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Flanagan HC, Duncan WC, Lin CJ, Spears N, Horne AW. Recent advances in the understanding of tubal ectopic pregnancy. Fac Rev 2023; 12:26. [PMID: 37920274 PMCID: PMC10619208 DOI: 10.12703/r/12-26] [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] [Indexed: 11/04/2023] Open
Abstract
Ectopic pregnancy (EP) is described as the implantation of an embryo outside the normal uterine cavity. It most commonly occurs in the fallopian tube, hence termed a tubal ectopic pregnancy (tEP). It is a gynaecological emergency and remains the leading cause of direct maternal mortality related to the first trimester of pregnancy worldwide. This article explores the emergence of additional risk factors for tEP, showing new evidence for identifying patient risk factors and highlighting potential areas of research. Additionally, we discuss the up-to-date patient-centred approach for the diagnosis, management and counselling of patients with tEP and ongoing clinical trials for the improvement of medical management.
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Affiliation(s)
- Heather C Flanagan
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
- Biomedical Sciences, University of Edinburgh, Edinburgh, Scotland
| | - W Colin Duncan
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
| | - Chih-Jen Lin
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
| | - Norah Spears
- Biomedical Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
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Abdelmonem AH, Sayed G, Abugazia AE, Kohla S, Youssef R. Heterotopic pregnancy after a spontaneous conception a case report with a review of clinical, laboratory and imaging findings. Clin Case Rep 2021; 9:e04649. [PMID: 34430013 PMCID: PMC8365543 DOI: 10.1002/ccr3.4649] [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: 02/26/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Heterotopic pregnancy (HP) describes the simultaneous presence of two pregnancies at different implantation sites. Usually, one pregnancy is intrauterine and the other one is ectopic. The incidence of HP after assisted reproductive technologies reaches 1:3900, but is very rare after a spontaneous pregnancy, with a reported incidence of 1 to 30,000 pregnancies. Due to its rarity, complex clinical picture, and laboratory findings, it is challenging to diagnose HP. We present a case of spontaneous HP diagnosed in the first trimester by ultrasound (US) and magnetic resonance imaging (MRI) and subsequently managed successfully. We present an analysis of the clinical and laboratory findings as well as imaging, including MRI that we used to diagnose the condition. Additionally, we performed a literature review. CONCLUSIONS HP is a very rare condition frequently faced in obstetrics, gynecology, and emergency departments that requires a high index of clinical suspicion. US remains the imaging modality of choice in diagnosing a HP, however, in some cases, an MRI with a reported safety in the first trimester, can be used to provide additional information over US.
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Affiliation(s)
- Ahmed H. Abdelmonem
- Department of RadiologyHamad General HospitalDohaQatar
- Weill Cornell Medicine QatarDohaQatar
| | - Gamal Sayed
- Weill Cornell Medicine QatarDohaQatar
- Department of Obstetrics & GynecologyWomen’s Wellness and Research CenterDohaQatar
- Clinical DepartmentCollege of MedicineQU HealthQatar UniversityDohaQatar
- University of DundeeDundeeUK
| | | | - Samah Kohla
- Weill Cornell Medicine QatarDohaQatar
- Department of Laboratory Medicine and PathologyHematology DivisionHamad Medical CorporationDohaQatar
| | - Reda Youssef
- Weill Cornell Medicine QatarDohaQatar
- Department of RadiologyWomen’s Wellness and Research CenterDohaQatar
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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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Tabandeh A, Besharat M. Fever after Cervical Ectopic Pregnancy; a case report from Gorgan, Iran. Electron Physician 2014; 6:944-6. [PMID: 25763173 PMCID: PMC4324262 DOI: 10.14661/2014.944-946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/20/2014] [Accepted: 11/01/2014] [Indexed: 11/29/2022] Open
Abstract
Ectopic pregnancy is a rare condition, and, although its prevalence has decreased in recent years, it is still an important cause of mortality and morbidity in women. Cervical ectopic pregnancy is less than 1% of all ectopic pregnancies. Fever is one of signs of infection, and it is necessary to monitor patients closely for other signs of infection. This paper presents and discusses a case of cervical ectopic pregnancy with fever after treatment. The patient had a high fever that became worse after three hospitalizations. The probable cause of her pyelonephritis was a urinary catheter, although it had been removed earlier, and she was receiving antibiotic therapy. Even though cervical ectopic pregnancy is a rare condition, it has certain complications that must be managed appropriately.
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Affiliation(s)
- Afsaneh Tabandeh
- Assistant Professor, Gynecologist, Golestan University of Medical Sciences, Infertility Research Center, Gorgan, Iran
| | - Mahsa Besharat
- M.D., Golestan University of Medical Sciences, Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Gorgan, Iran
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