Audit reports
Audit of tubal ectopic pregnancy at Cork University Maternity Hospital 2025
Dr Atinuke Oguntuase, Dr Joachim Knoetze, Louise Dooley and Dr Deirdre Hayes Ryan
- Authors
Atinuke Oguntuase, Joachim Knoetze, Louise Dooley, Deirdre Hayes Ryan
- Year
- 2026
- Category
- Data
Abstract
Aims/Objectives
The aim of this audit was to review all cases of tubal ectopic pregnancy diagnosed and managed in CUMH in 2025 against national standards from the National Clinical Practice Guideline on the Diagnosis and Management of Ectopic Pregnancy 2024 (National Women and Infants Health Programme, Institute of Obstetricians & Gynaecologists. National Clinical Practice Guideline: The Diagnosis and Management of Ectopic Pregnancy [Internet]. HSE; 2024.
Methods
Retrospective audit of all women diagnosed with ectopic pregnancy in CUMH in 2025. Eligible cases were identified from the local early pregnancy ectopic database. Electronic health care records of eligible cases were reviewed and anonymised clinical data transcribed to an excel datasheet. Descriptive statistics were utilised to evaluate current practice in CUMH against national standards.
Results
There were 5,955 early pregnancy departmental ultrasounds performed in CUMH in 2025, of which 3,859 (64%) were first appointment. There were 8.3% (n=496) that had a diagnosis of pregnancy of unknown location (PUL). There were 81 cases of tubal ectopic pregnancy diagnosed and managed in CUMH in 2025. Review of all cases against national standards are summarised in the table below.
Discussion
Positive findings from this audit include incidence of low misdiagnosis of ectopic pregnancy as well as PUL subsequently identified as ectopic pregnancy. Areas for improvement identified include; case selection for conservative and medical management, provision of patient information leaflets and emergency contact information and diagnosis capture on electronic healthcare records. We plan to use this information to educate staff working in all areas of early pregnancy care in CUMH and plan to repeat this audit annually to assess for improvements.
Table: Comparison of CUMH against national standards 2025
| No. | Standard | Result % |
|---|---|---|
| 1 | Proportion of PULs (N=496) subsequently diagnosed as ectopic pregnancies | 4.8 |
| 2 | Proportion of women diagnosed with a tubal ectopic pregnancy on ultrasound (N=79) that have it diagnosed on the initial ultrasound scan | 54.4 |
| 3 | Proportion of women diagnosed with a tubal ectopic pregnancy undergoing investigation and treatment (N=56) who subsequently present with a ruptured ectopic pregnancy | 16.1 |
| 4 | Proportion of women diagnosed with a tubal ectopic pregnancy (N=81) who receive an incorrect diagnosis of intrauterine pregnancy or miscarriage | 0.0 |
| 5 | Proportion of women diagnosed with a tubal ectopic pregnancy (N=81) who had a diagnosis of ectopic captured on MNCMS | 23.5 |
| 6 | Proportion of women diagnosed with a tubal ectopic pregnancy (N=81) who had subsequently undergone EMA in the current pregnancy | 2.5 |
| 7 | Proportion of women diagnosed with a tubal ectopic pregnancy offered conservative management if clinically suitable for same (N=34) | 100.0 |
| 8 | Proportion of women diagnosed with a tubal ectopic pregnancy offered medical management if clinically suitable for same (N=41) | 92.6 |
| 9 | Proportion of women diagnosed with a tubal ectopic pregnancy offered surgical management if clinically suitable for same (N=81) | 76.5 |
| 10 | Proportion of women diagnosed with a tubal ectopic pregnancy provided with written information (N=56 clinically stable in outpatient setting) | 39.2 |
| 11 | Proportion of women diagnosed with a tubal ectopic pregnancy provided with emergency contact information (N=56 clinically stable in outpatient setting) | 39.2 |
| 12 | Proportion of women diagnosed with a tubal ectopic pregnancy (N=81) who choose conservative management | 18.5 |
| 13 | Proportion of women undergoing conservative management (n=15) who are successfully treated | 53.3 |
| 14 | Proportion of women undergoing conservative management (n=15) who subsequently require surgical intervention | 46.6 |
| 15 | Proportion of women undergoing conservative management (n=15) with subsequent tubal ectopic rupture/morbidity | 26.6 |
| 16 | Proportion of women diagnosed with a tubal ectopic pregnancy (N=81) who choose medical management | 18.5 |
| 17 | Proportion of women undergoing conservative management (n=15) who are successfully treated | 40.0 |
| 18 | Proportion of women undergoing conservative management (n=15) where a second dose of methotrexate is required | 20.0 |
| 19 | Proportion of women undergoing conservative management (n=15) who subsequently require surgical intervention | 46.6 |
| 20 | Proportion of women undergoing conservative management (n=15) with subsequent tubal ectopic rupture/morbidity | 40.0 |
| 21 | Proportion of women diagnosed with a tubal ectopic pregnancy (n=81) who choose surgical management | 62.9 |
| 22 | Proportion of women diagnosed with a tubal ectopic pregnancy (n=81) who ultimately require surgical management | 80.2 |
| 23 | Proportion of women with complications of surgery for tubal ectopic pregnancy (N=65) (includes bleeding >500 ml requiring RCC, HDU admission) | 10.7 |
| 24 | Proportion of women with surgical management of ectopic pregnancy (n=65) who have surgery outside or working hours (after 5 pm or prior to 8 am or at the weekend) | 47.0 |
| 25 | Proportion of women with surgical management of ectopic pregnancy (n=65) who have surgery performed in CUH | 87.6 |