RESUMO
Objectives: Worldwide, there is an estimated 40.3 million victims trapped in modern day slavery, including 24.9 million in forced labor and 15.4 million in forced marriage. A majority of labor and sex trafficking survivors report at least one healthcare encounter during their victimization. An approach to an informatics technology solution for identifying trafficked persons in real time, in the hospital / emergency department settings is the primary focus of this paper. Materials and methods: Octavia, a software application implemented in 3 California hospitals, scanned all patient encounters for social and clinical determinants that are consistent predictors of HT. Any encounter that matched these criteria was forwarded to a specially trained High-Risk Navigator who screened the data and when able, made direct contact in an effort to build rapport and possibly provide victim assistance. Results: During the observation period, the automated scanning of hospital patient encounters resulted in a notable increase in the detection of persons who had a likelihood of being trafficked when compared to a pre-project baseline. Discussion: Our experience demonstrated that automated technology is useful to assist healthcare providers in identification of potentially trafficked persons, improving the likelihood of care provision.
RESUMO
BACKGROUND Interstitial ectopic pregnancy, a pregnancy occurring in the part of the fallopian tube that is within the body of the uterus, poses a significant risk to patients, with a mortality rate of up to 2.5%, which is 7 times higher than for tubal ectopic pregnancies. Hysteroscopic sterilization reversal carries a potential risk of interstitial ectopic pregnancy; therefore, it is important to counsel patients appropriate and review the alternative option for in vitro fertilization. In vitro fertilization has been shown to have a superior pregnancy and live birth rate in comparison to sterilization reversal. Women who have undergone sterilization via hysteroscopic placement of the Essure device may complete in vitro fertilization with sterilization devices left in situ without significantly reducing the pregnancy rate. CASE REPORT A 34-year-old woman, G6P3023, presented to the Emergency Department after incidental detection of left interstitial ectopic pregnancy measuring 9 weeks of gestation. She had previously undergone a right salpingectomy for ectopic pregnancy soon after reversal of Essure sterilization via bilateral tubouterine reimplantation; this is a procedure that is infrequently performed due to limited evidence to suggest that this is a safe and efficacious method to achieve future pregnancies. This patient underwent an uncomplicated left cornuostomy and salpingectomy, rendering the need for in vitro fertilization to conceive in the future. CONCLUSIONS Patients seeking fertility treatment after hysteroscopic sterilization should be counseled that tubouterine reimplantation poses significant morbidity risk based on the nature of the surgery. Instead, patients who have undergone hysteroscopic sterilization who desire future pregnancy should be advised that in vitro fertilization, with or without salpingectomy, may be a safer and more efficacious option to achieve live birth.
