Topic: Ectopic pregnancy and ultrasound requests: quality assurance studyOrder Descriptiona research grant proposal written for the following draft please. I will need my referencing in numbered APA, I am happy to supply the endnote code for it if needed.Title: Quality assurance and ultrasound requests for ectopic pregnancy: A retrospective pilot study of the referral information from junior doctors to sonographers in a regional Victorian hospital.Key words: Ectopic Pregnancy, bHCG, Ultrasound, Quality Assurance, Referral patternsEctopic pregnancy is a common reproductive problem with an occurrence of 1:1000 pregnancies.1 Despite mortality dropping to almost 90% in the last 30 years, it is still the number 1 cause of maternal mortality in the first trimester.2Clinical presentation can vary from asymptomatic to hypovolemic shock, with general presentation of amenorrhea, pelvic pain and per vaginal bleeding.3 With such a varied list of symptoms, careful evaluation must be undertaken.In a normal intrauterine pregnancy (IUP), bHCG levels double every 48 hours and then plateau at weeks 9-112. Generally, women with ectopic pregnancies tend have a lower bHCG level.Barnhart et al. 4 developed a discriminatory level for bHCG at which an IUP could be detected on TVS. They found that levels between 1500-2500mIU/mL were reliable in the earliest detection on a sonogram4. If a IUP was not detected these levels, there would be a cause for concern and most likely alluded to an abnormal implantation. Levels lower than this with no confirmed IUP could simply mean a pregnancy that was too early to visualise and would result in follow up assessment of bHCG in the following days and a repeat ultrasound in the coming weeks.2A review of the literature demonstrated that transvaginal ultrasound in conjunction with serum bHCG is a necessary clinical step to exclude an ectopic pregnancy 5.In a clinical setting, evidence based guidelines, which includes the use of TVS and bHCG to assess and diagnose ectopic, IUP or a pregnancy of unknown location (PUL).5Junior doctors at North East Med often request ultrasound assessment to exclude an ectopic pregnancy, often, without confirming that the patient is pregnant. Upon request for further information by the sonographer, it can be confirmed that the patient has a negative pregnancy test or has previously had a confirmed IUP via ultrasound at a previous practice. This leads to inefficiencies within the department and frustration that the junior doctor did not collect vital information at the initial consultation with the patient. This is a quality practice study with the results of the study suggesting changes in practice.The aim of this study is to:• Retrospectively assess referrals for ectopic pregnancy to a public hospital radiology department to determine if the recommended BHCG level is supplied prior to the scan• Assess the referrals and see if serum BHCG has been noted.• Of the referrals that did not have a recorded BHCG, assess how many were actually pregnant.• Assess the number of confirmed Ectopic pregnancies were confirmed.• Approximately 150 participants with included variables such as gestational age, quantitative BHCG, PV bleeding and pain.• This is a retrospective cross-sectional descriptive quantitative study. Variables will be coded numerically eg BHG Y/N (yes=1, no=0)• With referrals querying ectopic pregnancy it needs to known how many have the BHG information included. If yes, it will look at the number of these that had an ectopic. If no, it will be looking at the number who are pregnant and the number of those who had an ectopic.• Equipment needed will be PACS system to access data and excel to collate information.• This is considered a low risk study as it is retrospective and there will be no participants actively sourced.***This basic lit review I have used can be expanded upon if need be.1. Kirk, E., Papageorghio, A.T., Condus, G., Tan, L., Shabana, B., Bourne, T. (2007). The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Human Reproduction, 22(11), 2824-2828. doi: doi:10.1093/humrep/dem2832. Raatz Stephenson, S. (2012). Diagnostic Medical Sonography Obstetrics and Gynaecology (3 ed.). Baltimore, MD: Lippencott Williams and Wilkins.3. Lin, E. P., Bhatt, S., Dogra, V.S. . (2008). Diagnostic clues to ectopic pregnancy. Radiographics, 28(6), 1661-1671.4. Barnhart, K., Mennuti, M.T., Benjamin, I., Jacobson, S., GOodman, D., Coutifaris, C. (1994). Prompt diagnosis of ectopic pregnancy in an emergency department setting. Obstetrics and Gynaecology, 84(6), 1010-1015.5. Mol, F., van den Boogaard, E., van Mello, N.M., van der Veen, F., Mol, B.W., Ankum, W.M., van Zonneveld, P., Dijkman, A.B., Verhoeve, H.R., Mozes, A., Goddijn, M., Hajenius, P.J. . (2011). Guideline adherence in ectopicpregnancy management. Human Reproduction, 26(2), 307-315. doi: doi:10.1093/humrep/deq329