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Reproductive Health Aug 2022Ectopic pregnancy is a life-threatening occurrence and is an important cause of pregnancy-related mortality. We launched the study to investigate the distribution and...
BACKGROUND
Ectopic pregnancy is a life-threatening occurrence and is an important cause of pregnancy-related mortality. We launched the study to investigate the distribution and its variation trend of the ectopic pregnancy sites and the clinical characteristics of caesarean scar pregnancy, to provide information for further clinical practice.
METHODS
A total of 3915 patients were included in our study to calculate the distribution of the implantation sites of ectopic pregnancies. Then, we performed a χ test for trend and calculated the quantity of each type of ectopic pregnancy during 2012-2015 and 2016-2019 to analyse the variation trend.
RESULTS
(1) The proportion of each site of ectopic pregnancy was as follows: tubal pregnancy (84.70%), ovarian pregnancy (1.56%), caesarean scar pregnancy (8.63%), abdominal pregnancy (0.61%), cornual pregnancy (2.68%), cervical pregnancy (0.49%), heterotopic pregnancy (0.43%). (2) Through the χ test for trend, the ratio of caesarean scar pregnancy to ectopic pregnancy showed an upward trend (P = 0.005). From 2012 to 2015 and 2016-2019, the ratio of caesarean scar pregnancy to ectopic pregnancy increased from 5.74 to 11.81% (P < 0.001). (3) A total of 72.78% (246/338) caesarean scar pregnancy patients had one caesarean delivery, 25.15% (85/338) had two caesarean deliveries, and 2.07% (7/338) had three caesarean deliveries. A total of 80.18% (271/338) had aborted before. The most common clinical manifestations were amenorrhea (98.52%), abdominal pain (25.74%) and vaginal bleeding (67.76%), the most common sign was uterine enlargement (46.75%).
CONCLUSION
As the ratio of caesarean scar pregnancy increases, the caesarean delivery rate should be decreased to decrease the morbidity of caesarean scar pregnancy.
Topics: Cesarean Section; Cicatrix; Female; Humans; Pregnancy; Pregnancy, Ectopic; Uterus
PubMed: 35987835
DOI: 10.1186/s12978-022-01472-0 -
American Family Physician Jul 2014Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy-related deaths in the United States. When a pregnant patient presents with...
Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy-related deaths in the United States. When a pregnant patient presents with first-trimester bleeding or abdominal pain, physicians should consider ectopic pregnancy as a possible cause. The patient history, physical examination, and imaging with transvaginal ultrasonography can usually confirm the diagnosis. When ultrasonography does not clearly identify the pregnancy location, the physician must determine whether the pregnancy is intrauterine (either viable or failing) or ectopic. Use of the beta subunit of human chorionic gonadotropin (ß-hCG) discriminatory level, the ß-hCG value above which an intrauterine pregnancy should be visualized by transvaginal ultrasonography, may be helpful. Failure to visualize an intrauterine pregnancy when ß-hCG is above the discriminatory level suggests ectopic pregnancy. In addition to single measurements of ß-hCG levels, serial levels can be monitored to detect changes. ß-hCG values in approximately 99% of viable intrauterine pregnancies increase by about 50% in 48 hours. The remaining 1% of patients have a slower rate of increase; these patients may have pregnancies that are misdiagnosed as nonviable intrauterine or ectopic. After an ectopic pregnancy has been confirmed, treatment options include medical, surgical, or expectant management. For patients who are medically unstable or experiencing life-threatening hemorrhage, a surgical approach is indicated. For others, management should be based on patient preference after discussion of the risks, benefits, and monitoring requirements of all approaches.
Topics: Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Pregnancy; Pregnancy, Ectopic
PubMed: 25077500
DOI: No ID Found -
CMAJ : Canadian Medical Association... Oct 2020
Topics: Dilatation and Curettage; Female; Humans; Postoperative Hemorrhage; Pregnancy; Pregnancy, Ectopic; Ultrasonography; Uterus
PubMed: 33051317
DOI: 10.1503/cmaj.200181 -
BMJ Case Reports Nov 2021The etonogestrel implant is the most effective contraceptive available. We report a case of ectopic pregnancy in a woman who had an etonogestrel implant inserted 15...
The etonogestrel implant is the most effective contraceptive available. We report a case of ectopic pregnancy in a woman who had an etonogestrel implant inserted 15 months ago and the effective concentration of the implant was within normal limits.
Topics: Contraceptive Agents, Female; Desogestrel; Drug Implants; Female; Humans; Pregnancy; Pregnancy, Ectopic
PubMed: 34785516
DOI: 10.1136/bcr-2021-245175 -
The Journal of Obstetrics and... Mar 2017The aim of this study was to assay the clinical characteristics of persistent ectopic pregnancy (PEP) and its influence on ongoing pregnancy.
AIM
The aim of this study was to assay the clinical characteristics of persistent ectopic pregnancy (PEP) and its influence on ongoing pregnancy.
METHODS
We retrospectively reviewed 2498 patients who received salpingostomies as primary management for ectopic pregnancies from January 2004 to December 2009, using medical records and telephone inquiries. Clinical characteristics of the 52 patients (2.08%) who were diagnosed with PEP after salpingostomy were compared with those who received satisfactory treatment. The odds ratios and 95% confidential intervals were calculated for each variable by univariate and (for significantly different factors) multivariate analysis.
RESULTS
Preoperatively, patients with PEP after salpingostomy significantly differed from the non-PEP patients in gestational age, mass size and pelvic adhesiolysis. Serum β-human chorionic gonadotropin levels in PEP patients were monitored after surgery, which had declined by 28.31% on postoperative day (POD) 4, 40.22% on POD 7, 51.46% on POD 10 and 53.43% on POD 21. Repeat ectopic pregnancy (REP) tended to occur more frequently in PEP patients (PEP: 5 cases, 10.20%; non-PEP: 4 cases, 2.80%; P = 0.034). Multivariate analysis showed that pelvic adhesions and PEP were the strongest independent predictors of REP.
CONCLUSION
Gestational age, mass size and pelvic adhesions were significantly correlated with PEP. PEP was an independent prognostic factor for REP. However, a multicenter study is needed to support and extend our findings.
Topics: Adult; Chorionic Gonadotropin, beta Subunit, Human; Female; Gestational Age; Humans; Pelvis; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Salpingostomy; Tissue Adhesions; Treatment Outcome; Young Adult
PubMed: 28127836
DOI: 10.1111/jog.13251 -
Reproductive Sciences (Thousand Oaks,... Aug 2021Splenic ectopic pregnancy is extremely rare but carries a high risk of uncontrollable life-threatening bleeding. Our aim is to try to diagnose those cases earlier and to... (Review)
Review
Splenic ectopic pregnancy is extremely rare but carries a high risk of uncontrollable life-threatening bleeding. Our aim is to try to diagnose those cases earlier and to include splenic preservation as good alternative for selected cases. Extensive review of the literature has been performed. Thirty-one case reports were identified, of which 4 have been excluded because they were not written in English. A 36-year-old woman presented to the Emergency Department with haemorrhagic shock. Despite the levonorgestrel intrauterine system (LNG-IUS) being in situ for 4 months, urinary and serum tests were both positive for pregnancy, and an ultrasound scan revealed haemoperitoneum suggestive of a ruptured ectopic pregnancy. An emergency Pfannenstiel laparotomy was performed and a diagnosis of spontaneous tubal abortion was made and the abdomen was subsequently closed. Following a period of cardiovascular instability on the Intensive Care Unit postoperatively, an urgent CT scan was performed which revealed bleeding from the spleen. A midline laparotomy was performed by the general surgeon, which involved resection of the gestational sac and splenorrhaphy. Twenty-seven cases were reviewed, and 73% of them presented as an emergency and 21 cases (81%) had been managed with splenectomy. CT scan had been used in eight of the previous case reports of splenic ectopic pregnancy with 100% diagnostic accuracy rate. Non-tubal ectopic pregnancies are very rare. Splenorrhaphy is a safe alternative to splenectomy in cases of splenic ectopic pregnancy. CT abdomen and pelvis with intravenous contrast can be very helpful in relatively stable patients with a vaginal ultrasound demonstrating an empty uterus, no clear adnexal masses or free fluid.
Topics: Adult; Female; Humans; Laparotomy; Pregnancy; Pregnancy, Ectopic; Spleen; Treatment Outcome; Ultrasonography
PubMed: 33638134
DOI: 10.1007/s43032-021-00476-8 -
Scientific Reports Oct 2023Ectopic pregnancy (EP) is associated with high maternal morbidity and mortality. Ultrasonography is the only dependable diagnostic tool for confirming an ectopic...
Ectopic pregnancy (EP) is associated with high maternal morbidity and mortality. Ultrasonography is the only dependable diagnostic tool for confirming an ectopic pregnancy. In view of inadequate early detection methods, women suffer from a high-life risk due to the severity of EP. Early detection of EP using pathological/molecular markers will possibly improve clinical diagnosis and patient management. Salivary proteins contain potential biomarkers for diagnosing and detecting various physiological and/or pathological conditions. Therefore, the present investigation was designed to explore the salivary proteome with special reference to EP. Gel-based protein separation was performed on saliva, followed by identification of proteins using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). Totally, 326 proteins were identified in the salivary samples, among which 101 were found to be specific for ruptured ectopic pregnancy (EPR). Reactome analysis revealed innate immune system, neutrophil degranulation, cell surface interactions at the vascular wall, and FCERI-mediated NF-kB activation as the major pathways to which the salivary proteins identified during EPR are associated. Glutathione-S-transferase omega-1 (GSTO1) is specific for EPR and has been reported as a candidate biomarker in the serum of EPR patients. Therefore, saliva would be a potential source of diagnostic non-invasive protein biomarker(s) for EP. Intensive investigation on the salivary proteins specific to EP can potentially lead to setting up of a panel of candidate biomarkers and developing a non-invasive protein-based diagnostic kit.
Topics: Pregnancy; Humans; Female; Chromatography, Liquid; Proteome; Tandem Mass Spectrometry; Biomarkers; Pregnancy, Ectopic; Salivary Proteins and Peptides; Saliva; Glutathione Transferase
PubMed: 37803047
DOI: 10.1038/s41598-023-43791-7 -
Fertility and Sterility Dec 2014To assess 2004-2008 ectopic pregnancy rates among Medicaid recipients in 14 states and 2000-2008 time trends in three states and to identify differences in rate by...
OBJECTIVE
To assess 2004-2008 ectopic pregnancy rates among Medicaid recipients in 14 states and 2000-2008 time trends in three states and to identify differences in rate by race/ethnicity.
DESIGN
Secondary analysis of Medicaid administrative claims data.
SETTING
Not applicable.
PATIENT(S)
Women ages 15-44 enrolled in Medicaid in Arizona, California, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, New York, or Texas in 2004-2008 (n = 19,135,106) and in California, Illinois, and New York in 2000-2003.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
Number of ectopic pregnancies divided by the number of total pregnancies (spontaneous abortions, induced abortions, ectopic pregnancies, and all births).
RESULT(S)
The 2004-2008 Medicaid ectopic pregnancy rate for all 14 states combined was 1.40% of all reported pregnancies. Adjusted for age, the rate was 1.47%. Ectopic pregnancy incidence was 2.3 per 1,000 woman-years. In states for which longer term data were available (California, Illinois, and New York), the rate declined significantly in 2000-2008. In all 14 states, black women were more likely to experience an ectopic pregnancy compared with whites (relative risk, 1.46; 95% confidence interval, 1.45-1.47).
CONCLUSION(S)
Ectopic pregnancy remains an important health risk for women enrolled in Medicaid. Black women are at consistently higher risk than whites.
Topics: Black People; Female; Health Status Disparities; Humans; Medicaid; Pregnancy; Pregnancy Rate; Pregnancy, Ectopic; United States
PubMed: 25439806
DOI: 10.1016/j.fertnstert.2014.08.031 -
BMC Pregnancy and Childbirth Dec 2022Previous studies have shown that the incidence of ectopic pregnancy (EP) is increasing in China. It is unclear, however, whether the incidence of EP has changed after...
BACKGROUND
Previous studies have shown that the incidence of ectopic pregnancy (EP) is increasing in China. It is unclear, however, whether the incidence of EP has changed after the implementation of the universal two-child policy in the context of China's aging population and declining fertility rate.
METHODS
Data concerning EP from January 2011 to December 2020 were collected from the hospital's electronic medical records, which included the annual number of delivery, caesarean section rate, ectopic pregnancies, treatment of tubal pregnancy, and average costs and length of hospitalization. Trends of the EP incidence were analysed and annual percentage change (APC) was calculated using connected point regression analyses.
RESULTS
A total of 9499 cases of EP were collected, among which caesarean scar pregnancy (CSP) accounts for the second highest (6.73%). The EP per 100 deliveries revealed a downward trend, from 7.60% in 2011 to 4.28% in 2020 with an APC of -1.87 (P < 0.05). The maternal age was increased, especially after the implementation of the universal two-child policy. The constituent ratio for the advanced maternal age (≥ 35) and the caesarean section rate, but not the CSP, were also increased. Laparoscopic salpingectomy was the main surgical method, whereas the adoption of laparotomy and laparoscopic salpingostomy was decreasing year by year.
CONCLUSIONS
Although no obvious effect of the two-child policy on EP has been observed under the conditions of this study, the change in EP especially in advanced-age women after the policy implementation needs further evaluation. A decreased caesarean section rate, in primipara is beneficial to reducing the CSP.
Topics: Female; Pregnancy; Humans; Aged; Retrospective Studies; Cesarean Section; Fertility; Recurrence; Pregnancy, Ectopic
PubMed: 36496359
DOI: 10.1186/s12884-022-05269-8 -
Australian Family Physician Nov 2006Ectopic pregnancy is still the most common cause of first trimester maternal deaths, accounting for 73% of early pregnancy mortalities.
BACKGROUND
Ectopic pregnancy is still the most common cause of first trimester maternal deaths, accounting for 73% of early pregnancy mortalities.
OBJECTIVE
Detailed management will not be discussed in this review. However, risk factors for tubal ectopic pregnancy, ultrasound diagnosis and the benefits of early pregnancy units will be discussed.
DISCUSSION
All women in the reproductive age group who present to a general practitioner or hospital emergency department with lower abdominal pain, with or without vaginal bleeding, have an ectopic pregnancy until proven otherwise. A urinary pregnancy test is mandatory in this clinical situation and if positive, these women should then have a transvaginal--not transabdominal--ultrasound scan (TVS) performed. The diagnosis of ectopic pregnancy should be based on the positive visualisation of an adnexal mass using TVS rather than on the basis of a scan that fails to demonstrate an intrauterine gestational sac. Diagnosing the condition earlier in its natural history using TVS has changed management options and reduced the associated mortality, with collapse and subsequent emergency laparotomy being the exception rather than the rule in modern practice. Early pregnancy units have been shown to benefit women with early pregnancy complications, reduce unnecessary admissions, reduce costs and are an effective use of resources.
Topics: Female; Humans; Pregnancy; Pregnancy, Ectopic; Risk Factors; Ultrasonography
PubMed: 17099802
DOI: No ID Found