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American Family Physician May 2020Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity. In the United States, the estimated prevalence of ectopic pregnancy is 1% to 2%,... (Review)
Review
Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity. In the United States, the estimated prevalence of ectopic pregnancy is 1% to 2%, and ruptured ectopic pregnancy accounts for 2.7% of pregnancy-related deaths. Risk factors include a history of pelvic inflammatory disease, cigarette smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility. Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa. However, most ectopic pregnancies do not reach this stage. More often, patient symptoms combined with serial ultrasonography and trends in beta human chorionic gonadotropin levels are used to make the diagnosis. Pregnancy of unknown location refers to a transient state in which a pregnancy test is positive but ultrasonography shows neither intrauterine nor ectopic pregnancy. Serial beta human chorionic gonadotropin levels, serial ultrasonography, and, at times, uterine aspiration can be used to arrive at a definitive diagnosis. Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management. A patient with diagnosed ectopic pregnancy should be immediately transferred for surgery if she has peritoneal signs or hemodynamic instability, if the initial beta human chorionic gonadotropin level is high, if fetal cardiac activity is detected outside of the uterus on ultrasonography, or if there is a contraindication to medical management.
Topics: Chorionic Gonadotropin, beta Subunit, Human; Diagnosis, Differential; Female; Humans; Methotrexate; Pregnancy; Pregnancy, Ectopic; Risk Factors; Salpingostomy; Ultrasonography, Prenatal
PubMed: 32412215
DOI: No ID Found -
Obstetrics and Gynecology Clinics of... Sep 2022Ectopic pregnancy occurs in 2% of all pregnancies and is a potentially life-threatening emergency. A high level of clinical suspicion is required for any pregnant... (Review)
Review
Ectopic pregnancy occurs in 2% of all pregnancies and is a potentially life-threatening emergency. A high level of clinical suspicion is required for any pregnant patient who presents with vaginal bleeding and/or pelvic pain. Workup should begin with immediate triage based on vital signs, a pregnancy test, and transvaginal ultrasound. Ectopic pregnancy can be treated either medically with methotrexate or surgically with either salpingectomy or salpingostomy. Carefully counseled, asymptomatic patients may be candidates for expectant management.
Topics: Female; Humans; Methotrexate; Pelvic Pain; Pregnancy; Pregnancy, Ectopic; Salpingectomy; Uterine Hemorrhage
PubMed: 36122984
DOI: 10.1016/j.ogc.2022.02.018 -
The Medical Clinics of North America Mar 2023Abnormal uterine bleeding is a common problem in premenopausal women and refers to uterine bleeding that is abnormal in frequency, duration, volume, and/or regularity.... (Review)
Review
Abnormal uterine bleeding is a common problem in premenopausal women and refers to uterine bleeding that is abnormal in frequency, duration, volume, and/or regularity. Etiologies can be classified using the PALM-COIEN system. Patients should receive a comprehensive history and physical with special attention to menstrual, sexual, and family history. Physical examination needs to include a pelvic examination with speculum and bimanual components. All patients need to have a pregnancy test and CBC with platelets. Treatments vary by etiology. Medical treatments include levonorgestrel intrauterine devices, oral contraceptive pills, and tranexamic acid. Surgical treatment options include endometrial ablation and hysterectomy.
Topics: Pregnancy; Humans; Female; Menorrhagia; Levonorgestrel; Uterine Hemorrhage; Contraceptives, Oral; Hysterectomy
PubMed: 36759094
DOI: 10.1016/j.mcna.2022.10.014 -
Current Problems in Pediatric and... May 2022Studies show that between 41% and 91.5% of young women, school-aged and university-aged, are affected by dysmenorrhea. Primary dysmenorrhea, which is caused by the...
Studies show that between 41% and 91.5% of young women, school-aged and university-aged, are affected by dysmenorrhea. Primary dysmenorrhea, which is caused by the production of prostaglandins, is defined as cramping pain in the lower abdomen and/or pelvis occurring just before or during menstruation, in the absence of other diseases such as endometriosis, and typically lasting 1-3 days and with a negative physical examination. Secondary dysmenorrhea presents with similar signs and symptoms but is a result of underlying pelvic pathology, for example endometriosis or uterine fibroids. Dysmenorrhea most typically presents as abdominal cramping; however, it can also present with headaches, nausea, vomiting or other generalized symptoms. The diagnosis is mainly clinical, but other tests such as a pelvic examination, a pregnancy test and STI screening may be helpful in ruling out other sources of pain. Although the mainstay of treatment for dysmenorrhea is NSAIDs and hormonal therapy, lifestyle changes and complementary/alternative medicine can also be helpful approaches. Lifestyle changes include aerobic exercise and stretching, while complementary alternative medicine include peppermint, cinnamon, ginger and other herbs and supplements. Finally, endometriosis must be considered as a potential cause for secondary dysmenorrhea and would warrant a prompt referral to gynecology.
Topics: Adolescent; Aged; Child; Complementary Therapies; Dysmenorrhea; Endometriosis; Female; Humans; Physical Examination; Pregnancy
PubMed: 35523674
DOI: 10.1016/j.cppeds.2022.101186 -
The New England Journal of Medicine Jan 2021In the United States, more intrauterine device (IUD) users select levonorgestrel IUDs than copper IUDs for long-term contraception. Currently, clinicians offer only... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
In the United States, more intrauterine device (IUD) users select levonorgestrel IUDs than copper IUDs for long-term contraception. Currently, clinicians offer only copper IUDs for emergency contraception because data are lacking on the efficacy of the levonorgestrel IUD for this purpose.
METHODS
This randomized noninferiority trial, in which participants were unaware of the group assignments, was conducted at six clinics in Utah and included women who sought emergency contraception after at least one episode of unprotected intercourse within 5 days before presentation and agreed to placement of an IUD. We randomly assigned participants in a 1:1 ratio to receive a levonorgestrel 52-mg IUD or a copper T380A IUD. The primary outcome was a positive urine pregnancy test 1 month after IUD insertion. When a 1-month urine pregnancy test was unavailable, we used survey and health record data to determine pregnancy status. The prespecified noninferiority margin was 2.5 percentage points.
RESULTS
Among the 355 participants randomly assigned to receive levonorgestrel IUDs and 356 assigned to receive copper IUDs, 317 and 321, respectively, received the interventions and provided 1-month outcome data. Of these, 290 in the levonorgestrel group and 300 in the copper IUD group had a 1-month urine pregnancy test. In the modified intention-to-treat and per-protocol analyses, pregnancy rates were 1 in 317 (0.3%; 95% confidence interval [CI], 0.01 to 1.7) in the levonorgestrel group and 0 in 321 (0%; 95% CI, 0 to 1.1) in the copper IUD group; the between-group absolute difference in both analyses was 0.3 percentage points (95% CI, -0.9 to 1.8), consistent with the noninferiority of the levonorgestrel IUD to the copper IUD. Adverse events resulting in participants seeking medical care in the first month after IUD placement occurred in 5.2% of participants in the levonorgestrel IUD group and 4.9% of those in the copper IUD group.
CONCLUSIONS
The levonorgestrel IUD was noninferior to the copper IUD for emergency contraception. (Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; ClinicalTrials.gov number, NCT02175030.).
Topics: Adolescent; Adult; Contraception, Postcoital; Female; Follow-Up Studies; Humans; Intention to Treat Analysis; Intrauterine Devices, Copper; Intrauterine Devices, Medicated; Levonorgestrel; Pregnancy; Pregnancy Rate; Pregnancy Tests; Unsafe Sex; Young Adult
PubMed: 33503342
DOI: 10.1056/NEJMoa2022141 -
Human Reproduction Update Apr 2020Recurrent pregnancy loss (RPL) occurs in 1-3% of all couples trying to conceive. No consensus exists regarding when to perform testing for risk factors in couples with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Recurrent pregnancy loss (RPL) occurs in 1-3% of all couples trying to conceive. No consensus exists regarding when to perform testing for risk factors in couples with RPL. Some guidelines recommend testing if a patient has had two pregnancy losses whereas others advise to test after three losses.
OBJECTIVE AND RATIONALE
The aim of this systematic review was to evaluate the current evidence on the prevalence of abnormal test results for RPL amongst patients with two versus three or more pregnancy losses. We also aimed to contribute to the debate regarding whether the investigations for RPL should take place after two or three or more pregnancy losses.
SEARCH METHODS
Relevant studies were identified by a systematic search in OVID Medline and EMBASE from inception to March 2019. A search for RPL was combined with a broad search for terms indicative of number of pregnancy losses, screening/testing for pregnancy loss or the prevalence of known risk factors. Meta-analyses were performed in case of adequate clinical and statistical homogeneity. The quality of the studies was assessed using the Newcastle-Ottawa scale.
OUTCOMES
From a total of 1985 identified publications, 21 were included in this systematic review and 19 were suitable for meta-analyses. For uterine abnormalities (seven studies, odds ratio (OR) 1.00, 95% CI 0.79-1.27, I2 = 0%) and for antiphospholipid syndrome (three studies, OR 1.04, 95% CI 0.86-1.25, I2 = 0%) we found low quality evidence for a lack of a difference in prevalence of abnormal test results between couples with two versus three or more pregnancy losses. We found insufficient evidence of a difference in prevalence of abnormal test results between couples with two versus three or more pregnancy losses for chromosomal abnormalities (10 studies, OR 0.78, 95% CI 0.55-1.10), inherited thrombophilia (five studies) and thyroid disorders (two studies, OR 0.52, 95% CI: 0.06-4.56).
WIDER IMPLICATIONS
A difference in prevalence in uterine abnormalities and antiphospholipid syndrome is unlikely in women with two versus three pregnancy losses. We cannot exclude a difference in prevalence of chromosomal abnormalities, inherited thrombophilia and thyroid disorders following testing after two versus three pregnancy losses. The results of this systematic review may support investigations after two pregnancy losses in couples with RPL, but it should be stressed that additional studies of the prognostic value of test results used in the RPL population are urgently needed. An evidenced-based treatment is not currently available in the majority of cases when abnormal test results are present.
Topics: Abortion, Habitual; Antiphospholipid Syndrome; Chromosome Aberrations; Female; Fertilization; Humans; Pregnancy; Risk Factors; Thrombophilia; Thyroid Diseases; Urogenital Abnormalities; Uterus
PubMed: 32103270
DOI: 10.1093/humupd/dmz048 -
Progress in Molecular Biology and... 2022Over the past decade, paper-based microfluidic devices have become popular for their simplicity and ability to conduct diagnostic tests at a low cost. An important class...
Over the past decade, paper-based microfluidic devices have become popular for their simplicity and ability to conduct diagnostic tests at a low cost. An important class of diagnostic assays that paper-based analytical devices have been used for is immunoassays. The lateral flow immunoassay (LFIA), of which the home pregnancy test is the most prominent example, has been one of the most commercially successful membrane-based diagnostic tests. Yet, the analytical sensitivity of LFIAs is lower than the corresponding laboratory technique called ELISA (enzyme-linked immunoassay). As a consequence, traditional LFIAs fail to deliver on the promise of bedside diagnostic testing for many applications. Recognizing this shortcoming, several new developments have been made by researchers to enhance the sensitivity of membrane-based immunoassays. In this chapter, we present the various strategies that have been employed to this end. In the end, we present a brief SWOT analysis to guide future work in this area.
Topics: Humans; Immunoassay; Microfluidics
PubMed: 35033288
DOI: 10.1016/bs.pmbts.2021.07.015