Abstract
The topic of ectopic pregnancies is so relevant to my mission as an Obstetric/Gynecologic Hospitalist—to improve the outcomes of women in the acute inpatient setting. We are all aware of the abysmal maternal mortality rate in the United States and its disproportionate effects on women of color. 1 There has been much focus on labor and delivery and the postpartum time, but we need to keep in mind the risk of early pregnancy as well. Ectopic pregnancies account for 6.3 deaths in 1,000,000 live births. 2 The Joint Commission has published standards involving management of hemorrhage, severe hypertension, and preeclampsia in response to the maternal mortality rate, but, as of yet, we have no further standards for management of ectopic pregnancies. 3
As the reader will note in the following articles, the nuance in diagnosis and management of ectopic pregnancy has only gotten more complex as our patients have increasing comorbidities, such as multiple cesareans and more-approachable assisted reproductive technologies, as well as other negative determinants of health. And, while ectopic pregnancies are not uncommon, some of these presentations can be very uncommon, which leads to a lack of definitive management recommendations and opens us up to missing a diagnosis or providing suboptimal treatment. This is where I hope the articles will help provide the reader with a refresher and reference for these situations.
I would also like to take a moment to make a statement about the increasing role of Obstetric/Gynecologic Hospitalists in our field as leaders of patient safety and quality outcomes. Hospitalists have been encouraged by the American College of Obstetricians and Gynecologists as “being vital to maintain patient safety.” 4 There is evidence that implementing Hospitalist programs can improve outcomes for labor and delivery, including reduced cesarean rates as well as other maternal and neonatal safety events.5,6 One of the roles of a Hospitalist is to provide standardization as well as expertise in the abilities and limitations of their facilities. 7 This also applies directly to the care of women with pregnancies of unknown location and ectopic pregnancies.
The Hospitalist as a patient-safety leader extends beyond labor and delivery and can—and should—include the care of all women in the acute-inpatient setting. A Hospitalist program provides continuity, education, and collaboration as well as establishing a culture of safety that is needed in order to reduce the number of pregnant and postpartum women and their families who experience poor outcomes.8,9
I would like to thank Mitch Hoffman, MD, for the opportunity to present this guest editorial to this journal. He has been a mentor I have looked up to since I was an intern. His role as mentor far exceeded my time as a resident. Now, as my career progresses, I see how the reach of mentorship perpetuates generations of medical education. When I teach my trainees, they are all getting a little bit of Dr. Hoffman in their training too. And so it is, with great honor, that I take my part in this generational mentorship and present these articles that have been curated from my first 3 Obstetric/Gynecologic Hospitalists Fellows; Kate Adkins, MD, Sarah Vanarendonk, MD, and Tony Grandelis, MD, as I hope to do my part in instilling a passion for quality and patient safety to our next generation of learners.