Clinical Presentation Of Ectopic Pregnancy Research Articles

Risk factors and clinical presentation of ectopic pregnancy in women attending a tertiary care hospital

Background: Ectopic pregnancy is one of the nightmare and a life threatening condition. The rising incidence of ectopic pregnancy in the past few years is due to a number of risk factors which include pelvic inflammatory disease and availability of better diagnostic techniques Objective: To study the ectopic pregnancy risk factors and their clinical presentation in ectopic pregnancy attending to a tertiary care center. Material and methods: It was a prospective study with 50 cases of ectopic pregnancy conducted in the Department of Obstetrics and Gynecology, in a Tertiary care Hospital for a period of 1 years were included. Detailed history suggestive of risk factors for ectopic pregnancy, menstrual and obstetric history was taken. General, systemic, abdominal and vaginal examination was done. SPSS (Version 22.0) was used for analysis. Results: A total of 2750 pregnancies were confirmed during the study period, of which 50 cases of ectopic pregnancies were diagnosed, giving an incidence of 1.8%. 84% of women were multigravidae and 16% were primigravidae.

Clinico-histopathological study of ectopic pregnancy in a tertiary care hospital with special focus on histomorphology of fallopian tubes in tubal ectopic pregnancy

Introduction: Ectopic pregnancy can present as an acute life‑threatening emergency when it ruptures and accounts for about 10% of all maternal mortalities; therefore, it is imperative to diagnose the unruptured ectopic pregnancy such that timely intervention will prevent morbidity and mortality. The fallopian tube is the most common site for ectopic pregnancy (90-95%). With an increasing incidence of ectopic pregnancy worldwide, a histopathological study of the resected fallopian tubes becomes important to look for predisposing/associated findings such as acute salpingitis, chronic salpingitis and salpingitis isthmica nodosa (SIN). Objectives: The aim was to study the clinical presentation of ectopic pregnancy and its association with various factors like age and gravida status. It also aims to study the histomorphology of the fallopian tubes with ectopic gestation and note the presence of predisposing factors such as acute salpingitis, chronic salpingitis and SIN. Materials and Methods: A total of 79 specimens of ectopic pregnancy received in Department of Pathology for a retrospective period of 2.5-years from January 2019 to May 2021 were reviewed.

Variance in clinical presentation of Ectopic pregnancy

Objective: To adjudge the prevalence of distinct presentations in ectopic pregnancy. Research Design: Descriptive cross-sectional. Place and Duration of Study: Emergency Labour Ward Department of Obstetrics & Gynecology, Nishtar Hospital Multan from 1.07.2017 to 31.12.2017. Methodology: Ninety five patients having positive pregnancy tests and uterine cavity with no intrauterine gestational sac on ultrasound were included. Clinical presentation like amenorrhea, vaginal bleeding, acute abdomen, shock or asymptomatic were assessed. Results: Amenorrhea observed in 73(76.8%) women, vaginal bleeding was seen in 32 (33.7%) women, 88 (92.6%) patients presented with acute abdomen and vitals instability was seen in 8 (8.4%) patients and 6(6.3%) patients were without symptoms. Conclusion: The two most common clinical presentations in patients included in study were amenorrhea and acute abdomen. Thorough evaluation of the patients with sub-acute or chronic presentation should be adopted to diagnose the cases of ectopic pregnancy. Key words: Ectopic pregnancy; Clinical presentation; Variations

Chronic Tubal Ectopic Pregnancy with Diagnostic Conundrum: A Case Report

Ectopic pregnancy is a life threatening condition and mostly ectopic pregnancies occurs in fallopian tube. The most common site of ectopic tubal pregnancy is ampulla. Ectopic pregnancy is a complication of pregnancy and usually easy to diagnose by ultrasonography during the first trimester of pregnancy. Due to limited healthcare resources in developing countries, women do not undergo for ultrasound examination during pregnancy which leads to late diagnosis. In most of cases women with ectopic pregnancy are asymptomatic, unless ruptured. The mean gestational age for clinical presentation of ectopic pregnancy is 7.2 weeks after the last normal menstrual period. In rural population, late presentations of ectopic pregnancies are more commonly seen because of lack of modern diagnostic ability. Present case report is a rare case of non-viable, unruptured, tubal ampullary chronic ectopic pregnancy of 12 weeks gestational age. Keywords: Ectopic pregnancy, Unruptured, gestational age, ultrasonography.

Ectopic pregnancy concomitant with borderline ovarian tumor

The most common clinical presentation of ectopic pregnancy is vaginal bleeding in the first trimester and abdominal pain. The existence of a borderline tumor concomitant to ectopic pregnancy has not been described in the literature. The study reported a patient with ectopic pregnancy undergoing surgical treatment, and during the procedure was found an ovarian cyst. Histopathology confirmed the diagnosis of borderline serous cystadenoma. The article demonstrates the need for anatomic-pathological investigation of ovarian cysts, and especially the surgical care in the approach of ectopic pregnancy concomitant with these cysts, since it can occur in women who still desire children, aiming at the maintenance of fertility.

A study on risk factors and clinical presentation of ectopic pregnancy

A study on risk factors and clinical presentation of ectopic pregnancy

A Retrospective Study on Risk Factors and Clinical Presentation of Ectopic Pregnancy

A Retrospective Study on Risk Factors and Clinical Presentation of Ectopic Pregnancy

Ectopic pregnancy—a diagnostic challenge in the emergency department

The aim of this study was to elucidate the clinical presentation of ectopic pregnancy in the emergency department and highlight the atypical presentations and pitfalls in its diagnosis. This was a 4-year retrospective descriptive study carried out at a tertiary teaching hospital. Two hundred and seven cases of ectopic pregnancy treated in a tertiary teaching hospital were reviewed. Among the risk factors, 4.9% had a history of tubal ligation. Two patients developed ectopic pregnancy while breastfeeding. Of the patients, 43.7% did not have the triad symptoms of lower abdominal pain, vaginal bleeding and amenorrhoea. One patient presented with rectal bleeding while three patients presented with epigastric pain and central abdominal pain instead of lower abdominal pain. All who had tachycardia (10.4% of all cases) had ruptured ectopic pregnancy. Of the cases, 30% and 49% did not have abdominal pain and rebound tenderness respectively; 37.5% had negative cervical motion tenderness; 3.1% and 2.6% of cases had negative urine HCG and plasma beta HCG tests respectively. Ultrasound missed 1.6% of ectopic pregnancies. Missed pregnancy, normal ultrasound study and diagnosis of other gynaecological conditions were reasons for the delayed diagnosis of 5.8% of cases. There was one mortality. Any female in the reproductive age group with syncope, abdominal symptoms or any of the components of the classical triad must have ectopic pregnancy excluded. Patients with normal ultrasound studies should have their serum beta HCG levels and ultrasound scans repeated until the condition can be completely excluded. Transabdominal or transvaginal ultrasound studies done within the emergency department would enable earlier diagnosis and management.

Interventions for tubal ectopic pregnancy.

The diagnosis of ectopic pregnancy can now often be made by non-invasive methods due to sensitive pregnancy tests (in urine and serum) and high resolution transvaginal sonography, which have been integrated in diagnostic algorithms. These algorithms, in combination with the increased awareness and knowledge of risk factors among both clinicians and patients, have enabled an early and accurate diagnosis of ectopic pregnancy. As a consequence, the clinical presentation of ectopic pregnancy has changed from a life threatening disease to a more benign condition. This in turn has resulted in major changes in the options available for therapeutic management. Many treatment options are now available to the clinician in the treatment of tubal pregnancy: surgical treatment, which can be performed radically or conservatively, either laparoscopically or by an open surgical procedure; medical treatment, with a variety of drugs, that can be administered systemically and/or locally by different routes (transvaginally under sonographic guidance or under laparoscopic guidance); expectant management. The choice of a treatment modality should be based on short-term outcome measures (primary treatment success and reinterventions for clinical symptoms or persistent trophoblast) and on long-term outcome measures (tubal patency and future fertility). In the treatment of tubal pregnancy various types of treatments are available: surgical treatment, medical treatment and expectant management. In this review the effects of various treatments are summarized in terms of treatment success, need for reinterventions, tubal patency and future fertility. The Cochrane Menstrual Disorders and Subfertility Group trials register and MEDLINE were searched. Randomized controlled trials comparing treatments in women with ectopic pregnancy. Trial quality was assessed and data extracted independently by two reviewers. Differences were resolved by discussion with all reviewers. Laparoscopic conservative surgery is significantly less successful than the open surgical approach in the elimination of tubal pregnancy due to a higher persistent trophoblast rate of laparoscopic surgery. Long term follow-up shows similar tubal patency rates, whereas the number of subsequent intrauterine pregnancies is comparable, and the number of repeat ectopic pregnancies lower, although these differences are not statistically significant. The laparoscopic approach is less costly as a result of significantly less blood loss and analgesic requirement, and a shorter duration of operation time, hospital stay, and convalescence time. Compared to laparoscopic conservative surgery (salpingostomy) local methotrexate is not a treatment option. Injection of this drug, both under laparoscopic guidance and under ultrasound guidance, is significantly less successful in the elimination of tubal pregnancy. Systemic methotrexate in a single dose intramuscular regimen is not effective enough in eliminating the tubal pregnancy compared to laparoscopic salpingostomy. This as a result of inadequately declining serum hCG concentrations after one single dose of methotrexate necessitating additional methotrexate injections or surgical interventions. If methotrexate primarily given in a multiple dose intramuscular regimen is compared with laparoscopic salpingostomy no large differences are found in medical outcomes, both short term and long term. However, this treatment regimen is associated with a greater impairment of health related quality of life and is more expensive, due to surgical interventions for clinical signs of tubal rupture, generating additional direct costs due to prolonged hospital stay. Furthermore, indirect costs due to productivity loss are higher. Only in patients with low initial serum hCG concentrations systemic methotrexate leads to costs savings compared to laparoscopic salpingostomy.

Endovaginal Sonography

The incidence of ectopic pregnancy (EP) has significantly increased over the past two decades. The clinical presentation of EP has also changed from that of a life-threatening condition requiring urgent surgery to that of a more benign disease. The combined use of a highly sensitive screening test (β-hCG) and a very accurate diagnostic imaging tool (endovaginal sonography) is partly responsible for the apparent increase in the prevalence of the disease by detecting EPs that would have otherwise spontaneously resolved. The increased awareness of clinicians to evaluate patients who are at high risk for EP and the high accuracy of endovaginal sonography (EVS) to recognize early, small EP have resulted in the new trend in the presentation of the disease. However, it should be emphasized that potentially up to one-fourth of EPs currently diagnosed by EVS can be managed expectantly. EVS is used to guide the transvaginal injection of methotrexate (MTX) or potassium chloride (KCL) into the hematosalpinx for the medical treatment of EP. EVS with color duplex may play a role in the prediction of the outcome of EP, based on the initial vascularity and the presence or absence of peritrophoblastic flow. An algorithm based on the combination of serum β-hCG levels and EVS has replaced diagnostic laparoscopy as the gold standard in the diagnosis of EP at our institution.

Ectopic Pregnancy

The diagnosis of ectopic pregnancy has become precise and reliable. Consequently, the management of ectopic pregnancy has progressed to the point where the physician is often able to preserve fertility. Therefore, conservative surgery is indicated if the patient desires future fertility and conditions are appropriate. The combination of ultrasound, beta-hCG pregnancy testing, and laparoscopy has led to a rising incidence of diagnosed ectopic pregnancy prior to rupture. This has greatly facilitated the use of the conservative approach to the management of tubal pregnancy. Although ectopic pregnancy can be diagnosed early and managed conservatively, it is, and will remain a potentially life-threatening disease and must be approached as such. Table 3 summarizes our proposed surgical management of tubal pregnancy. Table 4 summarizes the results of conservative surgery for tubal pregnancy.