Evaluation of Adherence Rates following Ectopic Pregnancy to Inform Management Decisions in a Public Hospital System - 06/06/21

Doi : 10.1016/j.jogoh.2021.102180

Janelle Sobecki-Rausch, MD, MA ^a,^b : Project development;Data Collection;Manuscript writing/editing, Jessica M Madrigal, MS, PhD ^b : Project development;Data Analysis;Manuscript writing, Arjeme Cavens, MD ^a,^b : Data Collection;Manuscript writing, Carly Dahl, MD ^a,^b : Manuscript writing/editing, Ashlesha Patel, MD, MPH ^a,^b,^⁎ : Project development;Manuscript writing/editing
^a Northwestern University Feinberg School of Medicine, Department of Obstetrics & Gynecology
^b John H. Stroger Hospital, Department of Obstetrics & Gynecology, Division of Family Planning

^⁎Corresponding Author: Department of Obstetrics and Gynecology, John H Stroger, Jr. Hospital of Cook County, 1950 W. Polk St., 7th Floor, Chicago, IL 60612, Telephone: 312 864 5935Department of Obstetrics and GynecologyJohn H Stroger, Jr. Hospital of Cook County1950 W. Polk St., 7th FloorChicago, IL60612

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Abstract

Introduction

Adherence to follow-up is an important consideration when treating non-emergent ectopic pregnancy. Our aim was to evaluate the management of ectopic pregnancy among patients in a public hospital system and to identify factors related to adherence of medical management in this population.

Material and methods

A retrospective review to evaluate the management of ectopic pregnancy among women in a public hospital system, including all women undergoing treatment for ectopic pregnancy from 2012 to 2017. Data were abstracted from the medical record. Women who were adherent to follow-up were compared to those who were non-adherent. Log-binomial regression was used to identify factors associated with management type and adherence to follow-up of medical management.

Results

Of 283 women diagnosed with an ectopic pregnancy, 182 (64.3%) were managed surgically and 101 (35.7%) were managed with methotrexate. Among non-emergent cases, presence of fetal cardiac activity, human chorionic gonadotropin (HCG) level ≥5000mIU/mL, ectopic size ≥3.5cm, and multigravid status was associated with surgical management. Among patients receiving methotrexate, 66 (65.3%) adhered to required lab draws 4 and 7 days following methotrexate administration (+/-1 day). Among those receiving methotrexate 45.5% (n=46) were lost to follow-up. Lower prevalence of adherence to follow-up (i.e. lab draws completed until pregnancy levels were negative) was observed among non-Hispanic African American (RR=0.64, 95%CI 0.45-0.94) compared to white women and women with multigravid status (RR=0.67, 95%CI 0.48-0.95) after adjustment.

Conclusions

Nearly half of those treated with methotrexate failed to complete follow-up. African-American women and multigravida women were at higher risk of being lost to follow up.

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Keywords : Adherence, Ectopic, Pregnancy, Methotrexate