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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Non-tubal ectopic pregnancies (707)

Objectives

The purpose of this guideline is to aid the management of women diagnosed with a non-tubal ectopic pregnancy.

Please report any inaccuracies or issues with this guideline using our online form

Ectopic pregnancies in locations other than the fallopian tubes are becoming more common. In vitro fertilisation, pelvic inflammatory disease and the rise in the caesarean section rate are known risk factors. Whilst non tubal pregnancies only account for 5% of all ectopic pregnancies they disproportionately account for morbidity and mortality associated with ectopic pregnancy.

Management

An unstable patient should be managed in accordance with emergency protocols.

A stable patient should have a group and save, FBC and if appropriate a βhCG taken.

Initial diagnosis, management and scans or biochemical results of non tubal pregnancies must be discussed with a consultant gynaecologist. A gynaecologist with early pregnancy expertise should be involved in planning ongoing care and management.

Site of ectopic

Ultrasound features

Biochemical investigations

Management options

Cervical pregnancy

Empty uterine cavity

Barrel shaped cervix

Gestational sac (GS) below the level of the internal cervical os

Blood flow around the GS

Absence of sliding signi

Serum βhCG  

Consider systemic methotrexate if:

  • βhCG levels <10000iu
  • absence of fetal cardiac activity
  • <12+0 weeks gestation

Consider systemic methotrexate +/- surgical debulking +/- intracervical methotrexate if:

  • βhCG ≥10000iu
  • Evidence of fetal cardiac activity
  • CRL ≥10 mm

Caesarean ectopic

Empty uterine cavity

GS or trophoblast located anteriorly at the level of the internal cervical os

Embedded at site of previous caesarean section

Thin or absent myometrium between GS and bladder

Evidence of prominent trophoblastic circulation on doppler examination

Empty endocervical canal

Not routinely required

Consider MRI if diagnosis is in doubt

Treatment requires individualised care

1st trimester options:

  • Surgical management is the most effective
  • Consideration of surgical evacuation with Foley catheter insertion for additional haemostasis
  • Local injection of methotrexate into the GS. Risk of haemorrhage remains high from degenerating placental tissue

If the pregnancy continues after the first trimester then the patient must be highlighted to the Obstetric Consultant leading the patient’s care as there is a risk of invasive placentation.

Interstitial pregnancy

Empty uterine cavity

GS located in the intramural part of the fallopian tube

<5mm of myometrium in all planes

Presence of interstitial lineii

Consider sequential βhCG

Consider MRI to aid diagnosis following discussion with gynaecology consultant

Medical management with systemic methotrexate should be considered 1st line

Consider expectant management in those with low initial βhCG levels

Cornual pregnancy

GS mobile and separate from the uterus and surrounded by myometrium

Vascular pedicle adjoining the unicornuate uterus

Consider sequential βhCG 48 hours apart

Surgical management should be 1st line

Removal of the rudimentary horn should be undertaken

Ovarian pregnancy

Empty uterus

Internal anechoic area on the ovary

Consider sequential βhCG 48 hours apart

Laparoscopic management should be 1st line

Abdominal pregnancy

Empty uterus

GS surrounded by loops of bowel and separated from them by peritoneum

Mobile mass when pressing with the transvaginal probe

βhCG

Laparoscopic management should be 1st line.

Heterotopic pregnancy

Intrauterine pregnancy and co-existing ectopic pregnancy

Not required

Management needs to be individualised based on the intrauterine pregnancy and wishes of the patient

Surgical management is 1st line with salpingectomy of the ectopic

Systemic methotrexate should only be used if the intrauterine pregnancy Is non-viable or patient wishes termination

Scan following surgery to assess viability of intrauterine pregnancy

i Sliding sign: the vaginal probe is used to apply pressure onto the cervix. In a miscarriage, the gestational sac slides against the cervical canal, but does not do so in a pregnancy implanted in the endocervix or caesarean section scar.
ii Interstitial line sign: an echogenic line from the mass to the endometrial echo.

Editorial Information

Last reviewed: 26/11/2019

Next review date: 30/11/2024

Author(s): Claire Higgins.

Approved By: Gynaecology Clinical Guidelines Group

Document Id: 707