Objective: To identify risk factors that may lead to the rupture of ectopic pregnancies. Study De... more Objective: To identify risk factors that may lead to the rupture of ectopic pregnancies. Study Design: A retrospective chart review was performed on patients with ectopic pregnancies at the University of Miami/Jackson Memorial Hospital between 1/1/1995 and 3/1/2002. 738 patients were identified with ectopic pregnancies. Women with tubal rupture were compared to those without rupture. Variables analyzed were demographic data, patient-related risk factors (history of pelvic surgery, bilateral tubal ligation, history of pelvic inflammatory disease, previous ectopic pregnancy, intrauterine device use) and β-human chorionic gonadotropin (βhCG) measurement. Results: There were 439 (59%) cases with a ruptured and 299 (41%) cases with an unruptured ectopic pregnancy. Multivariate logistic regression analysis revealed that previous ectopic pregnancy (OR 2.88; 95% CI 1.92, 4.33) and βhCG level ≧5,000 mIU/ml (OR 1.85; 95% CI 1.12, 3.06) were the only significant risk factors for tubal rupture....
To identify risk factors for conversion to laparotomy during laparoscopic management of ectopic p... more To identify risk factors for conversion to laparotomy during laparoscopic management of ectopic pregnancy. A retrospective chart review of patients who underwent laparoscopy for treatment of ectopic pregnancy, during a 32-month period (6/1999-2/2002), at the University of Miami Jackson Memorial Hospital. We identified 229 patients; 201 had a successful laparoscopy (non-converted group) and 28 who were converted to laparotomy (converted group). Variables analyzed between the two groups were demographic data, patient-related risk factors available to the surgeon prior to the surgery (previous laparotomy, previous laparoscopy, history of PID, history of endometriosis, diameter of ectopic pregnancy as measured by ultrasound, amount of free fluid on ultrasound, BMI), and surgeons' experience. Out of the 229 laparoscopies, 28 were converted to laparotomy (12.2%). The rate of conversion was significantly higher for less experienced compared to experienced surgeon (OR = 6.1, 95% CI = 2.35-15.88). Significantly more women had a BMI > 30 kg/m2 in the converted group compared to the non-converted group (42% vs. 14%; OR = 4.28, 95% CI = 1.7-10.75) and the converted group had significantly higher rate of large free fluid reported on ultrasound compared to the non-converted group (21.42% vs. 7.46%; OR = 3.38, 95% CI = 1.04-10.61). Less experienced surgeon, BMI > 30 kg/m2, and large amount of free fluid on ultrasound increase the risk of conversion to laparotomy during laparoscopic management of ectopic pregnancy.
The Journal of the American Association of Gynecologic Laparoscopists, 2003
Study Objective. To evaluate the impact of a formal laparoscopic training program on patient outc... more Study Objective. To evaluate the impact of a formal laparoscopic training program on patient outcomes in an obstetrics and gynecology residency. Design. Retrospective cohort study (Canadian Task Force classification II-1). Setting. University-affiliated public hospital. Intervention. Comparison of nonlaparoscopy-trained group (A) with a formally trained group (B). Subjects. Three hundred sixty-eight women (group A) and 154 women (group B) undergoing operative laparoscopy. Measurements and Main Results. Beginning October 1, 1999, residents, regardless of postgraduate year status, participated in six 4-hour sessions/year in a committed laparoscopic training program consisting of didactics, bench exercises (designed to mimic laparoscopic gynecologic technical skills), instrumentation instruction, animate tissue model surgery, and supervised gynecologic operating experience. Two certified gynecology laparoscopists facilitated each training session, and gynecologists with various laparoscopic skill levels supervised patient surgeries. Operating room time, blood loss, hospital stay, and conversion to laparotomy were less for group B than for group A, but the groups did not differ in complication rates. Adhesions and bleeding were the main reasons for conversion to laparotomy. Conclusion. Formal laparoscopic training of gynecologic residents improved patient outcomes.
Objective: To identify risk factors that may lead to the rupture of ectopic pregnancies. Study De... more Objective: To identify risk factors that may lead to the rupture of ectopic pregnancies. Study Design: A retrospective chart review was performed on patients with ectopic pregnancies at the University of Miami/Jackson Memorial Hospital between 1/1/1995 and 3/1/2002. 738 patients were identified with ectopic pregnancies. Women with tubal rupture were compared to those without rupture. Variables analyzed were demographic data, patient-related risk factors (history of pelvic surgery, bilateral tubal ligation, history of pelvic inflammatory disease, previous ectopic pregnancy, intrauterine device use) and β-human chorionic gonadotropin (βhCG) measurement. Results: There were 439 (59%) cases with a ruptured and 299 (41%) cases with an unruptured ectopic pregnancy. Multivariate logistic regression analysis revealed that previous ectopic pregnancy (OR 2.88; 95% CI 1.92, 4.33) and βhCG level ≧5,000 mIU/ml (OR 1.85; 95% CI 1.12, 3.06) were the only significant risk factors for tubal rupture....
To identify risk factors for conversion to laparotomy during laparoscopic management of ectopic p... more To identify risk factors for conversion to laparotomy during laparoscopic management of ectopic pregnancy. A retrospective chart review of patients who underwent laparoscopy for treatment of ectopic pregnancy, during a 32-month period (6/1999-2/2002), at the University of Miami Jackson Memorial Hospital. We identified 229 patients; 201 had a successful laparoscopy (non-converted group) and 28 who were converted to laparotomy (converted group). Variables analyzed between the two groups were demographic data, patient-related risk factors available to the surgeon prior to the surgery (previous laparotomy, previous laparoscopy, history of PID, history of endometriosis, diameter of ectopic pregnancy as measured by ultrasound, amount of free fluid on ultrasound, BMI), and surgeons' experience. Out of the 229 laparoscopies, 28 were converted to laparotomy (12.2%). The rate of conversion was significantly higher for less experienced compared to experienced surgeon (OR = 6.1, 95% CI = 2.35-15.88). Significantly more women had a BMI > 30 kg/m2 in the converted group compared to the non-converted group (42% vs. 14%; OR = 4.28, 95% CI = 1.7-10.75) and the converted group had significantly higher rate of large free fluid reported on ultrasound compared to the non-converted group (21.42% vs. 7.46%; OR = 3.38, 95% CI = 1.04-10.61). Less experienced surgeon, BMI > 30 kg/m2, and large amount of free fluid on ultrasound increase the risk of conversion to laparotomy during laparoscopic management of ectopic pregnancy.
The Journal of the American Association of Gynecologic Laparoscopists, 2003
Study Objective. To evaluate the impact of a formal laparoscopic training program on patient outc... more Study Objective. To evaluate the impact of a formal laparoscopic training program on patient outcomes in an obstetrics and gynecology residency. Design. Retrospective cohort study (Canadian Task Force classification II-1). Setting. University-affiliated public hospital. Intervention. Comparison of nonlaparoscopy-trained group (A) with a formally trained group (B). Subjects. Three hundred sixty-eight women (group A) and 154 women (group B) undergoing operative laparoscopy. Measurements and Main Results. Beginning October 1, 1999, residents, regardless of postgraduate year status, participated in six 4-hour sessions/year in a committed laparoscopic training program consisting of didactics, bench exercises (designed to mimic laparoscopic gynecologic technical skills), instrumentation instruction, animate tissue model surgery, and supervised gynecologic operating experience. Two certified gynecology laparoscopists facilitated each training session, and gynecologists with various laparoscopic skill levels supervised patient surgeries. Operating room time, blood loss, hospital stay, and conversion to laparotomy were less for group B than for group A, but the groups did not differ in complication rates. Adhesions and bleeding were the main reasons for conversion to laparotomy. Conclusion. Formal laparoscopic training of gynecologic residents improved patient outcomes.
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Papers by Greg Latchaw