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Tran NBT, Cao TN, Nguyen QHV, Truong LGT, Tran LM, Tran Nguyen TN, Le TM. Serum CA-125 as a predictor in the early diagnosis of ectopic pregnancy in Vietnam - A case-control study. Placenta 2023; 140:84-89. [PMID: 37549441 DOI: 10.1016/j.placenta.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION This study aimed to determine the predictive value of cancer antigen-125 (CA-125) in combination with serum beta-human chorionic gonadotropin (β-hCG) and progesterone in the early detection of ectopic pregnancy (EP). METHODS Between May 2019 and May 2020, the cross-sectional study recruited 42 cases of EP and 42 cases of IUP at the same gestational age who visited the Department of Obstetrics and Gynecology, Hospital of Hue University of Medicine and Pharmacy. EP was diagnosed based on surgical (laparoscopy) and postoperative pathology examination. RESULTS There were significant differences of mean level of β-hCG (2570 mUI/mL vs. 18357.7 mUI/mL), progesterone (10.79 ± 8.16 ng/ml vs. 27.42 ± 4.17 ng/ml) and CA-125 (26.90 ± 10.26 U/mL vs. 70.61 ± 20.89 U/mL) between the EP and the IUP groups (p < 0.001). In the prediction of early diagnosis of EP, the cut-off value of CA-125 at 30.94 U/mL has a sensitivity of 89.3% and a specificity of 87,9%; the cut-off value of β hCG at 2750mIU/ml has the sensitivity of 75%, specificity of 78,8%; the cut-off value of progesterone at 10.24 ng/mL has the sensitivity of 85.7%, specificity of 81.8%. A combination of CA-125, β hCG, and progesterone had a sensitivity of 92.8% and a specificity of 90.9% in early diagnosis of EP. DISCUSSION Serum CA-125 levels can be used independently or in combination with other markers in the early diagnosis of EP.
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Affiliation(s)
- Ngoc Bich Thi Tran
- Department of Obstetrics & Gynaecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, 49120, Hue, Viet Nam
| | - Thanh Ngoc Cao
- Department of Obstetrics & Gynaecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, 49120, Hue, Viet Nam; Center for Reproductive Endocrinology and Infertility (HueCREI), Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, 49120, Hue, Viet Nam
| | - Quoc Huy Vu Nguyen
- Department of Obstetrics & Gynaecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, 49120, Hue, Viet Nam
| | - Linh Giang Thi Truong
- Department of Obstetrics & Gynaecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, 49120, Hue, Viet Nam
| | - Linh Manh Tran
- Department of Obstetrics & Gynaecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, 49120, Hue, Viet Nam
| | - Thao Nguyen Tran Nguyen
- Department of Obstetrics & Gynaecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, 49120, Hue, Viet Nam
| | - Tam Minh Le
- Department of Obstetrics & Gynaecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, 49120, Hue, Viet Nam; Center for Reproductive Endocrinology and Infertility (HueCREI), Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, 49120, Hue, Viet Nam.
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Identification of noninvasive diagnostic biomarkers for ectopic pregnancy using data-independent acquisition (DIA)proteomics: a pilot study. Sci Rep 2022; 12:19992. [PMID: 36411308 PMCID: PMC9678856 DOI: 10.1038/s41598-022-23374-8] [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: 04/23/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022] Open
Abstract
At present, the diagnosis of ectopic pregnancy mainly depends on transvaginal ultrasound and β-hCG. However, these methods may delay diagnosis and treatment time. Therefore, we aimed to screen for serological molecular markers for the early diagnosis of ectopic pregnancy (EP).Using data-independent acquisition (DIA)proteomics, the differential proteins in serum were selected between the intrauterine pregnancy (IP) and EP groups. Then, the expression levels of these differential proteins were measured by enzyme-linked immunosorbent assay. The diagnostic value of the serum biomarkers was evaluated by receiver operating characteristic curve analysis.GSTO1, ECM-1 and β-hCG showed significant differences between the EP and IP groups (P < 0.05). The combination of GSTO1/ECM-1/β-hCG had an area under the curve of 0.93 (95% CI 0.88-0.99), a sensitivity of 88.89% (95% CI 73.94-96.89) and a specificity of 86.11% (95% CI 70.50-95.33) with a likelihood ratio of 6.40.The combination of GSTO1/ECM-1/β-hCG may be developed into a possible approach for the early diagnosis of EP.
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Dogan K, Helvacioglu C, Baghaki S, Kural A, Dogan M. Ischemia-Modified Albumin (IMA) levels in ectopic pregnancy and early pregnancy loss. Niger J Clin Pract 2022; 25:975-978. [DOI: 10.4103/njcp.njcp_1464_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Andola S, Kumar R R, Desai RM, S A K. Study of Risk factors and treatment modalities of ectopic pregnancy. J Family Med Prim Care 2021; 10:724-729. [PMID: 34041068 PMCID: PMC8138340 DOI: 10.4103/jfmpc.jfmpc_1279_20] [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: 06/27/2020] [Revised: 09/13/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction: In the past two decades globally, the incidence of ectopic pregnancy has been increasing exponentially. One of the major triggering factors being the introduction of medical assisted procreation techniques. The present study emphasis more on clinical presentations, risk factors, associated maternal morbidity and mortality with respect to ectopic pregnancy. Methodology: Patients diagnosed with ectopic pregnancy in reproductive age group (15-44 years) after clinical examination and investigations during one year period were included in the study. It was a prospective study using contingency table analysis and Chi-square test. Results: A total of 42 patients were diagnosed and treated as ectopic pregnancy during the study period. Risk factors were found in 37 patients, of which most common were white discharge per vagina (WDPV) in 20 and tubectomy in 6 patients. PID was seen in 5 and no risk factors in 5 patients. Of the 42 patients, 37 underwent surgery as primary modality of treatment and 5 patients underwent medical management. Only 2 patients had complete resolution with medical management while 3 failed medical management. Post operative period was uneventful. Conclusion: As the incidence of ectopic pregnancy has been on the rise, screening of high risk cases, early diagnosis and early intervention are required to enhance maternal survival and conservation of reproductive capacity.
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Affiliation(s)
- Shruthi Andola
- Department of Obstetrics and Gynecology, KLE's Dr Prabhahkar Kore Hospital and J.N. Medical College, Belagavi, Karnataka, India
| | - Ramesh Kumar R
- Department of Obstetrics and Gynecology, S.D.M. College of Medical Sciences and Hospital Sattur, Dharwad, Karnataka, India
| | - Ratnamala M Desai
- Department of Obstetrics and Gynecology, S.D.M. College of Medical Sciences and Hospital Sattur, Dharwad, Karnataka, India
| | - Krutika S A
- Department of Obstetrics and Gynecology, M.R. Medical College and BTGH, Kalaburagi, Karnataka, India
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Li H, Liu Y, Wen S, Jia H, Du Y. Evaluation of serum biomarkers and efficacy of MTX in women with ectopic pregnancy. Mol Med Rep 2019; 20:2902-2908. [PMID: 31524242 DOI: 10.3892/mmr.2019.10533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/10/2019] [Indexed: 11/05/2022] Open
Abstract
Ectopic pregnancy occurs when a fertilized ovum attaches outside the uterus. As a complication in approximately 1‑2% of all pregnancies, ectopic pregnancies may cause catastrophic hemorrhage as a result of invading maternal blood vessels. Therefore, early diagnosis and timely treatment are crucial for women with ectopic pregnancy. In this study, we aimed to identify and determine the efficacy of serum biomarkers for the prompt diagnosis of ectopic pregnancy. For this purpose, the serum concentrations of progesterone, β human chorionic gonadotropin (β‑hCG) and cancer antigen‑125 (CA125) were detected by solid‑phase, competitive binding chemiluminescent enzyme immunoassays. Flow cytometry was used to analyze the percentage of CD3+ T cells in women with ectopic pregnancy. Pathological analysis of tubal and villus tissues was performed by hematoxylin and eosin (H&E) staining. After receiving an injection of methotrexate (MTX), patients were examined by transvaginal ultrasound to detect the size of the echogenic mass. The results revealed that the serum levels of progesterone, β‑HCG and CA125 were significantly decreased in women with ectopic pregnancy, whereas the percentage of CD3+ T cells was increased in women with ectopic pregnancy. Histopathological examination revealed blood clots with small tissue fragments of a tubal‑type epithelium and incomplete pile structures. Five days after the MTX injection, an echogenic mass was found with a size of 1.7x1.2x1.6 cm that contained a gestational sac‑like structure and a yolk sac. On the whole, the findings of this study indicate the at the joint detection of progesterone, β‑HCG, CA125 serum levels and the CD3+ T cell percentage could be applied as a reliable indicator for the early diagnosis of ectopic pregnancy. MTX administration was determined to be an efficacious approach for the treatment of ectopic pregnancy.
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Affiliation(s)
- Haiyan Li
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Ying Liu
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Shubin Wen
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Hanbing Jia
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Yuanjie Du
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
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Bozkaya G, Karaca I, Fenercioglu O, Yildirim Karaca S, Bilgili S, Uzuncan N. Evaluation of maternal serum ischemia modified albumin and total antioxidant status in ectopic pregnancy. J Matern Fetal Neonatal Med 2018; 32:2003-2008. [PMID: 29284337 DOI: 10.1080/14767058.2017.1422718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ectopic pregnancies constitute about 2% of all pregnancies which are the leading cause of pregnancy-related deaths and a considerable cause of maternal morbidity. Oxidative stress can lead to a number of pregnancy related diseases including miscarriage, eclampsia and preterm labor. Ischemia modified albumin (IMA) which reflects the oxidative stress may be used as a marker for ectopic pregnancy. Our aim was to compare the levels of IMA and total antioxidant status (TAS) in ectopic and normal pregnancies and to understand if IMA can be used as a marker to diagnose ectopic pregnancy. MATERIALS AND METHODS Our case-control study consisted of 38 women with ectopic and 42 women with normal pregnancy. IMA and TAS levels were determined in serum samples with an albumin-cobalt binding test and by commercially available kits, respectively. IMA levels were adjusted according to serum albumin levels. Index of oxidation (IOS) was calculated by dividing adjusted IMA (A-IMA) levels with TAS. A receiver operating characteristics (ROC) curve analysis was made and cut-off values for the biomarkers were investigated in SPSS 21.0 program (SPSS, Chicago, IL). Data were presented as mean ± standard deviation and a p value < .05 was accepted as statistically significant. RESULTS There was a statistically significant difference in IMA, A-IMA, and IOS levels between ectopic and normal pregnancies. Although TAS level was not different statistically, it was lower in ectopic pregnancy. According to ROC curve analysis, IOS had the largest area under curve. A cut-off value of 0.545 for IOS had 81.6% sensitivity and 59.5% specificity. CONCLUSIONS According to our study, oxidative stress plays an important role in ectopic pregnancy and either A-IMA or IOS can be evaluated as a marker of ectopic pregnancy after further studies.
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Affiliation(s)
- Giray Bozkaya
- a Department of Medical Biochemistry , Health Sciences University, Bozyaka Training and Research Hospital , Izmir , Turkey
| | - Ibrahim Karaca
- b Department of Gynecology , Health Sciences University, Bakırköy Dr. Sadi Konuk Research and Training Hospital , Istanbul , Turkey
| | - Ozge Fenercioglu
- a Department of Medical Biochemistry , Health Sciences University, Bozyaka Training and Research Hospital , Izmir , Turkey
| | - Suna Yildirim Karaca
- c Department of Gynecology , Health Sciences University, Kanuni Sultan Suleyman Research and Training Hospital , Istanbul , Turkey
| | - Sibel Bilgili
- a Department of Medical Biochemistry , Health Sciences University, Bozyaka Training and Research Hospital , Izmir , Turkey
| | - Nuriye Uzuncan
- a Department of Medical Biochemistry , Health Sciences University, Bozyaka Training and Research Hospital , Izmir , Turkey
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Hübener C, Bidlingmaier M, Wu Z, Diebold J, Strasburger CJ, Mahner S, Hasbargen U, Delius M. Human placental growth hormone in ectopic pregnancy: Detection in maternal blood, immunohistochemistry and potential clinical implication. Growth Horm IGF Res 2017; 37:13-18. [PMID: 29073481 DOI: 10.1016/j.ghir.2017.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate human placental growth hormone (hGH-V) in ectopic pregnancy (EP): detection in maternal blood, correlation with immunohistochemistry and possible role as a marker for the course of EP. DESIGN Women presenting in the outpatient or emergency department of a tertiary care university hospital with a positive pregnancy test and strong suspicion of EP by ultrasound and/or symptoms were eligible for the study (n=70). Tissue specimens from the surgically treated patients (n=50) were examined by histopathology as well as by a hGH-V specific immohistochemistry set-up. A highly sensitive hGH-V specific immunoassay was used to analyse serum samples collected before treatment, day 1 post surgery samples and serial samples for medical treatment. RESULT(S) In EP patients' sera hGH-V was shown to be measurable for the first time (n=18). HGH-V however could not be detected in all patients' sera. HCG levels were significantly higher in the hGH-V serum positive group (p 0.001). HGH-V was localized to the syncytiotrophoblast in all specimens of EP examined by immunohistochemistry (n=10) regardless of the detection in the patient's blood. CONCLUSION(S) Placental growth hormone (hGH-V) was shown to be present both in ectopic pregnancy patients' sera and tissue. It may serve as a biomarker for monitoring the course and treatment of EP.
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Affiliation(s)
- Christoph Hübener
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 München, Germany.
| | - Martin Bidlingmaier
- Endocrine Laboratory, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336 München, Germany
| | - Zida Wu
- Klinik für Endokrinologie, Diabetes und Ernährungsmedizin, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Joachim Diebold
- Pathologisches Institut, Kantonsspital Luzern, Luzerner Kantonsspital, 6000 Luzern 16, Switzerland
| | - Christian J Strasburger
- Klinik für Endokrinologie, Diabetes und Ernährungsmedizin, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Sven Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 München, Germany
| | - Uwe Hasbargen
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 München, Germany
| | - Maria Delius
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 München, Germany
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Hamid AAA, Yousry A, El Radi SA, Shabaan OM, Mazen E, Nabil H. Clinical audit of ectopic pregnancy. Electron Physician 2017; 9:4009-4013. [PMID: 28461878 PMCID: PMC5407236 DOI: 10.19082/4009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/27/2016] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this study was to determine the risk factors of ectopic pregnancy in cases presented to the Woman’s Health Hospital (WHH) in Assuit University, and to perform clinical audit on strategies for management of ectopic pregnancy in the WHH. Methods This descriptive hospital based study was conducted at the Woman’s Health Hospital (WHH) of Assuit University (Egypt). There were 210 patients who were admitted to the WHH with the diagnosis of ectopic pregnancy in the period between February 1, 2015 through the end of October 2015. Data were analyzed by SPSS version 21, using descriptive statistics, Mann-Whitney U test, and Chi square. Results Ectopic pregnancy affects woman in the reproductive age. There are many risk factors that increase the chance of its occurrence; however, it may also occur in the absence of any risk factors (14.0%). Internal VD (72.5%) is the most frequent risk factor; other risk factors include history of abortion, previous CS, ovulation induction, history of infertility, or previous history of EP. Conclusion Clinical audit is an important item of any adequate health care. As regards to the clinical audit of EP management, we are not adhering to the guidelines.
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Affiliation(s)
| | - Almraghy Yousry
- Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Assuit Al-Azhar University, Egypt
| | - Safwat Abd El Radi
- Professor of Obstetrics & Gynecology Faculty of Medicine, Assuit University, Egypt
| | - Omar Mamdouh Shabaan
- Professor of Obstetrics & Gynecology Faculty of Medicine, Assuit University, Egypt
| | - Elzahry Mazen
- Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Assuit Al-Azhar University, Egypt
| | - Halal Nabil
- Lecturer of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt
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Saadati N, Najafian M, Masihi S, Safiary S, Abedi P. Comparison of Two Different Protocols of Methotrexate Therapy in Medical Management of Ectopic Pregnancy. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e20147. [PMID: 26756008 PMCID: PMC4706730 DOI: 10.5812/ircmj.20147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 07/15/2014] [Accepted: 08/13/2014] [Indexed: 11/30/2022]
Abstract
Background: Ectopic pregnancy (EP) is one of the most dangerous complications of pregnancy and without prompt diagnosis and treatment, it could become a major cause of maternal morbidity and mortality. Objectives: In this randomized controlled study, we compared single and double dose of methotrexate (MTX) therapy in the treatment of ectopic pregnancy. Patients and Methods: This study was performed on 76 patients who were admitted to Obstetrics Ward with primary diagnosis of ectopic pregnancy based on their medical history, physical examination, beta subunit (β-HCG) level, and transvaginal ultrasonography. Using random block allocation, the patients were classified in two groups of single dose and double dose administration of MTX. In single dose group, 50 mg/m2 of MTX was given at day 0 and in double dose group, the patients received two doses of MTX at day 0 and 4. The level of β-HCG was measured at day 0, 4, 7 in both groups. The successful treatment was defined as 15% reduction in β-HCG level between day 4 and 7. The two groups were compared with each other with regard to their need for operation, or extra dose of MTX; duration of hospitalization; and MTX complications. Results: Results showed that the rate of success in double dose method was more than single dose one (79% versus 69%) but the difference was not significant (P = 0.29). Although the need for operation and extra dose of MTX were lower in the double dose group (15.8% vs. 18.8% and 5.26% vs. 13.2%, respectively), these differences were not significant too. Duration of hospitalization was significantly lower in double dose compared to the single dose (11.55 d vs. 14.76 d, P < 0.001). Conclusions: Single dose therapy of MTX has sufficient power and efficacy in the treatment of ectopic pregnancy, however in patients with higher serum level of β-HCG, the successful treatment increases by using double dose method. Using double dose also could decrease the necessity of operation, re-administration of MTX, and duration of hospitalization.
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Affiliation(s)
- Najmieh Saadati
- Obstetrics and Gynecology Department, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mahin Najafian
- Obstetrics and Gynecology Department, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding Author: Mahin Najafian, Obstetrics and Gynecology Department, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-9161188801, Fax: +98-6113738333, E-mail:
| | - Sara Masihi
- Obstetrics and Gynecology Department, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Sara Safiary
- Obstetrics and Gynecology Department, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Parvin Abedi
- Midwifery Department, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Tong S, Skubisz MM, Horne AW. Molecular diagnostics and therapeutics for ectopic pregnancy. Mol Hum Reprod 2014; 21:126-35. [PMID: 25232044 DOI: 10.1093/molehr/gau084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Ectopic pregnancies are a serious gynaecological emergency that can be fatal. As such, prompt diagnosis and safe timely treatment is essential. Here, we review the literature on the development of molecularly targeted diagnostics and therapeutics for ectopic pregnancy. A blood-based biomarker that accurately identifies an ectopic pregnancy could be used to offer early diagnostic certainty in cases where ultrasound cannot determine the location of the embryo ('a pregnancy of unknown location'). Molecules examined so far can be broadly grouped into biological themes of relevance to reproduction: (i) Fallopian tube (dys)function, (ii) embryo/trophoblast growth, (iii) corpus luteum function, (iv) inflammation, (v) uterine function and (vi) angiogenesis. While a sensitive and specific biomarker for ectopic pregnancy has yet to be identified, it is possible that improvements in platform technologies or a multi-modal biomarker approach may yield an accurate diagnostic biomarker test. Furthermore, with the advent of better imaging technology, the need for a blood-based biomarker test may be superseded by improvements in ultrasound or magnetic resonance imaging technology. There have been some recent preclinical studies describing molecularly targeted therapeutic approaches for ectopic pregnancy. Notably, bench-to-bedside studies have examined the use of combination gefitinib (orally available epidermal growth factor receptor inhibitor) and methotrexate. Preclinical studies suggest that combination gefitinib and methotrexate is highly effective in inducing placental cell death, and is significantly more effective than methotrexate alone. In early human trials, encouraging preliminary efficacy data have shown that combination gefitinib and methotrexate can rapidly resolve tubal ectopic pregnancies, and large extra-tubal ectopic pregnancies. If a large clinical randomized controlled trial confirms these findings, combination gefitinib and methotrexate could become a new medical treatment option for ectopic pregnancy.
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Affiliation(s)
- Stephen Tong
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Rd, Heidelberg 3084, Australia
| | - Monika M Skubisz
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Rd, Heidelberg 3084, Australia
| | - Andrew W Horne
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
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Daniilidis A, Pantelis A, Makris V, Balaouras D, Vrachnis N. A unique case of ruptured ectopic pregnancy in a patient with negative preg-nancy test - a case report and brief review of the literature. Hippokratia 2014; 18:282-284. [PMID: 25694767 PMCID: PMC4309153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Despite the major advances made in the diagnosis and management of ectopic pregnancies in the last two decades, an accurate diagnosis can sometimes still be quite challenging, since it relies on the combination of ultrasound findings and serial serum beta-human chorionic gonadotrophin (β-hCG) measurements. CASE PRESENTATION This paper describes the case of a 36-year-old woman of Caucasian origin who was admitted to the emergency department of our clinic with clinical symptoms of hemorrhagic shock in combination with two negative pregnancy tests done by her at home and a negative urine test which was performed on her admission to the hospital. Quantitative measurement of β-hCG in the serum of the patient was 13 mIU/mL. On admission, right tubal pregnancy was diagnosed on ultrasound and she underwent an emergency laparotomy due to signs of hemodynamic shock. CONCLUSION It is sometimes a considerable challenge to identify a patient with an ectopic pregnancy at risk of rupture. This case of ectopic pregnancy which was followed by a negative pregnancy test illustrates the magnitude of the difficulties involved in the diagnosis of ectopic pregnancy. It also demonstrates the need to maintain a high clinical index of suspicion and to undertake careful clinical examination of the patient on the basis of the clinician's diagnostic research. Hippokratia 2014; 18 (3): 282-284.
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Affiliation(s)
- A Daniilidis
- 2 University Department of Obstetrics and Gynecology, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece
| | - A Pantelis
- 2 University Department of Obstetrics and Gynecology, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece
| | - V Makris
- 2 University Department of Obstetrics and Gynecology, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece
| | - D Balaouras
- 2 University Department of Obstetrics and Gynecology, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece
| | - N Vrachnis
- 2 University Department of Obstetrics and Gynecology, Aretaieio General Hospital, Kapodistrian University of Athens, Greece
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Jha RK, Jha PK, Chaudhury K, Rana SVS, Guha SK. An emerging interface between life science and nanotechnology: present status and prospects of reproductive healthcare aided by nano-biotechnology. NANO REVIEWS 2014; 5:22762. [PMID: 24600516 PMCID: PMC3943174 DOI: 10.3402/nano.v5.22762] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/14/2014] [Accepted: 01/19/2014] [Indexed: 11/24/2022]
Abstract
Among the various applications of nano-biotechnology, healthcare is considered one of the most significant domains. For that possibility to synthesize various kind of nanoparticles (NPs) and the ever-increasing ability to control their size as well as structure, to improve surface characteristics and binding NPs with other desired curing agents has played an important role. In this paper, a brief sketch of various kinds of nanomaterials and their biomedical applications is given. Despite claims of bio-nanotechnology about to touch all areas of medical science, information pertaining to the role of nanotechnology for the betterment of reproductive healthcare is indeed limited. Therefore, the various achievements of nano-biotechnology for healthcare in general have been illustrated while giving special insight into the role of nano-biotechnology for the future of reproductive healthcare betterment as well as current achievements of nanoscience and nanotechnology in this arena.
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Affiliation(s)
- Rakhi K Jha
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India
| | - Pradeep K Jha
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India
| | - Koel Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India
| | | | - Sujoy K Guha
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India
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The Lin28/Let-7 system in early human embryonic tissue and ectopic pregnancy. PLoS One 2014; 9:e87698. [PMID: 24498170 PMCID: PMC3909210 DOI: 10.1371/journal.pone.0087698] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/24/2013] [Indexed: 12/21/2022] Open
Abstract
Our objective was to determine the expression of the elements of the Lin28/Let-7 system, and related microRNAs (miRNAs), in early stages of human placentation and ectopic pregnancy, as a means to assess the potential role of this molecular hub in the pathogenesis of ectopic gestation. Seventeen patients suffering from tubal ectopic pregnancy (cases) and forty-three women with normal on-going gestation that desired voluntary termination of pregnancy (VTOP; controls) were recruited for the study. Embryonic tissues were subjected to RNA extraction and quantitative PCR analyses for LIN28B, Let-7a, miR-132, miR-145 and mir-323-3p were performed. Our results demonstrate that the expression of LIN28B mRNA was barely detectable in embryonic tissue from early stages of gestation and sharply increased thereafter to plateau between gestational weeks 7–9. In contrast, expression levels of Let-7, mir-132 and mir-145 were high in embryonic tissue from early gestations (≤6-weeks) and abruptly declined thereafter, especially for Let-7. Opposite trends were detected for mir-323-3p. Embryonic expression of LIN28B mRNA was higher in early stages (≤6-weeks) of ectopic pregnancy than in normal gestation. In contrast, Let-7a expression was significantly lower in early ectopic pregnancies, while miR-132 and miR-145 levels were not altered. Expression of mir-323-3p was also suppressed in ectopic embryonic tissue. We are the first to document reciprocal changes in the expression profiles of the gene encoding the RNA-binding protein, LIN28B, and the related miRNAs, Let-7a, mir-132 and mir-145, in early stages of human placentation. This finding suggests the potential involvement of LIN28B/Let-7 (de)regulated pathways in the pathophysiology of ectopic pregnancy in humans.
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Barnhart K, Speicher DW. Molecular diagnosis of ectopic pregnancy. Expert Rev Mol Diagn 2014; 11:759-62. [DOI: 10.1586/erm.11.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kurt Barnhart
- The Perelman School of Medicine at the University of Pennsylvania, Women’s Health Clinical Research Center, Penn Fertility Care, 3701 Market Street, Suite 800, Philadelphia, PA 19104, USA
| | - David W Speicher
- Center for Systems and Computational Biology, The Wistar Institute, Room 151, 3601 Spruce Street, Philadelphia, PA 19104, USA
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Brown JK, Lauer KB, Ironmonger EL, Inglis NF, Bourne TH, Critchley HOD, Horne AW. Shotgun proteomics identifies serum fibronectin as a candidate diagnostic biomarker for inclusion in future multiplex tests for ectopic pregnancy. PLoS One 2013; 8:e66974. [PMID: 23826180 PMCID: PMC3691233 DOI: 10.1371/journal.pone.0066974] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/14/2013] [Indexed: 12/28/2022] Open
Abstract
Ectopic pregnancy (EP) is difficult to diagnose early and accurately. Women often present at emergency departments in early pregnancy with a ‘pregnancy of unknown location’ (PUL), and diagnosis and exclusion of EP is challenging due to a lack of reliable biomarkers. The objective of this study was to identify novel diagnostic biomarkers for EP. Shotgun proteomics, incorporating combinatorial-ligand library pre-fractionation, was used to interrogate pooled sera (n = 40) from women undergoing surgery for EP, termination of viable intrauterine pregnancy and management of non-viable intrauterine pregnancy. Western blot was used to validate results in individual sera. ELISAs were developed to interrogate sera from women with PUL (n = 120). Sera were collected at time of first symptomatic presentation and categorized according to pregnancy outcome. The main outcome measures were differences between groups and area under the receiver operating curve (ROC). Proteomics identified six biomarker candidates. Western blot detected significant differences in levels of two of these candidates. ELISA of sera from second cohort revealed that these differences were only significant for one of these candidates, fibronectin. ROC analysis of ability of fibronectin to discriminate EP from other pregnancy outcomes suggested that fibronectin has diagnostic potential (ROC 0.6439; 95% CI 0.5090 to 0.7788; P>0.05), becoming significant when ‘ambiguous’ medically managed PUL excluded from analysis (ROC 0.6538; 95% CI 0.5158 to 0.7918; P<0.05). Fibronectin may make a useful adjunct to future multiplex EP diagnostic tests.
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Affiliation(s)
- Jeremy K. Brown
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Katarina B. Lauer
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Emily L. Ironmonger
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Neil F. Inglis
- Moredun Proteomic Facility, Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, Midlothian, United Kingdom
| | - Tom H. Bourne
- Queen Charlotte’s and Chelsea Hospital, Imperial College National Health Service Trust, London, United Kingdom
| | - Hilary O. D. Critchley
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Andrew W. Horne
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
- * E-mail:
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Unger HW, Starrs L, Scott L, Critchley HOD, Duncan WC, Horne AW. The financial costs to patients of diagnosing and excluding ectopic pregnancy. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2012; 39:197-200. [DOI: 10.1136/jfprhc-2012-100368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Unless an ectopic pregnancy is visible by ultrasound, diagnosis can be a challenge. Differentiating ectopic pregnancies from intrauterine pregnancies can be impossible without intervention or follow-up. This poses a clinical dilemma to the practitioner given the inherent danger to the mother of tubal rupture of an ectopic pregnancy versus the fear of intervening in the case of a desired pregnancy without certainty of diagnosis. Early diagnostic modalities are clearly lacking, and serum biomarkers are currently being investigated as a solution to need for a rapid and accurate test for ectopic pregnancy.
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Horne AW, Brown JK, Tong S, Kaitu'u-Lino T. Evaluation of ADAM-12 as a diagnostic biomarker of ectopic pregnancy in women with a pregnancy of unknown location. PLoS One 2012; 7:e41442. [PMID: 22927907 PMCID: PMC3424157 DOI: 10.1371/journal.pone.0041442] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/21/2012] [Indexed: 11/23/2022] Open
Abstract
Background Ectopic pregnancy (EP) remains the most life-threatening acute condition in modern gynaecology. It remains difficult to diagnose early and accurately. Women often present at emergency departments in early pregnancy with a ‘pregnancy of unknown location’ (PUL) and diagnosis/exclusion of EP is challenging due to a lack of reliable biomarkers. Recent studies suggest that serum levels of a disintegrin and metalloprotease protein-12 (ADAM-12) can be used differentiate EP from viable intrauterine pregnancy (VIUP). Here we describe a prospective study evaluating the performance of ADAM-12 in differentiating EP from the full spectrum of alternative PUL outcomes in an independent patient cohort. Methodology/Principal Findings Sera were collected from 120 patients at their first clinical presentation with a PUL and assayed for ADAM-12 by ELISA. Patients were categorized according to final pregnancy outcomes. Serum ADAM-12 concentrations were increased in women with histologically-confirmed EP (median 442 pg/mL; 25%–75% percentile 232–783 pg/mL) compared to women with VIUP (256 pg/mL; 168–442 pg/mL) or miscarriage (192 pg/mL; 133–476 pg/mL). Serum ADAM-12 did not differentiate histologically-confirmed EP from spontaneously resolving PUL (srPUL) (416 pg/mL; 154–608 pg/mL). The diagnostic potential of ADAM-12 was only significant when ‘ambiguous’ PUL outcomes were excluded from the analysis (AROC = 0.6633; P = 0.03901). Conclusions/Significance When measured in isolation, ADAM-12 levels had limited value as a diagnostic biomarker for EP in our patient cohort. The development of a reliable serum biomarker-based test for EP remains an ongoing challenge.
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Affiliation(s)
- Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, United Kingdom.
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Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26:2134-64. [PMID: 22736283 DOI: 10.1007/s00464-012-2331-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. METHODS Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. RESULTS A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). CONCLUSIONS Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
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Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy.
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Qi Y, Wang J, Wang Y, Ai Z, Teng Y. Peritoneal relative to venous serum biomarker concentrations for diagnosis of ectopic pregnancy. Arch Gynecol Obstet 2012; 285:1611-7. [PMID: 22215199 DOI: 10.1007/s00404-011-2202-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/22/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To retrospectively analyze the relationships of peritoneal serum relative to venous serum (R (p/v)) ratios for human chorionic gonadotropin, CA-125, and creatine kinase to the ectopic pregnancy (EP). METHODS Intra-abdominal fluid and venous blood samples of 118 subjects with suspected EP were obtained for biomarker measurements. R (p/v-hCG) >1 was considered indicative of EP, and final diagnosis was based on surgical finding of an ectopic chorionic villous or gynecological ultrasound finding of an intrauterine gestational sac. RESULTS R (p/v-hCG) and R (p/v-CA-125) were both significantly greater for abortive as compared to ruptured EP and for the absence as compared to presence of active bleeding. However, neither ratio differed significantly between ampullary and isthmic EP. R (p/v-hCG) and R (p/v-CA-125) correlated negatively with hemoperitoneum volume. R (p/v-hCG) exhibited only modest predictive value for rupture. However, with R (p/v-CA-125) as the diagnostic criterion for rupture, sensitivity and specificity were 66.7 and 100%, respectively; in patients initially diagnosed with EP, R (p/v-CA-125) values <22.43 effectively predicted rupture. R (p/v-CK) did not exhibit significant diagnostic value. CONCLUSIONS R (p/v-hCG) values >1 combined with positive culdocentesis test findings reliably indicate the presence of EP. In patients initially diagnosed with EP, R (p/v-CA-125) values <22.43 predict tubal rupture.
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Affiliation(s)
- Yanting Qi
- Department of Obstetrics and Gynecology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, China
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Abstract
PURPOSE OF REVIEW Understanding the cause of tubal ectopic pregnancy (tEP) remains incomplete. We aim to summarize the latest advances in laboratory models of tEP that we believe will, ultimately, contribute to improving the diagnosis and management of the condition. RECENT FINDINGS Progress in proteome prefractionation and multidimensional protein identification technology has proved particularly effective in identifying novel biomarkers of tEP. These, and related global proteomic and genomic approaches, have as yet to be fully exploited in this context but do have substantial potential to inform future hypothesis-driven studies. The majority of data generated since 2009 to explain the cause of tEP continues to derive from descriptive human ex-vivo studies. In-vitro models of fallopian tube ciliary and smooth muscle function have improved to a limited degree, on the back of continuing advances in imaging and data acquisition. We believe that the recent development of a primary human fallopian tube epithelium culture system represents the most significant recent advance in laboratory models for studying ectopic pregnancy. There remain no good animal models of tEP. SUMMARY The establishment of a viable animal model of tEP remains the key obstacle to a complete understanding of the cause of the condition.
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Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. ACTA ACUST UNITED AC 2011; 37:231-40. [PMID: 21727242 DOI: 10.1136/jfprhc-2011-0073] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Vanitha N Sivalingam
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
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Rausch ME, Beer L, Sammel MD, Takacs P, Chung K, Shaunik A, Speicher D, Barnhart KT. A disintegrin and metalloprotease protein-12 as a novel marker for the diagnosis of ectopic pregnancy. Fertil Steril 2011; 95:1373-8. [PMID: 21277576 PMCID: PMC3072600 DOI: 10.1016/j.fertnstert.2010.12.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 12/06/2010] [Accepted: 12/16/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the performance of a novel biomarker, a disintegrin and metalloprotease-12 (ADAM-12), to differentiate an ectopic pregnancy (EP) from normal intrauterine pregnancies (IUPs). DESIGN Case-control study. SETTING Three urban academic centers. PATIENT(S) Women who were seen in the emergency department with pain or bleeding in the first trimester of pregnancy. INTERVENTION(S) Sera from women with diagnosed EP or IUP were evaluated via proteomics and an ADAM-12 dissociation-enhanced lanthanide fluoroimmunoassay. MAIN OUTCOME MEASURE(S) Differences between groups, area under the receiver operating curve, sensitivity, and specificity. RESULT(S) Via a proteomics evaluation, we found a statistically significant decrease in ADAM-12 in the sera of patients with EP, which we confirmed in a larger group of 199 patients (median IUP 18.6 ng/mL versus median EP 2.5 ng/mL with good discrimination between the groups as assessed by receiver operating characteristics [area under the curve = 0.82]). At a low cut-point, the sensitivity was 70% and specificity 84%, but, at a higher cut-point optimizing sensitivity, the ADAM-12 test demonstrated a sensitivity of 97%. CONCLUSION(S) ADAM-12 is a promising marker for the diagnosis of EP in women with symptoms in the first trimester, validating the proteomics findings. Further studies in additional patient populations and in combination with other biomarkers are needed.
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Affiliation(s)
- Mary E Rausch
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Horne AW, McBride R, Denison FC. Normally rising hCG does not predict live birth in women presenting with pain and bleeding in early pregnancy. Eur J Obstet Gynecol Reprod Biol 2011; 156:120-1. [PMID: 21334129 DOI: 10.1016/j.ejogrb.2011.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 01/14/2011] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
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