Early Detection Of Ectopic Pregnancy Research Articles

A Landscape View of the Female Genital Tract Microbiome in Healthy Controls and Women With Reproductive Health Conditions Associated With Ectopic Pregnancy.

Disruption of the female genital microbiome is associated with several pregnancy complications, including miscarriage, preterm onset of labour, and tubal pregnancy. Ectopic pregnancy is a known cause of maternal morbidity and mortality, but early diagnosis and treatment of ectopic pregnancy remain a challenge. Despite growing established associations between genital microbiome and female reproductive health, few studies have specifically focused on its link with ectopic pregnancy. Therefore, the current review aims to provide a comprehensive account of the female genital microbiome in healthy and fertile women compared to those in ectopic pregnancy and its associated risk factors. The microbial diversity from various sites of the female genital tract was explored for a reliable proxy of female reproductive health in sequencing-based ectopic pregnancy research. Our report confirmed the predominance of Lactobacillus in the vagina and the cervix among healthy women. The relative abundance decreased in the vaginal and cervical microbiome in the disease state. In contrast, there were inconsistent findings on the uterine microbiome across studies. Additionally, we explore a spectrum of opportunities to enhance our understanding of the female genital tract microbiome and reproductive conditions. In conclusion, this study identifies gaps within the field and emphasises the need for visionary solutions in metagenomic tools for the early detection of ectopic pregnancy and other gynaecological diseases.

Ectopic pregnancy: search for biomarker in salivary proteome

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.

Serum CA-125 as a predictor in the early diagnosis of ectopic pregnancy in Vietnam – A case-control study

IntroductionThis study aimed to determine the predictive value of cancer antigen-125 (CA-125) in combination with serum beta-human chorionic gonadotropin (β-hCG) and progesterone in the early detection of ectopic pregnancy (EP). MethodsBetween May 2019 and May 2020, the cross-sectional study recruited 42 cases of EP and 42 cases of IUP at the same gestational age who visited the Department of Obstetrics and Gynecology, Hospital of Hue University of Medicine and Pharmacy. EP was diagnosed based on surgical (laparoscopy) and postoperative pathology examination. ResultsThere were significant differences of mean level of β-hCG (2570 mUI/mL vs. 18357.7 mUI/mL), progesterone (10.79 ± 8.16 ng/ml vs. 27.42 ± 4.17 ng/ml) and CA-125 (26.90 ± 10.26 U/mL vs. 70.61 ± 20.89 U/mL) between the EP and the IUP groups (p < 0.001). In the prediction of early diagnosis of EP, the cut-off value of CA-125 at 30.94 U/mL has a sensitivity of 89.3% and a specificity of 87,9%; the cut-off value of β hCG at 2750mIU/ml has the sensitivity of 75%, specificity of 78,8%; the cut-off value of progesterone at 10.24 ng/mL has the sensitivity of 85.7%, specificity of 81.8%. A combination of CA-125, β hCG, and progesterone had a sensitivity of 92.8% and a specificity of 90.9% in early diagnosis of EP. DiscussionSerum CA-125 levels can be used independently or in combination with other markers in the early diagnosis of EP.

Strategies to improve the early detection and management of ectopic pregnancies in primary care

Even in the advanced era of today, maternal morbidity and mortality are quite high; however, most pregnancy-related complications can be successfully prevented by early diagnosis and timely management. The primary care setting is of utmost importance in this regard, as it is the first line of contact between patients and physicians, and regular antenatal care services are provided by most of primary care settings. Ectopic pregnancy is one of the most prevalent pregnancy disorders and is further associated with high-risk complications and mortality. The clinical manifestations may mimic non-ectopic pregnancy conditions, making it difficult to develop diagnostic standards. However, ultrasonography and human chorionic gonadotropin (β-hCG) levels can ensure early diagnosis. Conservative treatment is pursued since surgical management is linked to multiple significant side effects. In most situations, pharmacotherapy using methotrexate in a single- or multi-dose regimen is the preferred course of treatment. Performing ultrasonography as soon as a pregnancy is confirmed to determine the location of the pregnancy, monitoring β-hCG levels, and ensuring prompt referral in the event of a possible ectopic pregnancy that cannot be treated conservatively are all important ways that primary care settings can play a significant role in early diagnosis and prompt management. Additionally, obstetric ultrasonography training for family physicians can help in the early detection of ectopic pregnancy, which can lead to favourable results. The purpose of this research is to review the available information about strategies to improve the diagnosis and management of ectopic pregnancy in primary care.

The role of microRNAs in ectopic pregnancy: A concise review.

Ectopic pregnancy (EP) is reported in about 1%–2% of pregnant females and is associated with mortality and morbidity. Several genetic and environmental factors might modulate occurrence of EP. Prediction of EP and patients' follow-up is an important task in management of pregnancy. MicroRNAs (miRNAs) as non-coding RNAs with sizes between 21 and 24 nucleotides have been shown to regulate several aspects of implantation and early fetal life. They have potential role in early detection of EP especially considering their presence in body fluids such as serum. Assessment of their expression in serum might provide a noninvasive method for diagnosis and patients' follow-up. However, data regarding their role in EP is not sufficient due to small sample sizes of the studies. Future studies are required to find miRNAs that regulate expression of EP-associated genes such as VEGFA, EGFR, ESR1 and immune response-related genes to provide new diagnostic biomarkers for EP.

Management outcome of ruptured ectopic pregnancy at a secondary level of health care delivery in South-West, Nigeria

Background: Ectopic pregnancy is a condition of high morbidity and mortality with an enormous threat to life. Therefore it is of immensegynaecological importance, particularly in the developing world, where the majority of patients present late with rupture and haemodynamic instability.Objectives: The objectives of this study were to determine the incidence and analyze the clinical presentations, risk factors, sites of ectopic pregnancy and associated morbidity and mortality.Methods: This was a retrospective review of records of patients managed as cases of ruptured ectopic pregnancy at Our Lady of Apostle (O.L.A)Catholic Hospital, Ibadan over a six-year period between January 1st 2010 and December 31st 2015.Results: The incidence of ectopic pregnancy was 1.03% (65/6,342) of total deliveries, 2.9% (65/2280) of all gynaecological admissions and 13.5% (65/480) of gynaecological emergencies. Fifty-four case folders were analyzed. The leading symptom was pain 87.3% (47/54), followed by amenorrhea 60.0% (32/54), while syncope attack and vaginal bleeding had 50.0% (27/54) and 36.4% (19/54) respectively. Pelvic infection was the leading risk factor of57.4% (31/54) of the study population, followed by induced abortion 36.4% (19/54). Two patients had previous ectopic pregnancy; hence the recurrent rate was 3.7%. Tubal pregnancy accounted for 85% (46/54) while the abdominaland cornual gestation accounted for 2% (1/54) and 13% (7/54) respectively. All patients with tubal pregnancy had salpingectomy while those with cornual pregnancy had wedged resection. The diagnosis was missed in 18.2% (10/54) of patients. There was no record of maternal death.Conclusion: The fact that all cases were ruptured and that pelvic infection and induced abortion were the major risk factors, efforts should be made to improve on early detection of ectopic pregnancy before rupture and prevent pelvic infection and induced abortion among the women of reproductive age. Keywords: Ruptured ectopic pregnancy, secondary healthcare delivery, management outcome.

P066: Methotrexate in the management of suspected ectopic pregnancy

Introduction: Early detection of ectopic pregnancy and careful management is critical to prevent adverse clinical outcomes, including fallopian tube rupture and future decreased fertility, in patients presenting to the ED with symptoms suggestive of ectopic pregnancy. Methotrexate therapy is widely accepted as a first line treatment of ectopic pregnancy, with success rates greater than 90% if used according to published guidelines. This study aims to determine the outcomes of pregnant women who presented to the ED with suspected ectopic pregnancy whom received methotrexate as first line treatment. Methods: This was a retrospective chart review of pregnant (&lt;12 week gestational age) women from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule out ectopic pregnancy, or pregnancy of unknown location (PUL) over a 7 year period. Results: Of 612 included patients, 30 (4.9%) were diagnosed with a ruptured ectopic pregnancy at the index ED visit. Of the remaining 582 patients, 256 (44.0%) were diagnosed with an ectopic pregnancy at the index ED visit, the Early Pregnancy Clinic, or a subsequent ED visit. Of these patients diagnosed with ectopic pregnancy, their initial treatments at time of discharge from the index ED visit were as follows: 102 (39.8%%) received methotrexate, 132 (51.6%) underwent expectant management, and 22 (8.6%) underwent surgical management. Of the 132 patients discharged with an expectant management plan, only 42 (31.8%) had a final outcome of expectant management; the others went on to be treated surgically or with methotrexate. Of the 165 patients treated with methotrexate at index visit or in follow-up, 30 (18.2%) went on to require surgical management with 17 (10.3%) documented as having ruptured on surgical evaluation. Clinical characteristics of patients treated with methotrexate include the following: mean age 32.8 years (SD 5.7), gestational age of 6.2 weeks (SD 1.2) and serum beta human chorionic gonadotropin level of 2702 mIU/mL (SD 8800). Conclusion: The proportion of patients receiving methotrexate as first-line treatment that resulted in rupture or required further surgical management is higher than reported literature at this institution. Further investigation is needed to determine if there was a relationship between methotrexate failure and non-adherence to recommended guidelines. Given the risk of a possible rupture, patient education of these risks is critical on discharge from the ED.

MicroRNAs as Potential Serum Biomarkers for Early Detection of Ectopic Pregnancy.

Diagnosis of ectopic pregnancy relies on both ultrasound findings and human chorionic gonadotropin (hCG) measurements but due to the need for serial tests, tubal rupture and death represent major maternal and fetal risks. Early detection of ectopic pregnancy is essential and thus a noninvasive diagnostic tool seems crucial for the prevention of adverse effects since studies suggest there is a specific relationship between ectopic pregnancy and increasing microRNA factors. Human fluids in women with ectopic pregnancy reveal a particular change in comparison to healthy women. In addition to certain placental microRNAs circulating through plasma that present a specific concentration and serum profile, microRNAs seem to be possible biomarkers for the detection of pregnancy complications linked to placental pathologies. The aim of this study is to review current literature considering the expression levels of several circulating microRNAs that have shown to be novel potential biomarkers for the diagnosis of tubal ectopic pregnancy.

Persistent ectopic pregnancy and recurrent ectopic pregnancy in our institute

In recent years, improvements in diagnostic technology have enabled the early detection of ectopic pregnancy, and the opportunities for preserving the oviduct have increased, particularly as laparoscopic surgery has become the first-line choice for treatment of ectopic pregnancy in an increasing number of institutions. At our institution we use laparoscopic techniques to attempt oviduct preservation in patients with ectopic pregnancy who wish to become pregnant again. In this report, we examined the rates of persistent ectopic pregnancy and repeat ectopic pregnancy over a ten year period in patients who were treated laparoscopically with oviduct preservation. When compared with other treatments, we found a lower rate of persistent and recurrent ectopic pregnancy in women who were treated with oviduct-persevering laparoscopy. We conclude that laparoscopic surgery with oviduct preservation should be the therapy of choice for ectopic pregnancy when the patient still desires to get pregnant. However, a thoroughly informed consent detailing the risks of persistent and recurrent ectopic pregnancies must be a priority because of the high emotional toll of these complications.

Human choriogonadotrophin protein core and sugar branches heterogeneity: basic and clinical insights

Human chorionic gonadotrophin (hCG) is measured in serum and urine for the early detection of ectopic pregnancy, patients with higher risk of miscarriage, embryos or fetuses with chromosome abnormalities, prediction of pre-eclampsia or fetal growth restriction and identification or follow-up of trophoblast neoplasia. This review examines basic knowledge on the heterogeneity of hCG protein core and sugar branches and its relevance to assays used in a clinical setting. The databases Scielo and Medline/Pubmed were consulted for identification of the most relevant published papers. Search terms were gonadotrophin, glycoprotein structure, hCG structure and molecular forms of hCG. The synthesis of alpha (hCGalpha) and beta (hCGbeta) peptide chains and their further glycosylation involve the complex action of different enzymes. After assembly, hCG reaches the cell surface and is secreted as a bioactive heterodimer. The complex cascade of enzymes acting in hCG secretion results in heterogeneous molecular forms. The hCG molecules are differently metabolized by the liver, ovary and kidney, but the majority of hCG forms are excreted in the urine. Intact hCG, hCGalpha, hCGbeta, hyperglycosylated (hCGh), nicked (hCGn) and core fragment of hCGbeta (hCGbetacf) forms have relevant clinical use. The immunogenicity of each hCG variant, their epitopes distribution and the available antibodies are important for the development of specific assays. Depending on the prevalent form or proportion in relation to the intact hCG, the choice of assay for measurement of a specific molecule in a particular clinical setting is paramount. Measurement of hCG and/or its related molecules is useful in clinical practice, but greater awareness is needed worldwide regarding the use of new sensitive and specific assays tailored for different clinical applications.

Ectopic pregnancy: an update.

This review addresses recent publications that investigate etiology, epidemiology and different modalities in diagnosis and therapy for ectopic pregnancy. A significant proportion of recent work has focused in the development of new diagnostic tools to aid in the early detection of ectopic pregnancy. Diagnostic modalities have included systemic and local markers, vascular endothelial growth factor, vascular cell adhesion molecule-1, urokinase plasminogen activator receptor, cervical fetal fibronectin, and hormonal level determinations. In addition, magnetic resonance imaging, ultrasonography, color flow mapping and endometrial thickness have been evaluated. New studies have investigated controversial issues related to the cost of the medical versus surgical treatment and the use of different medications and techniques for the management of ectopic pregnancy. Most important of all, several lines of investigation have addressed the use of human chorionic gonadotropin, algorithms, and scoring systems as prognostic indicators of successful therapy and to determine the risk of complications. The management of cervical, interstitial and heterotopic pregnancy is evaluated in this review and a summary of recent proposed diagnostic tools and concepts in management is also presented.

P146Early detection of ectopic pregnancy with ultrasound

ObjectiveTo determine if the typical appearance of endometrium for late proliferative phase and early secretary phase could be used as a patognomonic sign for early detection of ectopic pregnancy in combination with other patognomonic signs for ectopic pregnancy.MethodsOver a period of four 76 patients were admitted at our department as a result of suspicion of ectopic pregnancy.ResultsIn three patients out of those 76 at the time of admission ectopic pregnancy was not visible neither on ultrasound nor on laparoscopy. One of them was a cervical pregnancy, and two others were cornual pregnancies. Sixty‐six patients have had tubar abortions, including two pregnancies with live embryo in the tube.ConclusionTypical late endometrial look for late proliferative phase and early secretary phase can be used as a patognomonic ultrasound finding for ectopic pregnancy especially in combination with other patognomonic ultrasound findings and in combination with serum progesterone measurement.

Early detection of ectopic pregnancy visualizing the presence of a tubal ring with ultrasonography performed by emergency physicians

Early diagnosis of ectopic pregnancy (EP) continues to be problematic for emergency physicians. With the increasing availability of endovaginal ultrasonography (EVS) for emergency physicians, recognizing additional EVS findings, ie, the presence of a tubal ring, in patients with risk factors or clinical presentation for EP can assist the emergency physician in diagnosing EP. (Am J Emerg Med 2000;18:444-448.

Endovaginal color Doppler sonographic evaluation of ectopic pregnancy in women after in vitro fertilization and embryo transfer.

The aim of this study was to evaluate the value of endovaginal color Doppler ultrasonography in the early diagnosis of ectopic pregnancy in women after in vitro fertilization and embryo transfer, and to correlate the sonographic findings with ss-hCG serum levels. Thirty-five patients had proven ectopic pregnancies and 4 other patients had heterotopic pregnancies. The diagnosis was disclosed correctly in all cases by endovaginal color Doppler US by identifying an adnexal mass with placental flow and a nongravid uterus called a "cold uterus". An intrauterine sac with "double ring sign" was found in all normal intrauterine pregnancies when the hCG levels exceeded 1000 IU/l but in none of the patients with ectopic pregnancy (EP). These findings suggest the efficacy of the discriminatory hCG serum level of 1000 IU/l in the investigation of EP. In conclusion, this study describes the diagnostic importance of transvaginal color Doppler US in correlation with hCG serum levels in the early detection of EP avoiding life-threatening complications and improving patient outcome.

PELVIC ULTRASONOGRAPHY

Pelvic ultrasonography is a valuable tool for the emergency physician in the evaluation of the wide spectrum of pelvic complaints presenting to the emergency department. The goal of this article is to outline pelvic problems that can be readily identified by the emergency physician using pelvic sonography early in the patient's evaluation. A special emphasis is placed on the sonographic diagnosis of ectopic pregnancy.

Evaluation of serum creatine kinase levels in ectopic pregnancy

To analyze whether increased serum creatine kinase (CK) levels are useful in early detection of ectopic pregnancy (EP). Prospective cohort study. Patients in a university-based reproductive endocrinology and infertility practice. Infertile women who achieved clinical pregnancy. Serum CK with isoenzymes levels were drawn after sonographic evaluation in patients achieving clinical pregnancy. Comparison of serum CK levels in patients with EP versus those with normal and abnormal intrauterine pregnancy (IUP), both separately and together as one group. There was no significant difference in mean total CK levels for patients with EP (82.25 +/- 81.39 IU/L; conversion factor to SI unit, 1.00) versus normal IUP (62.54 +/- 44.79 IU/L), abnormal IUP (55.15 +/- 3.46 IU/L), or all IUP (60.87 +/- 40.72 IU/L). The mean gestational ages were similar in all three groups: EP, 46.78 +/- 6.65 days; normal IUP, 47.56 +/- 8.29 days; and abnormal IUP, 47.86 +/- 13.30 days. Serum CK levels do not help to predict EP for infertility patients achieving conception. To assist in preventing maternal morbidity, a more discriminative test is needed to identify this condition early in gestation.

Vaginal Sonography and a Positive Serum hCG Test for Early Detection of Ectopic Pregnancy

SummarySummaryA transvaginal scan was performed on 53 women with suspected ectopic pregnancy and a positive serum hCG. In 22 patients, ectopic pregnancy was correctly ruled out, and the diagnosis of ectopic pregnancy was proved at laparotomy in 30 patients. Only one false positive diagnosis was made. The sensitivity of diagnosis of ectopic pregnancy with transvaginal ultrasound was 100 per cent and the specificity was 96 per cent. The positive and negative predictive values of this approach were 97 and 100 per cent respectively. Laparoscopy was avoided in 12 patients (51 per cent) with early intra-uterine pregnancies and corpus luteum cyst complications. The addition of transvaginal ultrasound scan as an aid in the management of ectopic pregnancy gives improved accuracy of pre-operative diagnosis, reduces the number of unnecessary laparoscopies and allows the potential for use of non-surgical methods of treatment.

Early detection of ectopic pregnancy by transvaginal ultrasound

Transvaginal (TVU; 19 patients) and transabdominal ultrasound (TAU; 24 patients) were compared in their ability to visualize an ectopic pregnancy. The direct visualization of ectopic pregnancy (EUP) was 25% with TAU and 94.7% with TVU. All women had a proven EUP in laparoscopy. TAU approach showed a significant inferiority (P less than 0.02) and TVU a superiority (P less than 0.08) in comparison to clinical examination. 83% of 43 women had spotting. Nonspecific signs for EUP like fluid in the pouch of Douglas was seen in 20.9%. Thin endometrium was seen in 6.9%, in 37.2% the thickness of endometrium was under 10 mm, in 55.8% more than 10 mm. An intrauterine pseudogestation sac was detected in 6.9%, corpus luteum formation in 37.2%.

Serial β-hCG measurements in the early detection of ectopic pregnancy: Shepherd RW, Patton PE, Novy MJ, et al Obstet Gynecol 75:417–420 Mar 1990

Serial β-hCG measurements in the early detection of ectopic pregnancy: Shepherd RW, Patton PE, Novy MJ, et al Obstet Gynecol 75:417–420 Mar 1990