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Monteiro LJ, Varas-Godoy M, Acuña-Gallardo S, Correa P, Passalacqua G, Monckeberg M, Rice GE, Illanes SE. Increased Circulating Levels of Tissue-Type Plasminogen Activator Are Associated with the Risk of Spontaneous Abortion During the First Trimester of Pregnancy. Diagnostics (Basel) 2020; 10:diagnostics10040197. [PMID: 32244842 PMCID: PMC7235768 DOI: 10.3390/diagnostics10040197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 12/27/2022] Open
Abstract
Spontaneous abortion is a common complication in early pregnancy, with an incidence of around 20%. Ultrasound scan and measurement of human chorionic gonadotropin are used to identify patients at risk of spontaneous abortion; however, there is a clinical need to find new biomarkers to prospectively identify patients before the onset of clinical symptoms. Here, we aim to investigate potential biomarkers of spontaneous abortion taken in the first clinical appointment of pregnancy. A case–control study was conducted based on a prospectively collected cohort in which cases and controls were retrospectively stratified based on pregnancy outcome: normal healthy pregnancies (controls = 33) and pregnancies that ended in spontaneous abortion (cases = 10). We evaluated extracellular vesicles isolated by precipitation with ExoQuick™ and protein concentrations of tissue plasminogen activator, leptin, and adiponectin measured by ELISA. The extracellular vesicles showed the typical morphology and membrane proteins: CD63, Alix, and Flotilin-1. The size distributions of the isolated extracellular vesicles were 112 ± 27 and 118 ± 28 nm in diameter for controls and spontaneous abortion, respectively, and the total amount of extracellular vesicles did not show any difference between controls and the spontaneous abortion group. The tissue plasminogen activator showed a significant difference (p = 0.0004) between both groups, although neither adiponectin nor leptin revealed significant changes, indicating that women who had spontaneous abortions have significantly higher levels of tissue plasminogen activator than women who had normal pregnancies.
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Affiliation(s)
- Lara J. Monteiro
- Centre for Biomedical Research, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago 7620001, Chile; (L.J.M.)
| | - Manuel Varas-Godoy
- Centre for Biomedical Research, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago 7620001, Chile; (L.J.M.)
- Cancer Cell Biology Lab., Centre of Celullar Biology and Biomedicine (CEBICEM), Faculty of Medicine and Science, Universidad San Sebastián, Santiago 7510157, Chile
| | - Stephanie Acuña-Gallardo
- Centre for Biomedical Research, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago 7620001, Chile; (L.J.M.)
| | - Paula Correa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago 7620001, Chile
- Department of Maternal-Fetal Medicine, Clínica Dávila, Santiago 8420384, Chile
| | - Gianluca Passalacqua
- Centre for Biomedical Research, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago 7620001, Chile; (L.J.M.)
| | - Max Monckeberg
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago 7620001, Chile
| | - Gregory E. Rice
- Centre for Biomedical Research, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago 7620001, Chile; (L.J.M.)
- Centre for Clinical Research, University of Queensland, QLD 4029 Herston, Australia
| | - Sebastián E. Illanes
- Centre for Biomedical Research, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de Los Andes, Santiago 7620001, Chile; (L.J.M.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago 7620001, Chile
- Department of Maternal-Fetal Medicine, Clínica Dávila, Santiago 8420384, Chile
- Correspondence: ; Tel.: +56 2 2373 6552
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Abstract
Early in pregnancy women frequently experience nausea, vomiting, and vaginal bleeding. Nausea and vomiting can be mild, managed by dietary modifications and medications, or severe, requiring intravenous fluids and medications. Care should be used when selecting medications for nausea to avoid additional side effects or potential harm to the developing fetus. When evaluating vaginal bleeding in early pregnancy, ectopic pregnancy must be ruled out. If an intrauterine pregnancy is seen, threatened miscarriage should be considered and the patient appropriately counseled. If neither intrauterine pregnancy nor ectopic pregnancy can be established, a management algorithm for pregnancy of unknown location is presented.
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Affiliation(s)
- Elizabeth Pontius
- Department of Emergency Medicine, Georgetown University School of Medicine, MedStar Georgetown University Hospital, MedStar Washington Hospital Center, 110 Irving Street, Northwest, NA 1177, Washington, DC 20010, USA
| | - Julie T Vieth
- Department of Emergency Medicine, Canton-Potsdam Hospital, 50 Leroy Street, Potsdam, NY 13676, USA.
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Puget C, Joueidi Y, Bauville E, Laviolle B, Bendavid C, Lavoué V, Le Lous M. Serial hCG and progesterone levels to predict early pregnancy outcomes in pregnancies of uncertain viability: A prospective study. Eur J Obstet Gynecol Reprod Biol 2018; 220:100-105. [DOI: 10.1016/j.ejogrb.2017.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 12/17/2022]
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Andersen LB, Dechend R, Karumanchi SA, Nielsen J, Joergensen JS, Jensen TK, Christesen HT. Early pregnancy angiogenic markers and spontaneous abortion: an Odense Child Cohort study. Am J Obstet Gynecol 2016; 215:594.e1-594.e11. [PMID: 27287686 DOI: 10.1016/j.ajog.2016.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Spontaneous abortion is the most commonly observed adverse pregnancy outcome. The angiogenic factors soluble Fms-like kinase 1 and placental growth factor are critical for normal pregnancy and may be associated to spontaneous abortion. OBJECTIVE We investigated the association between maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor, and subsequent spontaneous abortion. STUDY DESIGN In the prospective observational Odense Child Cohort, 1676 pregnant women donated serum in early pregnancy, gestational week <22 (median 83 days of gestation, interquartile range 71-103). Concentrations of soluble Fms-like kinase 1 and placental growth factor were determined with novel automated assays. Spontaneous abortion was defined as complete or incomplete spontaneous abortion, missed abortion, or blighted ovum <22+0 gestational weeks, and the prevalence was 3.52% (59 cases). The time-dependent effect of maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor on subsequent late first-trimester or second-trimester spontaneous abortion (n = 59) was evaluated using a Cox proportional hazards regression model, adjusting for body mass index, parity, season of blood sampling, and age. Furthermore, receiver operating characteristics were employed to identify predictive values and optimal cut-off values. RESULTS In the adjusted Cox regression analysis, increasing continuous concentrations of both soluble Fms-like kinase 1 and placental growth factor were significantly associated with a decreased hazard ratio for spontaneous abortion: soluble Fms-like kinase 1, 0.996 (95% confidence interval, 0.995-0.997), and placental growth factor, 0.89 (95% confidence interval, 0.86-0.93). When analyzed by receiver operating characteristic cut-offs, women with soluble Fms-like kinase 1 <742 pg/mL had an odds ratio for spontaneous abortion of 12.1 (95% confidence interval, 6.64-22.2), positive predictive value of 11.70%, negative predictive value of 98.90%, positive likelihood ratio of 3.64 (3.07-4.32), and negative likelihood ratio of 0.30 (0.19-0.48). For placental growth factor <19.7 pg/mL, odds ratio was 13.2 (7.09-24.4), positive predictive value was 11.80%, negative predictive value was 99.0%, positive likelihood ratio was 3.68 (3.12-4.34), and negative likelihood ratio was 0.28 (0.17-0.45). In the sensitivity analysis of 54 spontaneous abortions matched 1:4 to controls on gestational age at blood sampling, the highest area under the curve was seen for soluble Fms-like kinase 1 in prediction of first-trimester spontaneous abortion, 0.898 (0.834-0.962), and at the optimum cut-off of 725 pg/mL, negative predictive value was 51.4%, positive predictive value was 94.6%, positive likelihood ratio was 4.04 (2.57-6.35), and negative likelihood ratio was 0.22 (0.09-0.54). CONCLUSION A strong, novel prospective association was identified between lower concentrations of soluble Fms-like kinase 1 and placental growth factor measured in early pregnancy and spontaneous abortion. A soluble Fms-like kinase 1 cut-off <742 pg/mL in maternal serum was optimal to stratify women at high vs low risk of spontaneous abortion. The cause and effect of angiogenic factor alterations in spontaneous abortions remain to be elucidated.
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Gerges B, Condous G. Minimising harm in the early pregnancy population. Aust N Z J Obstet Gynaecol 2015; 55:521-2. [PMID: 26437835 DOI: 10.1111/ajo.12412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Bassem Gerges
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Kingswood, New South Wales, Australia.
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Kingswood, New South Wales, Australia.,Omni Gynaecological Care Centre for Women's Ultrasound and Early Pregnancy, St Leonards, New South Wales, Australia
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Al-Memar M, Kirk E, Bourne T. The role of ultrasonography in the diagnosis and management of early pregnancy complications. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/tog.12201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maya Al-Memar
- Early Pregnancy & Acute Gynaecology Unit; Queen Charlotte's & Chelsea Hospital, Imperial College; Du Cane Road London W12 0HS UK
| | - Emma Kirk
- North Middlesex University Hospital; Sterling Way London N18 1QX UK
| | - Tom Bourne
- Queen Charlotte's & Chelsea Hospital, Imperial College; Du Cane Road London W12 0HS
- Imperial College; London
- KU Leuven; Belgium
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Ibrahim MI, Abdelhafeez MA, Ellaithy MI, Salama AH, Amin AS, Eldakrory H, Elhadad NI. Can Porphyromonas gingivalis be a novel aetiology for recurrent miscarriage? EUR J CONTRACEP REPR 2015; 20:119-27. [PMID: 25328050 DOI: 10.3109/13625187.2014.962651] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To study the association between Porphyromonas gingivalis (P. gingivalis) infection and recurrent miscarriage. METHODS This case control study included women with early pregnancy failure admitted for surgical evacuation of retained products of conception. Cases (group 1) included 50 women with unexplained recurrent early miscarriage whereas the control group (group 2) consisted of 50 women with no such history. The evacuated products of conception, subgingival plaques, cervicovaginal secretions and saliva of all participants were examined to detect P. gingivalis deoxyribonucleic acid (DNA) using a polymerase chain reaction. RESULTS The prevalence of P. gingivalis DNA in the chorionic villous tissue samples of group 1 was significantly higher than in group 2 (8 [16%] vs. 1 [2%], respectively; p = 0.036, odds ratio [OR]: 9.3, 95% confidence interval [CI]: 1.1-76.9). The prevalence of P. gingivalis DNA was significantly higher in cervicovaginal secretions of group 1 than in group 2 (9 [18%] vs. 1 [2%], respectively; p = 0.02, OR: 10.8, 95% CI: 1.3-88.5). On the contrary, P. gingivalis DNA could not be detected in subgingival plaques and saliva samples of either group. CONCLUSION The current study found an association between P. gingivalis infection of the female genital tract and the occurrence of recurrent miscarriage.
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Affiliation(s)
- Moustafa I Ibrahim
- * Obstetrics & Gynaecology Department, Ain-Shams Faculty of Medicine , Cairo , Egypt
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Seervi N, Hooja N, Rajoria L, Verma A, Malviya K, Mehta N. Comparison of different regimes of misoprostol for the termination of early pregnancy failure. Med J Armed Forces India 2014; 70:360-3. [PMID: 25382911 DOI: 10.1016/j.mjafi.2014.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Nearly 20% of all confirmed pregnancies end in spontaneous abortion. Misoprostol's use in early pregnancy failure is varied and dose and route are not well established. The aim of this study was to compare the efficacy and the side effects of different regimes of misoprostol in causing expulsion of products of conception in early pregnancy failure. METHOD Women patients with an ultrasound diagnosis of early pregnancy failure, less than 12 weeks gestation were divided into two, Group-A: tab. Misoprostol 800 mcg 6 hourly vaginally, upto 3 doses. Group-B tablet misoprostol 600 mcg 6 hourly, sublingually for 3 doses. All observations were noted and statistical analyzed. RESULTS Mean gestational age was 7.93 weeks. Mean induction abortion interval 18.183 h. Women patients with less than six weeks gestational age had least mean induction-abortion interval time, 15.75 ± 2.82 h in vaginal group but was highest in sublingual group 22 ± 2 h and 18.43 h in overall (P = 0.02). Though after 8 weeks, both routes were equally effective. Mean dose required in group-A was 20044 mcg and in group-B was 1564 mcg (P < 0.001). Efficacy of protocol was 88.89% in group-A and 92.85% in group-B. CONCLUSION Both regimes had comparable efficacy, acceptability (90%) and side effects. In women patients less than six weeks period of gestation, the vaginal (800 mcg) route was distinctly superior, in women patients with 6-8 weeks the sublingual (600 mcg) route was more advantageous. The correct dose must be used for the route chosen. The route of administration should be decided in accordance with the preference of the patient and the clinical situation.
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Affiliation(s)
- Nandaram Seervi
- Resident, Department of Obst. & Gynae., S.M.S. Medical College & Hospital, Jaipur, Rajasthan 302015, India
| | - Nupur Hooja
- Professor, Department of Obst. & Gynae., S.M.S. Medical College & Hospital, Jaipur, Rajasthan 302015, India
| | - Lata Rajoria
- Professor & Head, Department of Obst. & Gynae., S.M.S. Medical College & Hospital, Jaipur, Rajasthan 302015, India
| | - Asha Verma
- Professor, Department of Obst. & Gynae., S.M.S. Medical College & Hospital, Jaipur, Rajasthan 302015, India
| | - Kusum Malviya
- Assistant Professor, Department of Obst. & Gynae., S.M.S. Medical College & Hospital, Jaipur, Rajasthan 302015, India
| | - Neha Mehta
- Resident, Department of Obst. & Gynae., S.M.S. Medical College & Hospital, Jaipur, Rajasthan 302015, India
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Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2013.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Infante F, Casikar I, Menakaya U, Condous G. Rationalising the change in defining non-viability in the first trimester. Australas J Ultrasound Med 2013; 16:114-117. [PMID: 28191184 PMCID: PMC5029994 DOI: 10.1002/j.2205-0140.2013.tb00098.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: With the publication of four papers in late 2011, international cut-offs for definitions of non-viability in the first trimester of pregnancy were challenged. These definitions were inconsistent across different international guidelines. For example, a gestational sac with absent yolk sac or embryo and a mean diameter of ≥ 16 mm would be classified as a miscarriage in the USA, whereas the same sac would have to measure ≥ 20 mm in the UK or Australia to meet this definition. Likewise, an embryo with no detectable heartbeat and a CRL of ≥ 5 mm would also meet criteria for missed miscarriage in the USA, compared to a CRL ≥ 6 mm in the UK or Australia. Methods: Later in 2011 and then in 2012, guidelines across the three countries were updated and are now consistent, defining an empty gestational sac with a mean diameter of > 25 mm as a non-viable pregnancy and/or an embryo with CRL > 7 mm and no detectable heartbeat. In this paper we explore the rationale that led to these changes in order to potentially avoid wrongly diagnosing miscarriage at the decision boundary measurements and in turn avoiding inadvertent termination of potentially viable pregnancies. Conclusion: Although reducing women's anxiety and making a definitive diagnosis as early as possible is desirable, the need for absolute certainty is paramount before diagnosis of the death of an early pregnancy is made.
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Affiliation(s)
- Fernando Infante
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales Australia
| | - Ishwari Casikar
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales Australia
| | - Uche Menakaya
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales Australia
| | - George Condous
- Acute GynaecologyEarly Pregnancy and Advanced Endosurgery UnitSydney Medical School NepeanUniversity of SydneyNepean HospitalPenrithNew South WalesAustralia; OMNI Gynaecological CareCentre for Women's Ultrasound and Early Pregnancy St LeonardsSydneyNew South WalesAustralia
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Cervical and Cesarean scar ectopic pregnancies: Diagnosis and management. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2013.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bickhaus J, Perry E, Schust DJ. Re-examining Sonographic Cut-off Values for Diagnosing Early Pregnancy Loss. GYNECOLOGY & OBSTETRICS (SUNNYVALE, CALIF.) 2013; 3:141. [PMID: 25045591 DOI: 10.4172/2161-0932.1000141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jennifer Bickhaus
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, USA
| | - Erin Perry
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, USA
| | - Danny J Schust
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, USA
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Barnhart KT. Early pregnancy failure: beware of the pitfalls of modern management. Fertil Steril 2012; 98:1061-5. [PMID: 23084007 PMCID: PMC3479658 DOI: 10.1016/j.fertnstert.2012.09.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 09/17/2012] [Indexed: 12/27/2022]
Abstract
The evolution of the diagnosis and management of women with an early pregnancy loss has been a success story. The mortality from ectopic pregnancy has objectively been decreased in the past few decades. However, modern management has resulted in a new set of issues. Over-interpretation of a single ultrasound, misunderstanding of the utility of serial hCG values, and inappropriate use of methotrexate can result in iatrogenic complications. Modern management has successfully improved the diagnosis of ectopic pregnancy before rupture; it should now also focus on ensuring that an intrauterine pregnancy is not interrupted as a result of diagnosis and treatment. This article reviews some of the pitfalls of the modern management of early pregnancy failure and introduces a series of articles on the subject.
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MESH Headings
- Abortifacient Agents, Nonsteroidal/adverse effects
- Abortion, Spontaneous/blood
- Abortion, Spontaneous/diagnosis
- Abortion, Spontaneous/diagnostic imaging
- Abortion, Spontaneous/mortality
- Abortion, Spontaneous/therapy
- Abortion, Therapeutic/adverse effects
- Abortion, Therapeutic/methods
- Biomarkers/blood
- Chorionic Gonadotropin/blood
- Diagnosis, Differential
- Diagnostic Errors
- Early Diagnosis
- Female
- Humans
- Methotrexate/adverse effects
- Predictive Value of Tests
- Pregnancy
- Pregnancy Outcome
- Pregnancy, Ectopic/blood
- Pregnancy, Ectopic/diagnosis
- Pregnancy, Ectopic/diagnostic imaging
- Pregnancy, Ectopic/mortality
- Pregnancy, Ectopic/therapy
- Prenatal Diagnosis/methods
- Risk Assessment
- Risk Factors
- Treatment Outcome
- Ultrasonography, Prenatal
- Unnecessary Procedures
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Affiliation(s)
- Kurt T Barnhart
- Departments of Obstetrics and Gynecology and Epidemiology, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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