening maternal conditions (PLTCs) is an important proxy indicator of maternal mortality and the quality of maternal health services. It is helpful to monitor the rates of severe maternal morbidity to evaluate the quality of maternal care, particularly in low- and lower-middle-income countries. This study aims to systematically identify and synthesize available evidence on PLTCs. Methods We searched studies in English from 2009‒2023 in PubMed, the National Library of Medicine (NLM) Gateway, the POPLINE database, and the Science Direct website. The study team independently reviewed the illegibility criteria of the articles. Two reviewers independently appraised the included articles using the Joanna Briggs Instrument for observational studies. Disputes between the reviewers were resolved by consensus with a third reviewer. Meta-analysis was conducted in Stata version 16. The pooled proportion of PLTCs was calculated using the random effects model. The heterogeneity test was performed using the Cochrane Q test, and its level was determined using the I2 statistical result. Using Egger's test, the publication bias was assessed. Result Thirty-two cross-sectional, five case–control, and seven cohort studies published from 2009 to 2023 were included in the meta-analysis. The highest proportion of PLTC was 17.55% (95% CI: 15.51, 19.79) in Ethiopia, and the lowest was 0.83% (95% CI: 0.73, 0.95) in Iraq. The pooled proportion of PLTC was 6.98% (95% CI: 5.98–7.98). In the subgroup analysis, the pooled prevalence varied based on country income level: in low-income 13.44% (95% CI: 11.88–15.00) I2 = 89.90%, low-middle income 7.42% (95% CI: 5.99–8.86) I2 = 99.71%, upper-middle income 6.35% (95% CI: 4.21–8.50) I2 = 99.92%, and high-income 2.67% (95% CI: 2.34–2.99) I2 = 99.57%. Similarly, it varied based on the diagnosis criteria; WHO diagnosis criteria used 7.77% (95% CI: 6.10–9.44) I2 = 99.96% at P = 0.00, while the Centers for Disease Controls (CDC) diagnosis criteria used 2.19% (95% CI: 1.89–2.50) I2 = 99.41% at P = 0.00. Conclusion The pooled prevalence of PLTC is high globally, predominantly in low-income countries. The large disparity of potentially life-threatening conditions among different areas needs targeted intervention, particularly for women residing in low-income countries. The WHO diagnosis criteria minimize the underreporting of severe maternal morbidity. Trial registration CRD42023409229.

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Je consulte en urgence car… j’ai des douleurs

Bourret¹

2022

Urgences en Gynécologie

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A Framework Proposal for Quality and Safety Measurement in Gynecologic Emergency Care

Abstract: Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.

Cited by 10 publications

References 31 publications

Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion

Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion

Global burden of potentially life-threatening maternal conditions: a systematic review and meta-analysis

Je consulte en urgence car… j’ai des douleurs

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