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Ugeskrift For Laeger Apr 2020This review summarises the knowledge of abdominal ectopic pregnancy (AEP), which is a rare condition with higher morbidity and mortalilty than other types of ectopic... (Review)
Review
This review summarises the knowledge of abdominal ectopic pregnancy (AEP), which is a rare condition with higher morbidity and mortalilty than other types of ectopic pregnancies. The condition can be primary, if the pregnancy implants directly on to an abdominal site, or it can be secondary after a tubar abortion. AEP differs from tubal pregnancies by a normal level of human chorionic gonadotropin and rare vaginal bleeding, which causes a diagnostic delay. In an early pregnancy the treatment is laparoscopic removal, but in second and third trimester pregnancies laparotomy is preferred, if possible preceded by MRI for mapping of vascular involvement and location of placenta.
Topics: Abortion, Induced; Chorionic Gonadotropin; Delayed Diagnosis; Female; Humans; Pregnancy; Pregnancy, Ectopic; Pregnancy, Tubal
PubMed: 32286219
DOI: No ID Found -
Medicine Dec 2021Ectopic pregnancy (EP) is a common cause of acute abdominal pain in the field of gynecology. Because the majority of women with EP are hemodynamically stable,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ectopic pregnancy (EP) is a common cause of acute abdominal pain in the field of gynecology. Because the majority of women with EP are hemodynamically stable, non-surgical therapy is a viable option. The goal of this study was to determine the most effective non-surgical therapy for hemodynamically stable EP.
METHODS
We performed a systematic review and meta-analysis. We searched PubMed, LILACS, SciELO, CINAHL, Embase, and the Cochrane library in May 2020, with no starting date restrictions.Studies were restricted to randomized controlled trials, which were included if the target population contained women with tubal EP and the intervention was non-surgical management. The primary outcome measure was treatment success defined by a decrease in serum hCG to a level ranging from five mIU/mL to 50 mIU/mL. Secondary outcome measures were side effects, time needed to treat, number of injections and operative rate.
RESULTS
We conducted a meta-analysis of 15 studies that included 1573 women who were diagnosed with EP and managed non-surgically. There was no significant difference in treatment success in the matched groups; however, single-dose MTX was associated with fewer side effects than multiple-dose (relative risk 0.48, 95% confidence interval 0.28-0.80, P = .006) and two-dose therapies (relative risk 0.74, 95% confidence interval 0.55-1.00, P = .05).
CONCLUSIONS
We highly recommend that single-dose MTX without mifepristone be used first-line in patients who require conservative therapy due to the inherent negative effects of mifepristone. An EP woman with a low -hCG level that is falling or plateauing should receive expectant treatment to reduce adverse effects.
Topics: Adult; Female; Humans; Methotrexate; Mifepristone; Pregnancy; Pregnancy, Ectopic; Pregnancy, Tubal; Treatment Outcome
PubMed: 34918633
DOI: 10.1097/MD.0000000000027851 -
Reproductive Biology and Endocrinology... Jun 2021The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality.
PURPOSE
The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality.
METHODS
This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, β-human chorionic gonadotropin (β-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA).
RESULTS
The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10) that was diagnosed in the 7th gestational week. The only association found was between the β-HCG level and LOS, with a linear regression β coefficient of 0.01 and a P-value of 0.04.
CONCLUSION
EP is a relatively common condition affecting approximately 1% of all pregnancies. β-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.
Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Adult; Cesarean Section; Chorionic Gonadotropin, beta Subunit, Human; Douglas' Pouch; Female; Humans; Incidence; Intrauterine Devices; Laparoscopy; Length of Stay; Methotrexate; Middle Aged; Pregnancy; Pregnancy, Ectopic; Pregnancy, Heterotopic; Pregnancy, Ovarian; Pregnancy, Tubal; Reproductive Techniques, Assisted; Retrospective Studies; Risk Factors; Salpingectomy; Salpingostomy; Smoking; Young Adult
PubMed: 34059064
DOI: 10.1186/s12958-021-00761-w -
BMJ Clinical Evidence Feb 2012Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others... (Review)
Review
INTRODUCTION
Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others continue to grow and lead to rupture of the tube. Risks are higher in women with damage to the fallopian tubes due to pelvic infections, surgery, or previous ectopic pregnancy.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What treatments improve outcomes in women with unruptured tubal ectopic pregnancy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2011 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations, such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). The authors also separately searched Medline and Pubmed up to July 2011 in addition to the Clinical Evidence systematic search to support the comments and clinical guide sections.
RESULTS
We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: salpingotomy, salpingectomy, methotrexate, methotrexate following salpingotomy, methotrexate plus mifepristone, and expectant management.
Topics: Animals; Fallopian Tubes; Female; Humans; Incidence; Methotrexate; Pregnancy; Pregnancy, Ectopic; Pregnancy, Tubal
PubMed: 22321966
DOI: No ID Found -
Canadian Medical Association Journal Jul 1974In the last five years, laparoscopy has become increasingly popular in North America. The procedure has been mainly embraced by the gynecologist and its use in this... (Review)
Review
In the last five years, laparoscopy has become increasingly popular in North America. The procedure has been mainly embraced by the gynecologist and its use in this field has largely supplanted culdoscopy. Other specialties, nevertheless, have been slower in recognizing its value.The procedure has wide applications in gynecology. In pediatrics, laparoscopy proves useful in elucidation of amenorrhea, intersex and precocious puberty. In general surgery, laparoscopy has been recognized as a useful tool in the patient with multiple trauma, and in establishing the diagnosis of many intra-abdominal conditions.Numerous perlaparoscopic operative procedures which include biopsies and tubal sterilizations may be carried out by an experienced operator. Complications associated with the procedure are few, but may be severe. These can be avoided by careful adherence to proper technique.
Topics: Amenorrhea; Disorders of Sex Development; Endometriosis; Female; General Surgery; Gynecology; Humans; Hysterosalpingography; Infertility, Female; Intestinal Obstruction; Intrauterine Devices; Laparoscopy; Liver Diseases; Liver Neoplasms; Methods; Ovarian Neoplasms; Pediatrics; Pelvic Inflammatory Disease; Pelvic Neoplasms; Peritoneal Neoplasms; Pregnancy; Pregnancy, Tubal; Puberty, Precocious; Sterilization, Tubal; Turner Syndrome
PubMed: 4276392
DOI: No ID Found -
BMJ (Clinical Research Ed.) Nov 1990
Topics: Adult; Female; Humans; Pregnancy; Pregnancy, Tubal; Prognosis
PubMed: 2091635
DOI: 10.1136/bmj.301.6760.1057 -
Fertility and Sterility Jun 1988
The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions.
Topics: Adnexa Uteri; Adnexal Diseases; Fallopian Tube Diseases; Female; Fertility; Humans; Mullerian Ducts; Pregnancy; Pregnancy, Tubal; Societies, Medical; Sterilization, Tubal; Tissue Adhesions; United States; Uterus
PubMed: 3371491
DOI: 10.1016/s0015-0282(16)59942-7 -
Ugeskrift For Laeger Jul 2023In this case report, a woman with no risk factors was admitted with bilateral tubal ectopic pregnancy. Bilateral ectopic pregnancy is a rare clinical condition with...
In this case report, a woman with no risk factors was admitted with bilateral tubal ectopic pregnancy. Bilateral ectopic pregnancy is a rare clinical condition with clinical findings which in their symptoms do not differ from those of unilateral ectopic pregnancy. The condition can therefore easily be missed. The risk of rupture and haemorrhagic shock might be increased because of the increased danger of both tubes presenting with complications. Thus, it is important to examine both adnexa by transvaginal ultrasound. Even if unilateral ectopic pregnancy is considered before operation, the inspection of the abdomen, especially of the other fallopian tube, must always be done during surgery.
Topics: Pregnancy; Female; Humans; Pregnancy, Tubal; Pregnancy, Ectopic; Fallopian Tubes; Ultrasonography; Rupture
PubMed: 37539800
DOI: No ID Found -
BMJ Clinical Evidence Apr 2009Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others... (Review)
Review
INTRODUCTION
Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others continue to grow and lead to rupture of the tube. Risks are higher in women with damage to the fallopian tubes due to pelvic infections, surgery, or previous ectopic pregnancy.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What treatments improve outcomes in women with unruptured tubal ectopic pregnancy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). The authors also separately searched Medline and Pubmed up to May 2008 in addition to the Clinical Evidence systematic search to support the comments and clinical guide sections.
RESULTS
We found 47 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: salpingotomy, salpingectomy, systemic methotrexate, systemic methotrexate following salpingotomy, and expectant management.
Topics: Animals; Drug Administration Schedule; Fallopian Tubes; Female; Humans; Incidence; Methotrexate; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Pregnancy, Tubal; Salpingectomy
PubMed: 19445747
DOI: No ID Found -
Acta Clinica Croatica Feb 2022The objective was to investigate whether the method of treatment (surgical or medical) affects achieving a new pregnancy, as well as the time to and prognosis of the new...
The objective was to investigate whether the method of treatment (surgical or medical) affects achieving a new pregnancy, as well as the time to and prognosis of the new pregnancy, in women with ectopic pregnancy (EP). Information on patients treated in our hospital between 2013 and 2014 for EP was retrieved from the computerized patient records. Data on whether these patients achieved pregnancy after EP treatment, time from treatment to new pregnancy, and prognosis of pregnancy were collected by phone interviews. A total of 101 women were analyzed. In addition to descriptive analysis, the χ-test and Kruskal Wallis test were used to compare the groups. A new pregnancy was present in 84 (83.2%) of the women after EP treatment. There was no significant difference among the women having undergone medical treatment (methotrexate), surgical treatment, medical treatment followed by surgical treatment, or observational management approach in terms of achieving a new pregnancy after treatment and time to and prognosis of the new pregnancy. The study could not determine which treatment method would be superior in women with EP and in planning future pregnancy, but concluded that close clinical and laboratory monitoring is appropriate before deciding on aggressive interventions.
Topics: Female; Fertility; Humans; Pregnancy; Pregnancy, Ectopic; Pregnancy, Tubal; Prognosis; Recurrence
PubMed: 35282476
DOI: 10.20471/acc.2021.60.03.02