Subido por Sarahí Barrón O

CLINICAL CASE APPLYING PICO QUESTION AND QUERY

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CLINICAL EPIDEMIOLOGY 2021
ACTIVITY U1A8
Clinical Case
A 26-year-old woman comes to the emergency department because of a sudden onset
of right-sided lower abdominal pain that began 3 hours ago and has been increasing in
intensity. She noticed vaginal spotting 2 hours ago. Her last menstrual period was 6
weeks ago. She has been sexually active since age 17 with multiple partners. She uses
foam for contraception. She had an appendectomy in the past. She is afebrile, and vital
signs are stable. On examination she has flat abdomen with lower quadrant tenderness
and rebound, right more than the left. Speculum examination reveals only minimal dark
vaginal blood without cervical purulence. Bimanual examination reveals a closed, thick
cervix moderately tender to motion. Her uterus is slightly enlarged and softened. Right
adnexal tenderness is present, but there is no palpable mass.
Serum quantitative β-hCG: 3,500 mIU/mL
CBC: Hemoglobin 13.0
Transvaginal U/S: normal uterus without an intrauterine gestational sac
PATIENT
INTERVENTION
• Young woman
• Ectopic regnancy
Laparoscopic
salpingostomy
COMPARISON
Laparoscopic
methotrexate injection
vs laparoscopic
salpingostomy
OUTCOMES
• Lower treatment
failure rate?
• Reduce risk for future
ectopic pregnancies?
• Preserves future
fertility?
• Lower post treatment
complications?
• Lower rate of
persistent EP?
Is salpingostomy related to bene cial e ect on future fertility in ectopic pregnancies than
laparoscopic methotrexate injection?
Laparoscopy, methotrexate injection, fertility, ectopic pregnancies, salpingostomy
Laparoscopic surgery is the most effective treatment in women with tubal EP. There’s
no difference in fertility between intratubal MTX or salpingostomy. Both have not
showed beneficial effect on posterior IUP rates, whereas the risk of repeat EP was
increased although not significantly. Long-term reproductive outcomes are slightly
more favorable in patients with laparoscopic local methotrexate injection, in a
retrospective study where women who went under local MTX injection had higher
IUP rate than those with salpingostomy. Although must be considered that the MTX
injection is only effective on those women who’s initial hCG is <2,000miU/ml and
size at laparoscopy less than <2.0.
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Martha Sarahí Barrón Onofre 217017
1
CLINICAL EPIDEMIOLOGY 2021
ACTIVITY U1A8
1. On PubMed, start an advanced search
2. Select MeSH Terms
3. Introduce the key words from the break
down of your PICO query
4. Obtained only 2 results
5. Click on one of the results and discover
similar articles
6. Collect 7 articles from this database
Martha Sarahí Barrón Onofre 217017
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CLINICAL EPIDEMIOLOGY 2021
ACTIVITY U1A8
1.
2.
3.
4.
Sing in with CREATIVA account
Select Tripdatabase resource
Select PICO search
Introduce the data from your previous
breakdown
5. Select Evidence type and/or Clinical Area (i.e.
Evidence type: All secondary evidence, Clinical
area: OB-Gyn
6. Select the results
7. I obtained only 2 results related with my
clinical question and type of clinical evidence
Martha Sarahí Barrón Onofre 217017
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CLINICAL EPIDEMIOLOGY 2021
ACTIVITY U1A8
1. Enter to Scopus database
2. Start an advanced search
3. Introduce keywords and add to the search
with the boolean operators
4. Initiate search
5. Obtained only 1 result
Martha Sarahí Barrón Onofre 217017
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CLINICAL EPIDEMIOLOGY 2021
ACTIVITY U1A8
SELECTED ARTICLES:
• Hajenius, P., Mol, B., Bossuyt, P., Ankum, W., & Van der Veen, F. (2000). Interventions
for tubal ectopic pregnancy. The Cochrane Database of Systematic Reviews.
doi:10.1002/14651858.cd000324
• Kooi, S. (1993). Critical Comparisons of Alternative Therapies for Ectopic Pregnancy!
Fertility and Sterility, 59(1), 244–245. doi:10.1016/s0015-0282(16)55651-9
• Mol, F., Mol, B., Ankum, W., Van der Veen, F., & Hajenius, P. (2008). Current evidence
on surgery, systemic methotrexate and expectant management in the treatment of
tubal ectopic pregnancy: a systematic review and meta-analysis. Hum. Reprod, 14(4),
309-319. doi:10.1093/humupd/dmn012
• Porpora, M. G., Oliva, M. M., Cristofaro, A. D., Montanino, G., & Cosmi, E. V. (1996).
Comparison of local injection of methotrexate and linear salpingostomy in the
conservative laparoscopic treatment of ectopic pregnancy. The Journal of the
American Association of Gynecologic Laparoscopists, 3(2), 271–276. doi:10.1016/
s1074-3804(96)80012-0
• Practice Committee of American Society for Reproductive Medicine. (2013). Medical
treatment of ectopic pregnancy: a committee opinion. Fertil Steril. 100(3):638-44.
doi: 10.1016/j.fertnstert.2013.06.013.
• Shalev, E., Peleg, D., Bustan, M., Romano, S., & Tsabari, A. (1995). Limited role for
intratubal methotrexate treatment of ectopic pregnancy. Fertility and Sterility, 63(1),
20–24. doi:10.1016/s0015-0282(16)57290-2
• Zilber, Pansky, Bukovsky, & Golan. (1996). Laparoscopic salpingostomy versus
laparoscopic local methotrexate injection in the management of unruptured ectopic
gestation. American Journal of Obstetrics and Gynecology, 175(3), 600–602.
doi:10.1053/ob.1996.v175.a74249
Martha Sarahí Barrón Onofre 217017
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