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Shulman Y, Cohen A, Bercovich O, Cohen Y, Gil Y, Levin I. Prognostic factors for spontaneous resolution of an ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 2023; 291:235-239. [PMID: 37925893 DOI: 10.1016/j.ejogrb.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To identify factors that can accurately predict the spontaneous resolution of an ectopic pregnancy. STUDY DESIGN This retrospective cohort analysis was conducted in the Department of Gynecology of a tertiary, university-affiliated medical center. Patients admitted to the center from January 2015 to July 2022 with a tubal ectopic pregnancy who met the criteria for expectant management were included. Beta-human chorionic gonadotropin (ß-hCG) levels were assessed at admission and at subsequent 24-hour intervals. Patients with declining levels were discharged for routine ambulatory ß-hCG follow-up until levels became undetectable. Patients who achieved a successful outcome were designated as the "spontaneous resolution group," while patients who underwent further hospitalization for methotrexate or surgery constituted the" failure group". Demographic, clinical, laboratory, and ultrasound parameters collected at first admission were compared between groups. RESULTS Among the initial group of 210 eligible patients, 7 were lost to follow-up, 161 achieved spontaneous resolution, and 42 were readmitted for active intervention. Multivariate logistic regression analysis revealed that the last ß-hCG level before discharge (last ß-hCG) and the ratio between ß-hCG at discharge to ß-hCG at admission were the only independent parameters to predict outcomes. Patients with ß-hCG < 650 IU/L at discharge and a decline of 50% or more in ß-hCG level during hospitalization, had a 97% success rate with expectant management. Patients with ß-hCG discharge levels ≥ 1,000 IU/L had a 50% chance of success, regardless of whether their ß-hCG levels had declined. For all other patients, a 76% success rate was found. CONCLUSION Short-term, serial ß-hCG follow-up at the initial presentation can help predict the spontaneous resolution of an ectopic pregnancy.
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Affiliation(s)
- Yael Shulman
- Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviad Cohen
- Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Bercovich
- Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel
| | - Yoni Cohen
- Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Gil
- Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ishai Levin
- Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Levin I. Magic bullet or simply nice to have: safety and tolerability of oral vinorelbine for ectopic pregnancy. Fertil Steril 2023; 120:697-698. [PMID: 37385396 DOI: 10.1016/j.fertnstert.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Ishai Levin
- Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
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Aiob A, Yousef H, Abu Shqara R, Mustafa Mikhail S, Odeh M, Lowenstein L. Risk factors and prediction of ectopic pregnancy rupture following methotrexate treatment: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 285:181-185. [PMID: 37146508 DOI: 10.1016/j.ejogrb.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Ectopic pregnancy (EP) rupture after methotrexate (MTX) treatment can have severe consequences. We examined clinical characteristics and beta-hCG trends that may predict EP rupture after MTX treatment. STUDY DESIGN In this 10-year retrospective study of 277 women with an EP, we compared clinical, sonographic and beta-hCG trends, before and after MTX treatment, between those who did and did not have an EP rupture after MTX treatment. RESULTS EP rupture was diagnosed in 41 women (15.1%) within 25 days of MTX treatment, and was correlated with higher parity and advanced pregnancy age: 2(0-5) vs. 1(0-6), P = 0.027 and 6.6(4.2-9.8) vs. 6.1(4-9.5), P = 0.045. EP rupture was also correlated with higher beta-hCG levels on days 0, 4 and 7 of MTX treatment: (2063 vs. 920 mIU/ml), (3221 vs. 921 mIU/ml) and (2368 vs. 703 mIU/ml), respectively, P < 0.001, for all. An increase of beta-hCG by>14% during days 0-4 showed a sensitivity of 71.4% CI 95% [55.4%-84.3%] and a specificity of 67.5% CI 95% [61.1%-73.6%] for predicting EP rupture after MTX treatment. Beta-hCG > 910 mIU/ml on day 0 showed a sensitivity of 80.9% CI 95% [66.7%-90.8%] and a specificity of 70.4% CI 95% [64.1%-76.3%] for predicting EP rupture after MTX treatment. A beta-hCG increase by>14% during days 0-4, and a beta-hCG value > 910 mUI/mL on day 0 were associated with increased risks of EP rupture after MTX treatment; the odds ratios were 6.4 and 10.5, respectively. Odds ratios were 8.06 [CI 95% (3.70-17.56)], P < 0.001 for every percent rise in beta-hCG during days 0-4; 1.37 [CI 95% (1.06-1.86)], P = 0.046 for every week change in gestational age; and 1.001 [CI 95% (1.000-1.001)], P < 0.001 for every unit rise in beta-hCG at day 0. CONCLUSION Beta-hCG > 910 mIU/ml at day 0, a rise in beta-hCG by>14% during days 0-4, and more advanced gestational age were associated with EP rupture after MTX treatment.
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Affiliation(s)
- Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Haddad Yousef
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Raneen Abu Shqara
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Susana Mustafa Mikhail
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Tavares BVG, Delfino LS, Ignarro IS, Baccaro LF. Changing Paradigms in the Initial Treatment of Ectopic Pregnancy at a University Hospital in Brazil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:192-200. [PMID: 37224841 PMCID: PMC10208733 DOI: 10.1055/s-0043-1768999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To evaluate the use of different treatment options for ectopic pregnancy and the frequency of severe complications in a university hospital. METHODS Observational study with women with ectopic pregnancy admitted at UNICAMP Womeńs Hospital, Brazil, between 01/01/2000 and 12/31/2017. The outcome variables were the type of treatment (first choice) and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran-Armitage test, chi-square test, Mann-Whitney test and multiple Cox regression. RESULTS In total 673 women were included in the study. The mean age was 29.0 years (± 6.1) and the mean gestational age was 7.7 (± 2.5). The frequency of surgical treatment decreased significantly over time (z = -4.69; p < 0.001). Conversely, there was a significant increase in the frequency of methotrexate treatment (z = 4.73; p < 0.001). Seventy-one women (10.5%) developed some type of severe complication. In the final statistical model, the prevalence of severe complications was higher in women who were diagnosed with a ruptured ectopic pregnancy at admission (PR = 2.97; 95%CI: 1.61-5.46), did not present with vaginal bleeding (PR = 2.45; 95%CI: 1.41-4.25), had never undergone laparotomy/laparoscopy (PR = 6.69; 95%CI: 1.62-27.53), had a non-tubal ectopic pregnancy (PR = 4.61; 95%CI: 1.98-10.74), and do not smoke (PR = 2.41; 95%CI: 1.08-5.36). CONCLUSION there was a change in the first treatment option for cases of ectopic pregnancy in the hospital during the period of analysis. Factors inherent to a disease that is more difficult to treat are related to a higher frequency of severe complications.
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Affiliation(s)
| | - Letícia Sathler Delfino
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Luiz Francisco Baccaro
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Conservative Management for Retained Products of Conception in Late Pregnancy. Healthcare (Basel) 2023; 11:healthcare11020168. [PMID: 36673536 PMCID: PMC9859269 DOI: 10.3390/healthcare11020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
This retrospective study aims to compare the early manual removal of placenta (MROP) and conservative management of retained products of conception (RPOC) after 34 weeks of gestation. Nineteen cases underwent MROP within 24 h of delivery, of which nine patients had no symptoms requiring emergent treatment. These 9 patients (group M) were compared with 22 patients who were treated conservatively (group C). Massive bleeding was observed in 5 (56%) patients in group M and 11 (50%) patients in group C, with no significant difference in frequency. However, the lowest hemoglobin level within 72 h after massive bleeding was lower in group M (median: 6.7 vs. 7.7 g/dL, p = 0.029), suggesting that massive bleeding occurred in a short period of time. On the other hand, a retained placenta was observed in four patients in group M after the MROP; however, the placenta disappeared more quickly than in group C (median; 1.0 vs. 99.0 days, p = 0.009). In group C, all bleeding and infection occurred within 60 days of delivery, including heavy bleeding in six cases during the placental-extraction trial. Human chorionic gonadotropin in group C fell below the measurable threshold at a median of 67 days postpartum. In conclusion, for RPOC without urgent symptoms, early MROP and conservative treatment have their advantages and disadvantages. Randomized controlled trials are needed to determine which of those treatments is superior.
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Muacevic A, Adler JR, Sanjaghsaz H, Nichols R. Ectopic Pregnancy in an Adolescent: A Case Report and Review of Literature. Cureus 2022; 14:e32220. [PMID: 36620848 PMCID: PMC9812281 DOI: 10.7759/cureus.32220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Ectopic pregnancy continues to be the leading cause of death in the first trimester. Here, we report the case of a 17-year-old female who presented with vaginal bleeding and a positive serum beta-human chorionic gonadotropin level. In addition, we review the literature, focusing on the early diagnosis and management with the increasing preference for nonsurgical management of ectopic pregnancy, particularly in adolescents.
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ÇETİN F, BAYRAMOĞLU TEPE N, SUCU S, BADEMKIRAN MH, KUTLAR İ. Analysis of multiple-dose methotrexate therapy in tubal ectopic pregnancies. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1037172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Grigoriu C, Bohiltea R, Mihai B, Zugravu C, Furtunescu F, Georgescu T, Munteanu D. Success rate of methotrexate in the conservative treatment of tubal ectopic pregnancies. Exp Ther Med 2021; 23:150. [DOI: 10.3892/etm.2021.11073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/23/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Corina Grigoriu
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Roxana Bohiltea
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bianca Mihai
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Corina Zugravu
- Department of Food Hygiene and Nutrition, ‘Carol Davila’ University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Tiberiu Georgescu
- Department of Pathology, ‘Carol Davila’ University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Diana Munteanu
- Department of Medical Expertise and Work Capacity Recovery, National Institute of Medical Expertise and Work Capacity Recovery, 050653 Bucharest, Romania
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Chen S, Chen XF, Qiu P, Huang YX, Deng GP, Gao J. Association Between White Blood Cells at Baseline and Treatment Failure of MTX for Ectopic Pregnancy. Front Med (Lausanne) 2021; 8:722963. [PMID: 34568378 PMCID: PMC8460899 DOI: 10.3389/fmed.2021.722963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose: The aim of this study was to evaluate white blood cell (WBC) count as a risk factor related to methotrexate (MTX) treatment failure in patients with ectopic pregnancy (EP). Methods: A total of 236 women diagnosed with EP and treated with a single dose of MTX were included. The exposure variable was WBC count at baseline, and the outcome was MTX treatment outcome. Both a multivariate binary logistics regression model and subgroup analysis were performed to evaluate the association between WBC and MTX non-response. Results: WBC count was associated with the risk of treatment failure, and the odds ratio (OR) in different multivariate models was stable [minimally adjusted model: OR 1.2, 95% confidence interval (CI): 1.0–1.3, p = 0.008; fully adjusted model: OR 1.2, 95% CI: 1.0–1.4, p = 0.026]. For WBCs in group T3 (>8.9 × 109/L), the association between WBC count and treatment failure was significant (minimally adjusted model: OR: 2.0, 95% CI: 1.0–3.8, p = 0.050; fully adjusted model: OR: 2.2, 95% CI: 1.1–5.6, p = 0.034). Subgroup analysis showed that in participants with regular menstruation (OR 1.1, 95% CI: 1.0–1.3), WBC count was significantly different from irregular menstruation (OR 1.8, 95% CI: 1.2–2.8); p for interaction was 0.031. Conclusions: We found a reliable and non-linear relationship between WBC count and MTX treatment failure for EP.
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Affiliation(s)
- Si Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Feng Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pin Qiu
- Department of Gynecology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Xi Huang
- Department of Gynecology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gao-Pi Deng
- Department of Gynecology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Gao
- Department of Gynecology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Peracheh M, Teymouri B, Noori N, Arbabzadeh T, Ghasemi M. Evaluating the agreement of ultrasound imaging and beta-human chorionic gonadotropin (β-hCG) measurement in confirming completed medical abortion: cross-sectional study. Qatar Med J 2021; 2021:22. [PMID: 34285887 PMCID: PMC8276587 DOI: 10.5339/qmj.2021.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 10/20/2020] [Indexed: 01/15/2023] Open
Abstract
Objective: Clinical methods that are generally used to evaluate the completeness of medical abortion are not reliable. Ultrasound imaging and beta-human chorionic gonadotropin (β-hCG) measurements are used to diagnose completed medical abortion, but a precise evaluation of these two methods has shown contradictory results. The purpose of this study is to evaluate the agreement of serum β-hCG measurement and ultrasound imaging to confirm complete medical abortion. Materials and Methods: This study was conducted on pregnant women who had been referred to our center for medical abortion from 2015 to 2017. All cases occurred in the first trimester of pregnancy. They obtained one or two doses of vaginal misoprostol for medical abortion. Success rate of medical abortion was measured by both transvaginal ultrasound imaging and consecutive serum β-hCG measurements two to four weeks after initial treatment. Results: Among the 275 women who completed the study, complete medical abortion was confirmed by serum β-hCG in 231 women (84.3%) and transvaginal ultrasound imaging in 195 women (70.8%) after two weeks. All remaining cases completed the medical abortion after an additional two weeks, confirmed by both transvaginal ultrasound imaging and serum β-hCG. The sensitivity, specificity, positive, and negative predictive values of β-hCG were 95.2%, 86.7%, 84%, and 70%, respectively; and these values for transvaginal ultrasound imaging were 68.5% 64.5%,77%, and 30.%, respectively, for the diagnosis of completed medical abortion. Conclusion: Serum β-hCG measurement is as effective as transvaginal ultrasound imaging to confirm successful medical abortion in early pregnancy.
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Affiliation(s)
- Mahboubeh Peracheh
- Department of Obstetrics and Gynecology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Batool Teymouri
- Department of Obstetrics and Gynecology, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran E-mail: ;
| | - Narjes Noori
- Department of Obstetrics and Gynecology, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran E-mail: ;
| | - Taraneh Arbabzadeh
- Department of Obstetrics and Gynecology and Perinatology, Shohaday Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Ghasemi
- Department of Obstetrics and Gynecology, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran E-mail: ;
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Pritchard N, Kaitu'u-Lino T, Harris L, Tong S, Hannan N. Nanoparticles in pregnancy: the next frontier in reproductive therapeutics. Hum Reprod Update 2020; 27:280-304. [PMID: 33279994 DOI: 10.1093/humupd/dmaa049] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Nanotechnology involves the engineering of structures on a molecular level. Nanomedicine and nano-delivery systems have been designed to deliver therapeutic agents to a target site or organ in a controlled manner, maximizing efficacy while minimizing off-target effects of the therapeutic agent administered. In both reproductive medicine and obstetrics, developing innovative therapeutics is often tempered by fears of damage to the gamete, embryo or developing foetus or of negatively impacting a woman's reproductive potential. Thus, nanomedicine delivery systems may provide alternative targeted intervention strategies, treating the source of the disease and minimizing long-term consequences for the mother and/or her foetus. OBJECTIVE AND RATIONALE This review summarizes the current state of nanomedicine technology in reproductive medicine and obstetrics, including safety, potential applications, future directions and the hurdles for translation. SEARCH METHODS A comprehensive electronic literature search of PubMed and Web of Science databases was performed to identify studies published in English up until February 2020. Relevant keywords were used to obtain information regarding use of nanoparticle technology in fertility and gene therapy, early pregnancy complications (ectopic pregnancy and gestational trophoblastic disease) and obstetric complications (preeclampsia, foetal growth restriction, preterm birth and gestational diabetes) and for selective treatment of the mother or foetus. Safety of specific nanoparticles to the gamete, embryo and foetus was also investigated. OUTCOMES Pre-clinical research in the development of nanoparticle therapeutic delivery is being undertaken in many fields of reproductive medicine. Non-hormonal-targeted nanoparticle therapy for fibroids and endometriosis may provide fertility-sparing medical management. Delivery of interventions via nanotechnology provides opportunities for gene manipulation and delivery in mammalian gametes. Targeting cytotoxic treatments to early pregnancy tissue provides an alternative approach to manage ectopic pregnancies and gestational trophoblastic disease. In pregnancy, nanotherapeutic delivery offers options to stably deliver silencing RNA and microRNA inhibitors to the placenta to regulate gene expression, opening doors to novel genetic treatments for preeclampsia and foetal growth restriction. Restricting delivery of teratogenic drugs to the maternal compartment (such as warfarin) may reduce risks to the foetus. Alternatively, targeted delivery of drugs to the foetus (such as those to treat foetal arrythmias) may minimize side effects for the mother. WIDER IMPLICATIONS We expect that further development of targeted therapies using nanoparticles in a reproductive setting has promise to eventually allow safe and directed treatments for conditions impacting the health and reproductive capacity of women and for the management of pregnancy and serious pregnancy complications.
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Affiliation(s)
- Natasha Pritchard
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Tu'uhevaha Kaitu'u-Lino
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Diagnostics Discovery and Reverse Translation, University of Melbourne, Heidelberg, Victoria, Australia
| | - Lynda Harris
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Maternal and Fetal Health Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester, UK
| | - Stephen Tong
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Natalie Hannan
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
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12
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Auger N, Ayoub A, Wei SQ. Letrozole: future alternative to methotrexate for treatment of ectopic pregnancy? Fertil Steril 2020; 114:273-274. [PMID: 32622661 DOI: 10.1016/j.fertnstert.2020.04.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
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13
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Niederberger C, Pellicer A, Simon C, Kathrins M, Goldstein M, Sigman M, Schlegel PN, Munné S, Gardner DK, Cobo A, Coutifaris C, Donnez J, Taylor HS, Giudice LC, Fauser BC, Lindheim SR, Rosenwaks Z, Casper RF, de Ziegler D, Gibbons WE, Paulson RJ, Laufer N, Klock SC, Mendola P, Sauer MV. 25 historic papers: an ASRM 75th birthday gift from Fertility and Sterility. Fertil Steril 2019; 112:e2-e27. [DOI: 10.1016/j.fertnstert.2019.08.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Lu Q, Wang Y, Sun X, Li Y, Wang J, Zhou Y, Wang Y. The diagnostic role of the β-hCG discriminatory zone combined with the endometrial pattern for ectopic pregnancy in Chinese women. Sci Rep 2019; 9:13781. [PMID: 31551446 PMCID: PMC6760119 DOI: 10.1038/s41598-019-50151-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
Previous studies have regarded the discriminatory serum β-hCG zone (DSZ) as a valuable tool for the diagnosis of ectopic pregnancy (EP). However, the wide range of the DSZ makes achieving a clinical diagnosis of EP difficult, and these reports do not indicate whether the DSZ is suitable for an EP diagnosis in Chinese women. Several studies have indicated that the endometrial pattern in patients with EPs is different from that in patients with intrauterine pregnancies (IUPs). The aims of this study were to define the DSZ cutoff value for Chinese women, test whether the endometrial pattern is a suitable predictor for EP, and assess the diagnostic value of these indicators. We enrolled participants with IUPs or EPs with abdominal pain and/or vaginal bleeding, and serum β-hCG level measurements and transvaginal ultrasound (TVS) were performed to assess the diagnostic value of the indicators for EP. The sensitivity and specificity for identifying an EP were improved by combining the DSZ, endometrial thickness and trilaminar pattern indexes. The results of this study might be helpful toward providing further options for the diagnosis of EP, especially for patients without hemoperitoneum or colporrhagia.
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Affiliation(s)
- Qi Lu
- Department of Gynecology, Jinshan Hospital of Fudan University, 1508 Longhang Rd., Shanghai, 201508, China
| | - Yiwei Wang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, 910 Hengshan Rd., Shanghai, 200030, China
| | - Xiao Sun
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, 910 Hengshan Rd., Shanghai, 200030, China
| | - Yuhong Li
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, 910 Hengshan Rd., Shanghai, 200030, China
| | - Jing Wang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, 910 Hengshan Rd., Shanghai, 200030, China
| | - Yun Zhou
- Department of Ultrasound in Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, 910 Hengshan Rd., Shanghai, 200030, China.
| | - Yudong Wang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, 910 Hengshan Rd., Shanghai, 200030, China.
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Lisonkova S, Tan J, Wen Q, Abdellatif L, Richter LL, Alfaraj S, Yong PJ, Bedaiwy MA. Temporal trends in severe morbidity and mortality associated with ectopic pregnancy requiring hospitalisation in Washington State, USA: a population-based study. BMJ Open 2019; 9:e024353. [PMID: 30782901 PMCID: PMC6367962 DOI: 10.1136/bmjopen-2018-024353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine temporal trend in maternal mortality/severe morbidity associated with hospitalisation due to ectopic pregnancy. DESIGN A population-based observational study. SETTING AND PARTICIPANTS All women hospitalised for ectopic pregnancy in Washington State, USA, 1987-2014 (n=20 418). The main composite outcome of severe morbidity/mortality included death, sepsis, need for transfusion, hysterectomy and systemic or organ failure, identified by diagnostic and procedure codes from hospitalisation files. Severe morbidity/mortality due to ectopic pregnancy were expressed as incidence ratios among women of reproductive age (15-64 years) and among women hospitalised for ectopic pregnancy. Comparisons were made between 1987-1991 (reference) and 2010-2014 using ratios of incidence ratios (RR) and ratio differences (RD). The Cochran-Armitage test for trend assessed statistical significance; logistic regression was used to obtain adjusted OR (AOR) and 95% CI, adjusted for demographic factors and comorbidity. RESULTS Hospitalisation for ectopic pregnancy declined from 0.89 to 0.16 per 1000 reproductive age women between 1987-1991 and 2010-2014 (p<0.001). Among reproductive age women, ectopic pregnancy mortality remained stable (0.03 per 100 000); and mortality/severe morbidity increased among women aged 25-34 years (p=0.022). Among women hospitalised for ectopic pregnancy, mortality increased from 0.29 to 1.65 per 1000 between 1987-1991 and 2010-2015 (p=0.06); severe morbidity/mortality increased from 3.85% to 19.63% (RR=5.10, 95% CI 4.36 to 5.98; RD=15.78 per 100 women, 95% CI 13.90 to 17.66; AOR for 1-year change was 1.08, 95% CI 1.07 to 1.08). CONCLUSIONS Hospitalisation for ectopic pregnancy declined in Washington State, USA, between 1987 and 2014; however, mortality/severe morbidity associated with ectopic pregnancy increased in female population aged 25-34 years.
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Affiliation(s)
- Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Tan
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Qi Wen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Lobna Abdellatif
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay L Richter
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Sukainah Alfaraj
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
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Hutchinson AP, Pereira N, Chung ER, Shah NJ, Zeku M, Chung PH, Rosenwaks Z. Risk factors and human chorionic gonadotropin trends in patients with ruptured tubal ectopic pregnancies despite methotrexate treatment. Gynecol Endocrinol 2019; 35:49-52. [PMID: 30322280 DOI: 10.1080/09513590.2018.1490406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This retrospective cohort study investigates the risk factors and beta-human chorionic gonadotropin (β-hCG) trends in patients with ruptured tubal ectopic pregnancies (EPs) despite methotrexate (MTX) treatment. All patients receiving MTX for sonographically confirmed tubal EPs at our fertility center between 2004 and 2014 were included. Baseline demographics and β-hCG trends of patients with EP rupture after MTX were compared to patients with resolved EPs after MTX. One-hundred-thirty-seven patients with EPs were treated with MTX during the study duration; 27 experienced EP rupture and 110 EP resolution. There was no difference in the baseline demographics or β-hCG levels on the day of MTX between the groups. Patients with ruptured EPs after MTX had higher β-hCG levels on day-4 (1223.9 ± 243.5 vs. 1111.2 ± 179.7 mIU/mL; p < .001) and day-7 (1156.9 ± 206.2 vs. 872.4 ± 690.2 mIU/mL; p < .001). The odds of EP rupture compared to EP resolution was 6.2 (95% CI 2.1-19.1), 13.7 (95% CI 4.8-38.9), and 3.0 (95% CI 1.2-7.2) times higher when the change in β-hCG levels was <5% between day-7 vs. day of MTX, day-7 vs. day-4, and day-4 vs. day of MTX, respectively. Our results demonstrate that ruptured tubal EPs despite MTX have <5% change in β-hCG levels between the day of MTX and day-4 or day-7 after MTX.
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Affiliation(s)
- Anne P Hutchinson
- a Department of Obstetrics and Gynecology , Weill Cornell Medical College , New York , NY , USA
| | - Nigel Pereira
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
| | - Eric R Chung
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
| | - Nirali J Shah
- a Department of Obstetrics and Gynecology , Weill Cornell Medical College , New York , NY , USA
| | - Megi Zeku
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
| | - Pak H Chung
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
| | - Zev Rosenwaks
- b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA
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Park JE, Yuk JS, Cho IA, Baek JC, Lee JH, Park JK. Ectopic pregnancy incidence in the Republic of Korea in 2009-2015: A population-based cross-sectional study. Sci Rep 2018; 8:17308. [PMID: 30470815 PMCID: PMC6251880 DOI: 10.1038/s41598-018-35466-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 11/06/2018] [Indexed: 11/22/2022] Open
Abstract
We estimated the incidence of ectopic pregnancy (EP) and the success rate of expectant management of EP in South Korea. We analyzed data from 2009 to 2015 using the Health Insurance Review and Assessment Service National Inpatient Sample (HIRA-NIS) database. EP was identified by diagnostic codes, and strict EP was identified by both diagnostic codes and treatment codes. From 2009 to 2015, 369,701 cases of EP, abortion, or delivery were extracted from a total of 4,476,495 women. Of the total pregnancies, 8,556 cases were EPs. The incidence of EP was 34.1 ± 0.7 per 1,000 pregnancies and the incidence of strict EP was 17.3 ± 0.3 per 1,000 pregnancies. Among women aged 25-44 years, age was associated with a higher incidence of EP (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.06, 1.19; P < 0.01). The incidence rates of EP (OR: 0.99; 95% CI: 0.97, 1.01; P = 0.51) did not significantly differ by year. The incidence of EP in Korea was 17.3 ± 0.3 per 1,000 pregnancies, and almost did not change over 7 years. About 50% of EPs were treated without surgery or methotrexate. This study provides an important reference for the treatment of EP.
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Affiliation(s)
- Ji Eun Park
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, 51472, Republic of Korea
| | - Jin-Sung Yuk
- Department of Obstetrics and Gynecology, College of Medicine, Eulji University, Nowon Eulji Medical Center, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, 01830, Republic of Korea.
| | - In Ae Cho
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, 52727, Republic of Korea
| | - Jong Chul Baek
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, 51472, Republic of Korea
| | - Jung-Hun Lee
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, 51472, Republic of Korea
| | - Ji Kwon Park
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, 51472, Republic of Korea
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San Lazaro Campillo IS, Meaney S, O'Donoghue K, Corcoran P. Ectopic pregnancy hospitalisations: A national population-based study of rates, management and outcomes. Eur J Obstet Gynecol Reprod Biol 2018; 231:174-179. [PMID: 30391866 DOI: 10.1016/j.ejogrb.2018.10.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine whether there were changes in the incidence, management and outcomes of ectopic pregnancy hospitalisations in Ireland during 2005-2016. STUDY DESIGN Population-based study was carried out from January 2005 to December 2016. A total of 12,098 women hospitalised due to ectopic pregnancy. All acute maternity hospital settings in the Republic of Ireland. Electronic health records were retrieved using the Hospital In-Patient Enquiry database. Rates ratios were calculated to estimate trends, risk of blood transfusion and risk of extended stay at the hospital. RESULTS The rate of hospitalisation for ectopic pregnancy increased over the 12-year study period from 12.8/1,000 deliveries in 2005 to 17.7/1,000 deliveries in 2016. Risk of blood transfusion reduced over time (aIRR 0.8; 95%CI 0.6-0.9). Women aged at least 40 years had double the risk of hospitalisation and double the risk of blood transfusion. Women undergoing open surgical procedures were more likely to need a blood transfusion than those undergoing laparoscopic salpingectomy. Similar results were found for length of stay over two days. Blood transfusion was rare for patients who underwent medical management (aIRR 0.1; 95%CI 0.05-0.2). CONCLUSION Advanced maternal age increased risk of hospitalisation for ectopic pregnancy. While the overall rate of hospitalisations increased over time, there was a reduction in the risk of blood transfusion and length of stay over two days. Type of management significantly affected the risk of blood transfusion and length of stay over two days at the hospital.
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Affiliation(s)
- Indra San San Lazaro Campillo
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
| | - Sarah Meaney
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland; The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre (NPEC), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland
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Xin H, Liu W, Li P. Diagnostic value of detection of serum β-HCG and CT-IgG combined with transvaginal ultrasonography in early tubal pregnancy. Exp Ther Med 2018; 16:277-281. [PMID: 29896250 PMCID: PMC5995067 DOI: 10.3892/etm.2018.6166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 04/23/2018] [Indexed: 11/06/2022] Open
Abstract
The diagnostic value of detection of serum β-human chorionic gonadotropin (β-HCG) and Chlamydia trachomatis immunoglobulin G (CT-IgG) combined with transvaginal ultrasonography in early tubal pregnancy was investigated. A total of 55 patients with early tubal pregnancy were selected as the tubal pregnancy group, while 55 subjects of normal intrauterine pregnancy were enrolled as the intrauterine pregnancy group. Transvaginal ultrasonography and quantitative detection of serum β-HCG and CT-IgG were performed for all patients, and the clinical examination results were analyzed and compared. The endometrial thickness and serum β-HCG level of patients with early tubal pregnancy were significantly lower than those of women with intrauterine pregnancy (6.7±1.5 vs. 11.6±1.2 mm; 776±109 vs. 5,598±187 U/l), and the differences were statistically significant (p<0.01); the serum CT-IgG antibody positive rate of patients in tubal pregnancy group (49.1%) was significantly higher than that in intrauterine pregnancy group (12.7%) (p<0.01); the serum CT-IgG antibody positive rates of patients with degree I, II and III of pelvic adhesion intubal pregnancy group were 28.6, 75.0 and 81.8%, respectively; the more severe the pelvic adhesion was, the higher the CT-IgG positive rate would be. The diagnostic coincidence rate of combined detection was significantly higher than that of single detection of serum β-HCG, progesterone and endometrial thickness. The detection of serum β-HCG and CT-IgG combined with transvaginal ultrasonography can diagnose the early tubal pregnancy soonest possible, and help choose the appropriate therapeutic methods depending on the situation to reduce the tubal damage of patients, so as to provide a reliable basis for the diagnosis, treatment and prognosis, and it has important clinical application value.
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Affiliation(s)
- Hongyan Xin
- Department of Ultrasonography, Linyi People's Hospital, Linyi, Shandong 276000, P.R. China
| | - Wenlian Liu
- Department of Obstetrics and Gynecology, Linyi People's Hospital, Linyi, Shandong 276000, P.R. China
| | - Ping Li
- Department of Obstetrics and Gynecology, Linyi People's Hospital, Linyi, Shandong 276000, P.R. China
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Mooij R, Mgalega GC, Mwampagatwa IH, van Dillen J, Stekelenburg J. A cohort of women with ectopic pregnancy: challenges in diagnosis and management in a rural hospital in a low-income country. BMC Pregnancy Childbirth 2018; 18:159. [PMID: 29751791 PMCID: PMC5948812 DOI: 10.1186/s12884-018-1777-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ectopic pregnancy (EP) is a serious complication of early pregnancy. In low-income countries diagnosis of EP is difficult and it is a major contributor to maternal mortality. We aimed to assess and improve the diagnostic process of women with EP. METHODS We conducted a retrospective medical records study of all women with confirmed EP in Ndala Hospital from 2010 to 2012. We used data on demographics, symptoms, diagnostic procedures, surgical findings, treatment and post-operative status. RESULTS Six thousand six hundred sixty-two women gave birth in the hospital, and 88 women were diagnosed with EP (incidence 1.3%). Thirty-nine percent of women did not report to be pregnant or to have a history of amenorrhea. On admission in Ndala hospital, a diagnosis of 'suspected EP' was made in less than half (47%) of the cases. Most women had a urine pregnancy test done (sensitivity of 98%). Peritoneal aspiration was done in 42%. The fifty-five women with EP who were diagnosed by ultrasound received a lower mean number of units of blood transfusion and had less often severe anaemia than women who were diagnosed by abdominal aspiration (abdominocentesis). The majority of women (65%) had surgery within 24 h after admission. CONCLUSIONS Diagnosing EP in a rural hospital in Tanzania is challenging. Often there is a large doctors' delay before the right diagnosis is made. Abdominal aspiration can be useful for rapid diagnosis. A pelvic ultrasound, when available, allows the diagnosis to be made earlier with less intra-abdominal bleeding.
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Affiliation(s)
- R Mooij
- Ndala Hospital, PO Box 15, Ndala, Tanzania. .,VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands.
| | | | - I H Mwampagatwa
- College of Health Sciences, University of Dodoma, PO Box 395, Dodoma, Tanzania
| | - J van Dillen
- Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - J Stekelenburg
- Leeuwarden Medical Centre, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.,University Medical Centre Groningen/University of Groningen, Antonius Deusinglaan 1, 9700 AD, Groningen, The Netherlands
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Brüggmann D, Kollascheck J, Quarcoo D, Bendels MH, Klingelhöfer D, Louwen F, Jaque JM, Groneberg DA. Ectopic pregnancy: exploration of its global research architecture using density-equalising mapping and socioeconomic benchmarks. BMJ Open 2017; 7:e018394. [PMID: 29025848 PMCID: PMC5652463 DOI: 10.1136/bmjopen-2017-018394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE About 2% of all pregnancies are complicated by the implantation of the zygote outside the uterine cavity and termed ectopic pregnancy. Whereas a multitude of guidelines exists and related research is constantly growing, no thorough assessment of the global research architecture has been performed yet. Hence, we aim to assess the associated scientific activities in relation to geographical and chronological developments, existing research networks and socioeconomic parameters. DESIGN Retrospective, descriptive study. SETTING On the basis of the NewQIS platform, scientometric methods were combined with novel visualising techniques such as density-equalising mapping to assess the scientific output on ectopic pregnancy. Using the Web of Science, we identified all related entries from 1900 to 2012. RESULTS 8040 publications were analysed. The USA and the UK were dominating the field in regard to overall research activity (2612 and 723 publications), overall citation numbers and country-specific H-Indices (US: 80, UK: 42). Comparison to economic power of the most productive countries demonstrated that Israel invested more resources in ectopic pregnancy-related research than other nations (853.41 ectopic pregnancy-specific publications per 1000 billlion US$ gross domestic product (GDP)), followed by the UK (269.97). Relation to the GDP per capita index revealed 49.3 ectopic pregnancy-specific publications per US$1000 GDP per capita for the USA in contrast to 17.31 for the UK. Semiqualitative indices such as country-specific citation rates ranked Switzerland first (24.7 citations per ectopic pregnancy-specific publication), followed by the Scandinavian countries Finland and Sweden. Low-income countries did not exhibit significant research activities. CONCLUSIONS This is the first in-depth analysis of global ectopic pregnancy research since 1900. It offers unique insights into the global scientific landscape. Besides the USA and the UK, Scandinavian countries and Switzerland can also be regarded as leading nations with regard to their relative socioeconomic input.
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Affiliation(s)
- Dörthe Brüggmann
- Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, California, USA
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
- Department of Gynecology and Obstetrics, Goethe-University, Frankfurt, Germany
| | - Jana Kollascheck
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - David Quarcoo
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - Michael H Bendels
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - Doris Klingelhöfer
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - Frank Louwen
- Department of Gynecology and Obstetrics, Goethe-University, Frankfurt, Germany
| | - Jenny M Jaque
- Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - David A Groneberg
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
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Insogna IG, Farland LV, Missmer SA, Ginsburg ES, Brady PC. Outpatient endometrial aspiration: an alternative to methotrexate for pregnancy of unknown location. Am J Obstet Gynecol 2017; 217:185.e1-185.e9. [PMID: 28433735 DOI: 10.1016/j.ajog.2017.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/03/2017] [Accepted: 04/11/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pregnancies of unknown location with abnormal beta-human chorionic gonadotropin trends are frequently treated as presumed ectopic pregnancies with methotrexate. Preliminary data suggest that outpatient endometrial aspiration may be an effective tool to diagnose pregnancy location, while also sparing women exposure to methotrexate. OBJECTIVE The purpose of this study was to evaluate the utility of an endometrial sampling protocol for the diagnosis of pregnancies of unknown location after in vitro fertilization. STUDY DESIGN A retrospective cohort study of 14,505 autologous fresh and frozen in vitro fertilization cycles from October 2007 to September 2015 was performed; 110 patients were diagnosed with pregnancy of unknown location, defined as a positive beta-human chorionic gonadotropin without ultrasound evidence of intrauterine or ectopic pregnancy and an abnormal beta-human chorionic gonadotropin trend (<53% rise or <15% fall in 2 days). These patients underwent outpatient endometrial sampling with Karman cannula aspiration. Patients with a beta-human chorionic gonadotropin decline ≥15% within 24 hours of sampling and/or villi detected on pathologic analysis were diagnosed with failing intrauterine pregnancy and had weekly beta-human chorionic gonadotropin measurements thereafter. Those patients with beta-human chorionic gonadotropin declines <15% and no villi identified were diagnosed with ectopic pregnancy and treated with intramuscular methotrexate (50 mg/m2) or laparoscopy. RESULTS Across 8 years of follow up, among women with pregnancy of unknown location, failed intrauterine pregnancy was diagnosed in 46 patients (42%), and ectopic pregnancy was diagnosed in 64 patients (58%). Clinical variables that included fresh or frozen embryo transfer, day of embryo transfer, serum beta-human chorionic gonadotropin at the time of sampling, endometrial thickness, and presence of an adnexal mass were not significantly different between patients with failed intrauterine pregnancy or ectopic pregnancy. In patients with failed intrauterine pregnancy, 100% demonstrated adequate postsampling beta-human chorionic gonadotropin declines; villi were identified in just 46% (n=21 patients). Patients with failed intrauterine pregnancy had significantly shorter time to resolution (negative serum beta-human chorionic gonadotropin) after sampling compared with patients with ectopic pregnancy (12.6 vs 26.3 days; P<.001). CONCLUSION With the use of this safe and effective protocol of endometrial aspiration with Karman cannula, a large proportion of women with pregnancy of unknown location are spared methotrexate, with a shorter time to pregnancy resolution than those who receive methotrexate.
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Role of day 4 HCG as an early predictor of success after methotrexate therapy for ectopic pregnancies. Eur J Obstet Gynecol Reprod Biol 2017; 215:230-233. [DOI: 10.1016/j.ejogrb.2017.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 06/09/2017] [Accepted: 06/11/2017] [Indexed: 11/23/2022]
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Scherer L, Zappolo K. Pregnancy Disasters in the First Trimester. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Disparities in the management of ectopic pregnancy. Am J Obstet Gynecol 2017; 217:49.e1-49.e10. [PMID: 28288792 DOI: 10.1016/j.ajog.2017.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/26/2017] [Accepted: 03/02/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ectopic pregnancy is common among young women. Treatment can consist of either surgery with salpingectomy or salpingostomy or medical management with methotrexate. In addition to acute complications, treatment of ectopic pregnancy can result in long-term sequelae that include decreased fertility. Little is known about the patterns of care and predictors of treatment in women with ectopic pregnancy. Similarly, data on outcomes for various treatments are limited. OBJECTIVE We examined the patterns of care and outcomes for women with ectopic pregnancy. Specifically, we examined predictors of medical (vs surgical) management of ectopic pregnancy and tubal conservation (salpingostomy vs salpingectomy) among women who underwent surgery. STUDY DESIGN The Perspective database was used to identify women with a diagnosis of tubal ectopic pregnancy treated from 2006-2015. Perspective is an all-payer database that collects data on patients at hospitals from throughout the United States. Women were classified as having undergone medical treatment, if they received methotrexate, and surgical treatment, if treatment consisted of salpingostomy or salpingectomy. Multivariable models were developed to examine predictors of medical treatment and of tubal conserving salpingostomy among women who were treated surgically. RESULTS Among the 62,588 women, 49,090 women (78.4%) were treated surgically, and 13,498 women (21.6%) received methotrexate. Use of methotrexate increased from 14.5% in 2006 to 27.3% by 2015 (P<.001). Among women who underwent surgery, salpingostomy decreased over time from 13.0% in 2006 to 6.0% in 2015 (P<.001). Treatment in more recent years, at a teaching hospital and at higher volume centers, were associated with the increased use of methotrexate (P<.05 for all). In contrast, Medicaid recipients (adjusted risk ratio, 0.92; 95% confidence interval, 0.87-0.98) and uninsured women (adjusted risk ratio, 0.87; 95% confidence interval, 0.82-0.93) were less likely to receive methotrexate than commercially insured patients. Among those who underwent surgery, black (adjusted risk ratio, 0.76; 95% confidence interval, 0.69-0.85) and Hispanic (adjusted risk ratio, 0.80; 95% confidence interval, 0.66-0.96) patients were less likely to undergo tubal conserving surgery than white women and Medicaid recipients (adjusted risk ratio, 0.69; 95% confidence interval, 0.64-0.75); uninsured women (adjusted risk ratio, 0.60; 95% confidence interval, 0.55-0.66) less frequently underwent salpingostomy than commercially insured patients. CONCLUSION There is substantial variation in the management of ectopic pregnancy. There are significant race- and insurance-related disparities associated with treatment.
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Farahani L, Sinha A, Lloyd J, Islam M, Ross JA. Negative histology with surgically treated tubal ectopic pregnancies - A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2017; 213:98-101. [PMID: 28441571 DOI: 10.1016/j.ejogrb.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 03/19/2017] [Accepted: 04/01/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the outcome of histological examinations of surgical specimens obtained from treatment of tubal ectopic pregnancy and to correlate with clinical findings, pre-operative ultrasound scans and the type of surgery. STUDY DESIGN A retrospective cohort study of 941 women diagnosed with a tubal ectopic pregnancy in the Early Pregnancy Unit and having surgical treatment at King's College Hospital, London. Clinical and ultrasound data had been entered contemporaneously on our electronic early pregnancy database and hospital clinical records over an 11year period from 2004 to 2014. Demographic data, clinical history, ultrasound scan parameters, type of surgical management and histological diagnosis were recorded. The primary outcome measure was the presence or absence of chorionic villi in the surgical specimen. Data were analysed using Mann Whitney U test for non-parametric data, relative risk for categorical data and binomial logistic regression. RESULTS A surgical specimen was obtained in 925 cases. Of these, 881/925 (95.2%) were positive for the presence of chorionic villi on histological examination. Patients with negative histology had a lower median gestational age, smaller ectopic pregnancies and lower serum human chorionic gonadotrophin levels. The relative risk of negative histology was significantly higher with a solid ectopic pregnancy on ultrasound (RR1.91, 95% CI 1.07-3.4) and with conservative surgery (RR 3.68, 95% CI 1.25-10.77). The relative risk was significantly lower with the presence of embryonic cardiac activity (RR 0.12, 95% CI 0.02-0.85). Only the serum hCG level was a significant predictor of negative histology on logistic regression analysis (p=0.048). In 39/44 women with negative histology, the human chorionic gonadotrophin level declined after surgery with no further intervention. Five of the 44 required a second surgical procedure as the ectopic pregnancy had been missed at the initial surgery and did not resolve. CONCLUSION There is lack of histological confirmation of sonographically diagnosed and surgically confirmed ectopic pregnancies in approximately 5% of cases, making this a relatively common finding following surgical treatment of tubal ectopic pregnancy. Clinicians should be aware of this when counselling women with tubal ectopic pregnancies about to undergo surgery, include this risk in the consent process and plan post-surgical follow up with this in mind.
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Affiliation(s)
- Linda Farahani
- Early Pregnancy Unit, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Anjita Sinha
- Early Pregnancy Unit, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Jilly Lloyd
- Early Pregnancy Unit, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Melissa Islam
- Early Pregnancy Unit, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Jackie A Ross
- Early Pregnancy Unit, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
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Cohen A, Almog B, Cohen Y, Bibi G, Rimon E, Levin I. The role of HCG increment in the 48 h prior to methotrexate treatment as a predictor for treatment success. Eur J Obstet Gynecol Reprod Biol 2017; 211:103-107. [DOI: 10.1016/j.ejogrb.2017.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
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Boykin T. Ipsilateral Recurrent Tubal Ectopic Pregnancy Following a Salpingectomy. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479316670712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sonographers are acquainted with the signs, symptoms, and findings of ectopic pregnancies as well as their recurrence; however, a recurrent ipsilateral ectopic pregnancy after a salpingectomy is also possible. While recurrent ipsilateral ectopic pregnancies are rare, they are a significant diagnostic discovery. It is important to highlight this rare manifestation and be aware of the potential for recurrent ipsilateral findings to avoid a misdiagnosis or prolonged treatment. The goal of this case study is to review a patient’s presentation and raise awareness of recurrent ipsilateral tubal ectopic pregnancy.
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Affiliation(s)
- Tabitha Boykin
- Diagnostic Medical Sonography Program, El Centro College, Dallas, TX, USA
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Cymbaluk-Płoska A, Chudecka-Głaz A, Kuźniak S, Menkiszak J. Ectopic pregnancy treatment by combination therapy. Open Med (Wars) 2016; 11:530-536. [PMID: 28352846 PMCID: PMC5329878 DOI: 10.1515/med-2016-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 11/18/2022] Open
Abstract
Detectability of early stages of ectopic pregnancies has increased due to improvements in ultrasonographic and biochemical techniques. Since the patients’ future procreative plans must be taken into consideration when commencing treatment, the goal of this work was to compare the effects of treatment methods and their impact on fertility. The study included 91 patients treated surgically for ectopic pregnancy. The choice of treatment depended on patients’ general condition, ultrasonographic evaluation and serum level of beta-hCG. A combination of laparoscopic and conservative systemic treatment was applied in 70% of cases. More rapid beta-hCG reduction was noted when laparoscopy and intra-oviductal injection of hyperosmolar glucose or methotrexate (MTX) were combined with intramuscular administration of MTX at a dose of 50 mg/m2. Follow-up examination of 66 patients revealed that the greatest number of spontaneous pregnancies (48%) resulted after this combination therapy. We conclude that this combination treatment is safe and provides satisfactory results in terms of future fertility.
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Affiliation(s)
- Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Anita Chudecka-Głaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - Sławomir Kuźniak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - Janusz Menkiszak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
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Youssef H, Emam M, Zayed A. Conservative management of 14weeks cervical ectopic pregnancy: Case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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31
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Qiao B, Zhang Z, Li Y. Uterine Artery Embolization Versus Methotrexate for Cesarean Scar Pregnancy in a Chinese Population: A Meta-analysis. J Minim Invasive Gynecol 2016; 23:1040-1048. [PMID: 27553186 DOI: 10.1016/j.jmig.2016.08.819] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 11/15/2022]
Abstract
This systematic review and meta-analysis was performed to compare the efficacy and safety of uterine artery embolization (UAE) followed by curettage and methotrexate (MTX) plus curettage in the treatment of cesarean scar pregnancy (CSP) in China. Studies published in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System), and China National Knowledge Information were systematically searched. The main outcome measures included the time for serum β-human chorionic gonadotropin (β-hCG) normalization, the duration of hospital stay, blood losses, and adverse events. Results were expressed as the weighted mean difference (WMD) or risk ratio with 95% confidence intervals (CIs). Results showed that 11 studies involving a total of 725 patients were included in this meta-analysis. Compared with MTX plus curettage, UAE followed by curettage had 16.76 days less time for β-hCG normalization (WMD = -16.76 days; 95% CI, -24.60 to -8.92; p < .001), and 15.05 days less of hospital stay (WMD = -15.05 days; 95% CI, -25.42 to -4.67; p = .004). CSP patients who underwent UAE had 343.24 mL less blood loss compared with those treated with MTX plus curettage (WMD = -343.24 mL; 95% CI, -432.95 to -253.54; p < .001). Moreover, UAE was associated with a lower incidence of adverse events than those treated with MTX plus curettage (relative risk = 0.46; 95% CI, 0.26-0.81; p = .008). In conclusion, UAE combined with curettage significantly shortened the time for β-hCG normalization and hospital stay and reduced blood losses and adverse events compared with the administration of MTX plus curettage. For patients with CSP, UAE followed by curettage appears to be more advantageous and may be a priority option. Further well-conducted, large-scale trials are needed to validate these findings.
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Affiliation(s)
- Baoli Qiao
- Department of Gynaecology and Obstetrics, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Zhenyu Zhang
- Department of Gynaecology and Obstetrics, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
| | - Yanfang Li
- Department of Gynaecology and Obstetrics, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
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Ohannessian A, Crochet P, Courbiere B, Gnisci A, Agostini A. Methotrexate treatment for ectopic pregnancy after assisted reproductive technology: A case-control study. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2016; 44:341-344. [PMID: 27216957 DOI: 10.1016/j.gyobfe.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/11/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Ectopic pregnancy (EP) occurs in 2% to 5.6% of pregnancies achieved by assisted reproductive technology (ART). EP treatment options include medical treatment by uses of methotrexate (MTX) systemic injection. The objective of this study was to compare MTX treatment effectiveness for EP occurring spontaneously or following ART. METHODS A case-control study performed in the department of obstetrics and gynecology at a tertiary health care center in France. Twenty EP achieved by ART (ART group) and 60 spontaneous EP (SEP group) received MTX treatment between January 2002 and May 2012. The main outcome measures were MTX treatment failure rates, number of MTX injections administered and recovery time. RESULTS MTX treatment failure rates observed in ART and SEP groups were similar (3/20 [15%] versus 10/60 [17%]: OR=0.88 [0.22-3.58]). Mean duration of recovery time in patients with successful MTX treatment did not differ between ART and SEP groups (33±14 days versus 28±13 days, P=0.39). A second MTX injection was required more frequently in ART group than in SEP group (10/20 [50%] versus 10/60 [17%]: OR=5 [1.65-15.15]). CONCLUSIONS It is concluded that MTX treatment is equally effective for spontaneous EP and EP achieved by ART, two injections of MTX being more frequently required in case of ART.
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Affiliation(s)
- A Ohannessian
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - P Crochet
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - B Courbiere
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - A Gnisci
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France.
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Hamza A, Meyberg-Solomayer G, Juhasz-Böss I, Joukhadar R, Takacs Z, Solomayer EF, Baum S, Radosa J, Mavrova L, Herr D. Diagnostic Methods of Ectopic Pregnancy and Early Pregnancy Loss: a Review of the Literature. Geburtshilfe Frauenheilkd 2016; 76:377-382. [PMID: 27134292 DOI: 10.1055/s-0041-110204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This review article presents recent evidence on early pregnancy loss and ectopic pregnancy. In the light of recent evidence, the β-hCG discriminatory zone may be extended in clinically stable cases without evidence of bleeding. A possible cut-off is 4300 mIU/ml, which corresponds to when a sonographer should detect an intrauterine pregnancy. Embryonic demise can be confirmed when a transvaginal ultrasound finding shows no heartbeat in an embryo of more than 7 mm CRL, no embryo in a gestational sac having a mean sac diameter of more than 25 mm, or no appearance of an embryo within 7-10 days after the primary examination. These are considered definitive signs of embryonic demise. Suggestive signs of embryonic demise require closer monitoring of the pregnancy.
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Affiliation(s)
- A Hamza
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, Homburg
| | - G Meyberg-Solomayer
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, Homburg
| | - I Juhasz-Böss
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, Homburg
| | - R Joukhadar
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, Homburg
| | - Z Takacs
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, Homburg
| | - E-F Solomayer
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, Homburg
| | - S Baum
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, Homburg
| | - J Radosa
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, Homburg
| | - L Mavrova
- Department of Obstetrics and Gynaecology, Homburg University Medical Centre, Homburg
| | - D Herr
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg
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Uterine artery embolization combined with curettage vs. methotrexate plus curettage for cesarean scar pregnancy. Arch Gynecol Obstet 2015; 294:71-6. [DOI: 10.1007/s00404-015-3952-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022]
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Flores AH, Kassamali S, Won GY, Stein JC, Reynolds T. Frequency of utilisation of ultrasound in the diagnosis of ectopic pregnancy in Sub-Saharan Africa countries: A systematic review. Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Li CL, Chen DJ, Song LP, Wang Y, Zhang ZF, Liu MX, Chen WL. Effectiveness and Safety of Lower Doses of Mifepristone Combined With Misoprostol for the Termination of Ultra-Early Pregnancy: A Dose-Ranging Randomized Controlled Trial. Reprod Sci 2014; 22:706-11. [PMID: 25394644 DOI: 10.1177/1933719114557897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate the effectiveness and safety of lower doses of mifepristone combined with misoprostol for the termination of ultra-early pregnancy. A total of 2500 women with ultra-early pregnancy (amenorrhea ≤ 35 days) were randomly divided into 5 groups with gradually decreased dose of oral mifepristone from 150 to 50 mg followed by 200 µg of oral misoprostol 24 hours later. The primary end point was complete abortion without surgical intervention. Secondary end points were vaginal bleeding, return of menses, and side effects. Rates of complete abortion were high in all groups. Moreover, the lower doses of mifepristone led to shorter vaginal bleeding period, the return of menses on the expected date, and fewer side effects. Lower doses of mifepristone combined with 200 µg of misoprostol are as effective and safe as higher doses of this combination for the termination of ultra-early pregnancy with lower possibility of vaginal bleeding and side effects.
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Affiliation(s)
- Cui-Lan Li
- The Third Affiliated Hospital of Guangzhou Medical University & Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
| | - Dun-Jin Chen
- The Third Affiliated Hospital of Guangzhou Medical University & Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
| | - Li-Ping Song
- The Third Affiliated Hospital of Guangzhou Medical University & Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
| | - Yan Wang
- The Third Affiliated Hospital of Guangzhou Medical University & Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
| | - Zhong-Fang Zhang
- The Third Affiliated Hospital of Guangzhou Medical University & Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
| | - Ming-Xing Liu
- The Third Affiliated Hospital of Guangzhou Medical University & Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
| | - Wei-Ling Chen
- The Third Affiliated Hospital of Guangzhou Medical University & Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
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Krissi H, Hiersch L, Stolovitch N, Nitke S, Wiznitzer A, Peled Y. Outcome, complications and future fertility in women treated with uterine artery embolization and methotrexate for non-tubal ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 2014; 182:172-6. [DOI: 10.1016/j.ejogrb.2014.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/03/2014] [Accepted: 09/09/2014] [Indexed: 02/08/2023]
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Hiersch L, Krissi H, Ashwal E, From A, Wiznitzer A, Peled Y. Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Aust N Z J Obstet Gynaecol 2014; 54:576-80. [DOI: 10.1111/ajo.12251] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/23/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Liran Hiersch
- The Helen Schneider Hospital for Women; Rabin Medical Center; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Haim Krissi
- The Helen Schneider Hospital for Women; Rabin Medical Center; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eran Ashwal
- The Helen Schneider Hospital for Women; Rabin Medical Center; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Anat From
- The Helen Schneider Hospital for Women; Rabin Medical Center; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Arnon Wiznitzer
- The Helen Schneider Hospital for Women; Rabin Medical Center; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yoav Peled
- The Helen Schneider Hospital for Women; Rabin Medical Center; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Ebner F, Varga D, Sorg F, Vorwerk E, Schochter F, Janni W, Wöckel A, DeGregorio N. Treatment cost evaluation of extrauterine gravidity: a literature review of medical and surgical treatment costs. Arch Gynecol Obstet 2014; 291:493-8. [PMID: 25260987 DOI: 10.1007/s00404-014-3488-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The diagnosis of extrauterine pregnancy is possible very early giving the patient and doctors treatment options. As the risks and success rate of medical and surgical treatment are similar, the decision is increasingly influenced by cost-effectiveness. OBJECTIVE The following article systematically reviews the known literature regarding cost, decision criteria and possible follow-up. METHODS Literature review of extrauterine gravity in combination with cost in the online National Library of Medicine since 1.1.1997 following the PRISMA recommendations. RESULTS Six articles were identified in which the cost of the laparoscopic versus medical treatment is reviewed. In five articles, the medical treatment was shown to be more cost effective and in the sixth article the costs were found to be equal. The cost saving varies between 18 and 88% depending on the consideration of direct and indirect costs. If indirect expenses are considered, the total sum increases with treatment failures. Failure rates are given as up to 27% depending on the type of failure (surgical or medical). These rates seem to be linked indirectly with the β-HCG levels. Predictive parameters for the successful medical treatment are missing. CONCLUSIONS The treatment of small extrauterine gravidities in haemodynamically stable patients (defined by HCG levels <1,500 IU/l) is medically successful and cost-effective. With HCG levels between 1,500 IU/l and 3,000 IU/l, the treatment costs are similar. HCG levels >5,000 IU/l favour the surgical treatment as being more cost-effective. A similar cut-off for the sonographic imaging is missing.
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Affiliation(s)
- Florian Ebner
- Universitätsfrauenklinik Ulm, Prittwitzstr. 43, 89075, Ulm, Germany,
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Pedroso C, Lermann R, Amaral N, Condeço P. Interstitial pregnancy rupture at 15 weeks of pregnancy. BMJ Case Rep 2014; 2014:bcr-2014-203979. [PMID: 25155486 DOI: 10.1136/bcr-2014-203979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ectopic pregnancy occurs when the developing blastocyst becomes implanted outside the uterine cavity. Interstitial pregnancy is a rare type, representing 2-3%, of all ectopic pregnancies. It is located outside the uterine cavity in the segment of the fallopian tube that penetrates the muscular layer of the uterus. Therefore, it is a difficult and challenging diagnosis. We report a case of a 19-year-old girl who was admitted to our emergency department because of a ruptured interstitial pregnancy at 15 weeks of gestation.
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Affiliation(s)
- Célia Pedroso
- Resident of Obstetrics and Gynecology of Alfredo da Costa Maternity, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Rita Lermann
- Medical Doctor of Obstetrics and Gynecology, Emergency Department of Beatriz Ângelo Hospital, Loures, Portugal
| | - Njila Amaral
- Medical Doctor of Obstetrics and Gynecology, Emergency Department of Beatriz Ângelo Hospital, Loures, Portugal
| | - Pedro Condeço
- Medical Doctor of Obstetrics and Gynecology, Emergency Department of Beatriz Ângelo Hospital, Loures, Portugal
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Ohannessian A, Loundou A, Courbiere B, Cravello L, Agostini A. Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod 2014; 29:1949-56. [DOI: 10.1093/humrep/deu174] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Nanotechnology in reproductive medicine: Emerging applications of nanomaterials. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2014; 10:921-38. [DOI: 10.1016/j.nano.2014.01.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/09/2013] [Accepted: 01/09/2014] [Indexed: 12/21/2022]
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Abstract
Acute abdominal pain represents the cardinal symptom of a large number of intra-abdominal pathologies. Because of multiple organ systems, varied pathology from life threatening to benign, and differences in presentation related to sex and age, identifying a final diagnosis is a challenge. The clinician’s goal for patients with acute abdominal pain is to rapidly identify whether the underlying cause requires an urgent or immediate surgical intervention. By developing a systematic approach to evaluating patients with abdominal pain, clinicians can generate a differential diagnosis to ensure appropriate treatment and improved patient outcomes. The purpose of this article is to provide clinicians with a framework for evaluating the complaint of acute abdominal pain and recognizing patients who require expedited evaluation.
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Affiliation(s)
- Helen F. Brown
- Helen F. Brown is Acute Care Nurse Practitioner, Emergency Department, Anne Arundel Medical Center, Annapolis, MD 21401 . Lynn Kelso is Assistant Professor, Department of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Nursing, Lexington
| | - Lynn Kelso
- Helen F. Brown is Acute Care Nurse Practitioner, Emergency Department, Anne Arundel Medical Center, Annapolis, MD 21401 . Lynn Kelso is Assistant Professor, Department of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Nursing, Lexington
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Orozco EM, Sánchez-Durán MA, Bello-Muñoz JC, Sagalá J, Carreras E, Roura LC. ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study. J Matern Fetal Neonatal Med 2014; 28:695-9. [PMID: 24871360 DOI: 10.3109/14767058.2014.928857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of different beta-human chorionic gonadotrophin (ß-hCG) levels measurement, for predicting success of medical treatment in cases diagnosed as tubal ectopic pregnancy (TEP). DESIGN Five-year prospective observational study. SETTING Prenatal Diagnosis Unit, Vall d'Hebron University Hospital - Barcelona. PATIENTS TEP cases fulfilling criteria for medical treatment with Methotrexate. INTERVENTIONS ß-hCG levels were measured on d 0, 4 and 7 of treatment. Results were compared by non-parametrical tests. A ROC curve was plotted to define cut-off points. Diagnostic accuracy of the different measurements was evaluated. MAIN OUTCOME MEASURE Failure of treatment defined as need for surgical treatment or persistence of high ß-HCG levels despite treatment. RESULTS 126 women were diagnosed as TEP, eligible for medical treatment. There were no differences in parity, age, previous TEP, or adnexal mass size. Success rate was 88%. ß-HCG decreased significantly more, between days 0-7 and 4-7, in the successful cases. LR for success prediction was 6.2 and 7.8 for ß-HCG levels at days 4 and 7 respectively, 4.02 and 2.47 for decrement between days 0-7 (25%) and 4-7 (20%), respectively. CONCLUSION ß-hCG cutoff values have a potential for predicting a successful medical treatment of TEP.
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Awareness about a life-threatening condition: ectopic pregnancy in a network for surveillance of severe maternal morbidity in Brazil. BIOMED RESEARCH INTERNATIONAL 2014; 2014:965724. [PMID: 24772441 PMCID: PMC3977561 DOI: 10.1155/2014/965724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/11/2014] [Indexed: 11/26/2022]
Abstract
Objective. To assess occurrence of severe maternal complications associated with ectopic pregnancy (EP). Method. A multicenter cross-sectional study was conducted, with prospective surveillance of potentially life-threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD). EP complications, patient sociodemographic/obstetric characteristics, and conditions of severity management were assessed, estimating prevalence ratios with respective 95% CI. Factors independently associated with greater severity were identified using multiple regression analysis. Results. Of the 9.555 severe maternal morbidity patients, 312 women (3.3%) had complications after EP: 286 (91.7%) PLTC, 25 (8.0%) MNM, and 1 (0.3%) MD. Severe maternal outcome ratio (SMOR) was 0.3/1000 LB among EP cases and 10.8/1000 LB among other causes. Complicated EP patients faced a higher risk of blood transfusion, laparotomy, and lower risk of ICU admission and prolonged hospitalization than women developing complications resulting from other causes. Substandard care was the most common in more severe maternal morbidity and EP cases (22.7% MNM and MD versus 15% PLTC), although not significant. Conclusion. Increased maternal morbidity due to EP raised awareness about the condition and its impact on female reproductive life. No important risk factors for greater severity were identified. Care providers should develop specific guidelines and interventions to prevent severe maternal morbidity.
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Human chorionic gonadotropin discriminatory zone in ectopic pregnancy: does assay harmonization matter? Fertil Steril 2014; 101:1671-4. [PMID: 24666754 DOI: 10.1016/j.fertnstert.2014.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/19/2014] [Accepted: 02/11/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the effect that lack of hCG assay harmonization has on the interpretation of a serum hCG concentration with regards to the hCG discriminatory zone. DESIGN A multisite method comparison study. SETTING Clinical laboratories. PATIENT(S) Eighty serum samples containing various concentrations of hCG. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Concentrations of hCG obtained from seven hCG reagent platforms. RESULT(S) The hCG concentrations were significantly different across hCG reagent platforms. Seventy-one percent of assay pairs showed significant differences with samples selected based on hCG concentrations between 1,500 and 3,500 IU/L as determined by a comparative method. Relative to the comparative method, the calculated hCG discriminatory zones for five assays were within 9%, and one assay was within 40% of the target concentrations of 1,500 and 3,500 IU/L. CONCLUSION(S) Despite significant differences in hCG concentrations across hCG immunoassays, an hCG concentration within a discriminatory zone of 1,500-3,500 IU/L can be used for all but one commonly used hCG reagent platform.
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Capmas P, Bouyer J, Fernandez H. Treatment of ectopic pregnancies in 2014: new answers to some old questions. Fertil Steril 2014; 101:615-20. [DOI: 10.1016/j.fertnstert.2014.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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Maiorana A, Incandela D, Giambanco L, Alio W, Alio L. Omental pregnancy: case report and review of literature. Pan Afr Med J 2014; 19:244. [PMID: 25852787 PMCID: PMC4382054 DOI: 10.11604/pamj.2014.19.244.3661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/07/2014] [Indexed: 11/11/2022] Open
Abstract
Pregnancy, the implantation of a fertilized ovum outside the endometrial cavity, occurs in 1.5%-2% of pregnancies. It is one of the major causes (about 6%) of maternal death during the first trimester of pregnancy. The remaining 5% implant in the ovary, peritoneal cavity, within the cervix, and the omental pregnancy is the least common form of abdominal pregnancies. A review of the literature on Medline for the period 1958-2012 reported only 16 cases of omental pregnancy. Here we report a case of primary omental pregnancy in a nulliparous woman. A 24 year-old woman gravid 1, para 0, with lower abdominal pain. Her last menstrual period occurred 8 weeks before the visit. The physical examination revealed abdominal tenderness in the lower quadrants, she was not bleeding. Transvaginal ultrasound showed: a free anechoic/hypoechoic area of 30 x 57 mm in the pouch of Douglas and the endometrium was homogeneus with a thickness of 12 mm and no evidence of gestational sac in the uterine cavity. Laboratory data revealed a normal cell blood count and beta hcg levels of 8047 IU / L. Because of continuing abdominal pain and a diagnosis of ectopic pregnancy a diagnostic laparoscopy was performed, which showed hemoperitoneum. Further inspection of abdominal cavity revealed a bloody lesion that was tenaciously adherent to the omentum, using non traumatic laparoscopic forceps and bipolar scissors we carefully removed a friable mass of about 30 mm from the omental attachments. Histological examination showed the presence of blood clot material mixed with trophoblastic tissue. Ultrasound evaluation and and hCG assessment are important to determine the extrauterine location of the ectopic pregnancy but the early diagnosis of abdominal pregnancy requires also a laparoscopic evaluation and, as our case has highlighted, thorough abdominal exploration especially in the absence of adnexal findings when ectopic pregnancy is highly suspected. Early diagnosis of omental pregnancy is difficult but essential to reduce the high mortality risk for the mother.
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Affiliation(s)
- Antonio Maiorana
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Domenico Incandela
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Laura Giambanco
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Walter Alio
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Luigi Alio
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
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Zee J, Sammel MD, Chung K, Takacs P, Bourne T, Barnhart KT. Ectopic pregnancy prediction in women with a pregnancy of unknown location: data beyond 48 h are necessary. Hum Reprod 2013; 29:441-7. [PMID: 24352889 DOI: 10.1093/humrep/det450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Are there improvements in the accuracy of prediction of ectopic pregnancy (EP) in women with early symptomatic pregnancy using human chorionic gonadotrophin (hCG) curves when clinicians consider visits beyond the first 48 h after initial presentation? SUMMARY ANSWER Two hCG values, measured 48 h (2 days) apart, are often not sufficient to accurately predict the outcome of a woman with a pregnancy of unknown location (PUL), but adding a third visit on Day 4 or 7 significantly improved the prediction for 1 in 15 women. WHAT IS KNOWN ALREADY The use of serial hCG values is commonly used to aid in the prediction of the final diagnosis in women with a PUL. Initial outcome predictions based on two hCG values may often be incorrect. STUDY DESIGN, SIZE, DURATION This retrospective multicenter cohort study included 646 women with a PUL, recruited over 2 years. Of these women, 146 were ultimately diagnosed with EP. PARTICIPANTS/MATERIALS, SETTING, METHODS Women presenting to the emergency room with first trimester pain or bleeding, with a PUL, at least 2 hCG values and a definitive final diagnosis from the University of Pennsylvania, University of Miami and University of Southern California, were recruited from 2007 to 2009. MAIN RESULTS AND THE ROLE OF CHANCE Using currently recommended prediction rules, adding a third hCG evaluation on Day 4 after initial presentation significantly improved the accuracy of initial prediction from the first two values (48 h apart, or Day 2) by 9.3% (P = 0.015). Adding a third value on Day 7 improved prediction significantly by 6.7% (P = 0.031), compared with prediction based on first two values. The improvement in prediction by assessing four hCG values (Days 0, 2, 4 and 7) compared with three values (Days 0, 2 and 4) was 1.3% and not statistically significant. LIMITATIONS, REASONS FOR CAUTION Missing data imputation likely biased results toward the null; predicted outcomes may not match those made by clinicians; and the study does not predict intrauterine pregnancy and spontaneous miscarriage separately. WIDER IMPLICATIONS OF THE FINDINGS This study provides useful information for the prediction of outcomes for women with a symptomatic first trimester pregnancy of unknown location, but may not be generalizable to all pregnant women. STUDY FUNDING/COMPETING INTEREST(S) Supported by NIH grant numbers R01-HD036455 to Dr Barnhart and Dr Sammel, K24HD060687 to Dr Barnhart, and 5T32MH065218 to Ms. Zee. The authors have no conflicts of interest to declare.
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Affiliation(s)
- J Zee
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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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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