-
Journal of Accident & Emergency Medicine Nov 1999
Topics: Diagnostic Errors; Female; Humans; Pregnancy; Pregnancy, Ectopic; Retrospective Studies
PubMed: 10572837
DOI: 10.1136/emj.16.6.462-c -
BMJ (Clinical Research Ed.) Oct 1988
Topics: Female; Humans; Pregnancy; Pregnancy, Ectopic; Scotland
PubMed: 3142617
DOI: 10.1136/bmj.297.6655.1046-a -
Reproductive Biology and Endocrinology... Apr 2015Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro... (Review)
Review
BACKGROUND
Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment.
METHODS
The scientific literature was searched for studies investigating EP/HP during IVF-ET. Publications in English and within the past 6 years were mostly selected.
RESULTS
A history of tubal infertility, pelvic inflammatory disease and specific aspects of embryo transfer technique are the most significant risk factors for later EP. Early measurement of serum hCG and performance of TVS by an expert operator as early as gestational week 5 can identify cases of possible EP. These women should be closely monitored with repeated ultrasound and hCG measurement until a diagnosis is reached. Treatment must be customised to the clinical condition and future fertility requirements of the patient. In cases of HP, the viable IUP can be preserved in the majority of cases but requires early detection of HP. No apparent negative impact of the different treatment approaches for EP/HP on subsequent IVF-ET, except for risk of recurrence.
CONCLUSIONS
EP/HP are tragic events in a couple's reproductive life, and the earlier the diagnosis the better the prognosis. Due to the increase incidence following IVF-ET, there is a compelling need to develop a diagnostic biomarker/algorithm that can predict pregnancy outcome with high sensitivity and specificity before IVF-ET to prevent and/or properly manage those who are at higher risk of EP/HP.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Incidence; Infertility, Female; Maternal Age; Pregnancy; Pregnancy, Ectopic; Prevalence; Risk Factors
PubMed: 25884617
DOI: 10.1186/s12958-015-0025-0 -
In Vivo (Athens, Greece) 2022During the COVID-19 pandemic, concerns regarding theoretical risks of surgery contributed to changes in clinical management to prevent contamination. We looked at the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
During the COVID-19 pandemic, concerns regarding theoretical risks of surgery contributed to changes in clinical management to prevent contamination. We looked at the effect the pandemic had on the management of ectopic pregnancy. Our review compares published data on pre-COVID to COVID management of ectopic pregnancies and evaluates the differences where Early Pregnancy Unit (EPU) structures exist.
MATERIALS AND METHODS
We performed a systematic review of the published evidence using a keyword strategy. The "Population Intervention Comparison and Outcome" (PICO) criteria were used to select studies. Three independent reviewers agreed on the data extracted after screening of the literature. The total population analysed included 3122 women. A meta-analysis of the included studies was completed using a random or fixed effect model depending on the heterogeneity (I). Our outcomes were the following: type of management of ectopic pregnancy (EP), incidence of ruptured EP and rate of complications. We compared units with and without EPU infrastructure.
RESULTS
We included every study which recruited women diagnosed with ectopic pregnancy and compared the type of management during and prior the COVID-19 peak. Our literature search yielded 34 papers. 12 were included using the PRISMA guidelines. We observed no difference in the type of management (surgical versus non-surgical) [OR=0.99 (0.63-1.55), p=0.96, I=77%] in the pre-Covid vs. Covid cohorts overall but a reduction of surgical management in EPU structures. There was no difference in the ectopic rupture rate within the EPU branch [OR=0.66 (0.33-1.31), p=0.24, I=37%]. In contrast, in non-EPU (NPEU) structures there was a clear increased risk of ruptured ectopic pregnancy [OR=2.86 (1.84-4.46), p<0.01 I=13%] and complications [OR=1.69 (1.23-2.31), p=0.001, I=45%].
CONCLUSION
The risk of ruptured ectopic and complications was significantly higher in the absence of EPU structures. This worldwide trend was not reflected in the UK, where EPU systems are widespread, suggesting that EPU structures contributed to prompt diagnosis and safe management. In the post-COVID era, healthcare systems have come to realise that pandemics might become the norm and thus the onus is to identify services that have worked seamlessly.
Topics: COVID-19; Female; Humans; Incidence; Pandemics; Pregnancy; Pregnancy, Ectopic
PubMed: 35738600
DOI: 10.21873/invivo.12867 -
Journal of the National Medical... Jan 1962
Topics: Female; Humans; Pregnancy; Pregnancy, Ectopic
PubMed: 14451037
DOI: No ID Found -
Medicine Jun 2022Ectopic pregnancy is the most common cause of maternal mortality in the first trimester of pregnancy. The aim of this study was to find risk factors and clinical... (Observational Study)
Observational Study
Ectopic pregnancy is the most common cause of maternal mortality in the first trimester of pregnancy. The aim of this study was to find risk factors and clinical characteristics associated with ruptured ectopic pregnancies at a medical center in eastern Taiwan in a 19-year period. This was a retrospective observational study that included patients diagnosed with ectopic pregnancy between August 1999 and December 2018. Data about the demographic variables, initial presentation, pre-treatment beta-human chorionic gonadotropin levels, treatment routes (laparoscopy or laparotomy), surgical methods (salpingostomy or salpingectomy), operation time, blood loss amount, the status of ectopic pregnancy (ruptured or unruptured), the requirement for transfusion, and duration of hospital stay were collected. The categorical and continuous variables were analyzed using the correlation coefficients. This study included 225 women who were diagnosed as having an ectopic pregnancy. There were 49 and 176 women with unruptured and ruptured ectopic pregnancies, respectively. The beta-human chorionic gonadotropin levels, history of previous ectopic pregnancy, pelvic inflammatory disease, tubal surgery, abdominal history, and vaginal bleeding were not significantly different between the 2 groups. The ratio of women with abdominal pain was significantly higher in the ruptured ectopic pregnancy group than in the unruptured group (89.1% vs. 63.8%, respectively, P < .001). Preoperative hemoglobin was lower in the ruptured group compared with the unruptured group (P < .001). Blood loss, postoperative hemoglobin, and blood transfusion were significantly higher in the ruptured group than in the unruptured group (P = .000 and P = .001 for blood loss and blood transfusion, respectively). Multiple logistic regression analysis revealed that abdominal pain and blood loss were associated with ruptured tubal pregnancies (adjusted odds ratio [95% confidence intervals]: 3.42 {1.40, 8.40}; 1.01 {1.005, 1.014}, respectively). In conclusion, early pregnancy with abdominal pain, more parity, and lower preoperative hemoglobin should be aware of the possibility of ruptured ectopic pregnancy. More blood loss, transfusion and lower postoperative hemoglobin were also noted with ruptured ectopic pregnancy.
Topics: Abdominal Pain; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Pregnancy; Pregnancy, Ectopic; Pregnancy, Tubal; Risk Factors; Rupture
PubMed: 35713461
DOI: 10.1097/MD.0000000000029514 -
Acta Clinica Croatica Dec 2022The aim of our study was to connect the possible complications of early pregnancy (miscarriage and symptomatic ectopic pregnancy) up to the 12 week of gestation with... (Observational Study)
Observational Study
The aim of our study was to connect the possible complications of early pregnancy (miscarriage and symptomatic ectopic pregnancy) up to the 12 week of gestation with biometeorological conditions while assuming a greater number of incidents with an unfavorable biometeorological forecast. We performed a retrospective observational study using medical data of a single medical center of Department of Gynecology and Obstetrics, Sveti Duh University Hospital and meteorological data from the Croatian Meteorological and Hydrometeorological Service in Zagreb. We tracked the number of visits to the gynecology and obstetrics emergency unit on a daily basis during 2017. Days with five or more visits were selected and underwent further analysis, during which the number of miscarriages and symptomatic ectopic pregnancies was noted. The information from the biometeorological forecast was then extracted and added to the database. Our results did not show a statistically significant difference between the groups determined by biometeorological forecast in the number of spontaneous abortions or ectopic pregnancy. Also, statistically significant results did not follow the expected trend of the increasing number of complications related to worse biometeorological forecast, or , a decreased number of complications with better forecast. Our single-center retrospective analysis of emergency unit visits related to weather conditions did not show a connection between the complications of early pregnancy and biometeorological conditions. However, different results could emerge in future studies. Considering the large and high-quality database collected for this study, efforts in researching the connection between other gynecologic pathologies and weather conditions will be feasible.
Topics: Pregnancy; Humans; Female; Retrospective Studies; Weather; Forecasting; Pregnancy, Ectopic; Meteorology
PubMed: 37868180
DOI: 10.20471/acc.2022.61.04.09 -
Fertility and Sterility Aug 2020
Topics: Abortifacient Agents, Nonsteroidal; Aromatase Inhibitors; Female; Humans; Letrozole; Methotrexate; Pregnancy; Pregnancy, Ectopic
PubMed: 32622661
DOI: 10.1016/j.fertnstert.2020.04.063 -
Fertility and Sterility Jan 2023To verify the accuracy of an online algorithm using Bayes' theorem for diagnosing ectopic pregnancy (EP) using human chorionic gonadotropin (hCG), ultrasound, and...
OBJECTIVE
To verify the accuracy of an online algorithm using Bayes' theorem for diagnosing ectopic pregnancy (EP) using human chorionic gonadotropin (hCG), ultrasound, and clinical data in a real cohort.
DESIGN
A retrospective cohort study.
SETTING
Gynecologic emergency unit in a tertiary teaching hospital.
PATIENT(S)
First-trimester pregnant women who attended the gynecologic emergency unit for any reason. Those who had <13 weeks of pregnancy confirmed by a recent positive pregnancy test; a digital image or electronic report of transvaginal ultrasound (TVUS) obtained from hospital database; and a follow-up with a pathology report or a clinical resolution of a confirmed pregnancy were included in the study. Clinical signs and symptoms, the presence of risk factors for EP, the TVUS findings in each consultation, and the hCG levels were independent variables obtained from the electronic medical records. From these data, the pretest probability, based on the clinical presentation and risk factors, and the likelihood ratio for each variable were calculated for their use in the algorithm, yielding a posttest probability.
INTERVENTION
Not applicable.
MAIN OUTCOME MEASURE(S)
The accuracy of the online algorithm to identify cases of EP using clinical signs and symptoms, the presence of risk factors for EP, the TVUS findings in each consultation, and the hCG levels. The main outcome was EP, confirmed either by pathology report or by the presence of fetal heartbeat or gestational sac outside the uterine cavity.
RESULT(S)
Between January 1, 2009 and December 27, 2016, 2,495 women were analyzed, and the algorithm was applied to 2,185 of them. The incidence of EP was 8.5% (212/2,495); 310 women were excluded because they were submitted to surgery with decision thresholds <95%. The algorithm was applied to 2,185 women. Just one case remained inconclusive after 3 consultations, and it was considered as an error in prediction. The sensitivity, specificity, and accuracy values (95% confidence interval) of the algorithm were 98.9% (96.1%-99.8%), 98.9% (98.3%-99.2%), and 98.9% (98.3%-99.2%), respectively.
CONCLUSION(S)
The accuracy of the Bayesian algorithm to confirm or rule out EP is excellent. Online Nomogram https://docs.google.com/spreadsheets/d/1jStXlMBjbPyDf6_W0deKGKQLZHU5EFAe8rLhNVPuJuY/edit?usp=sharing.
Topics: Pregnancy; Female; Humans; Bayes Theorem; Retrospective Studies; Sensitivity and Specificity; Pregnancy, Ectopic; Chorionic Gonadotropin
PubMed: 36307292
DOI: 10.1016/j.fertnstert.2022.09.016 -
Fertility and Sterility Aug 1999To review the definition and diagnosis of interstitial and heterotopic interstitial pregnancy and to evaluate the conservative management of these conditions. (Review)
Review
OBJECTIVE
To review the definition and diagnosis of interstitial and heterotopic interstitial pregnancy and to evaluate the conservative management of these conditions.
DESIGN
A MEDLINE computer search was used to identify relevant studies. The mean values for the duration of amenorrhea, serum beta-hCG level, size of the ectopic mass, and success rates of the various treatment modalities were calculated from the raw data in the original publications.
RESULT(S)
A review of 41 patients with interstitial pregnancy who were treated with methotrexate systemically, locally, or in combination revealed an overall success rate of 83%. The mean duration of amenorrhea, mean serum beta-hCG level, and mean size of the ectopic mass were 54 days, 15,127 mIU/mL, and 23 mm, respectively. Among 22 patients with interstitial pregnancy who were treated with conservative laparoscopic techniques, the overall success rate was 100%. In this group, the mean duration of amenorrhea, mean serum beta-hCG level, and mean size of the ectopic mass were 54 days, 7,572 mIU/mL, and 31 mm, respectively. There were nine cases of heterotopic interstitial pregnancy. Seven patients were managed with potassium chloride injected into the ectopic pregnancy, and two patients were treated by laparoscopy. Overall, 67% of the coexisting intrauterine pregnancies resulted in successful deliveries and the remainder ended in spontaneous abortions.
CONCLUSION(S)
Cornual resection or hysterectomy with a laparotomy should no longer be the first line of treatment for a hemodynamically stable patient with an interstitial pregnancy. In selected cases, methotrexate and laparoscopy can be used successfully in treating early interstitial pregnancy.
Topics: Abortifacient Agents, Nonsteroidal; Female; Humans; Incidence; MEDLINE; Methotrexate; Pregnancy; Pregnancy Complications; Pregnancy, Ectopic; United States; Uterine Rupture
PubMed: 10438980
DOI: 10.1016/s0015-0282(99)00242-3