Early Diagnosis Of Ectopic Pregnancy Research Articles

Lactate plasma level as a potential biomarker in early diagnosis of ectopic pregnancy: A case-control survey.

A novel metabolomics survey proposed lactic acid as a diagnostic biomarker to detect ectopic pregnancy (EP). Here we investigate the plasma level of lactate for early diagnosis of EP as a potential biomarker. In a case-control study, the reproductive aged women with definite tubal EP (6-10 weeks' gestation), referred to our department during 2021-2022, considered as case group, and women with normal singleton pregnancy in the same gestational age as control group. After informed concept, demographic data (maternal and gestational age and parity) recorded and 5 mL venous blood samples were taken to detect the lactate plasma level. The data analyzed using SPSS software ver22. Finally, 95 participations (50 in case and 45 in control group) enrolled. The clinical results showed that the most of case group were aged more than 35 years old with had higher parity and body mass index, but, no statistically significant difference showed up. On the other hand, although the lactate level was slightly higher in women with EP, but, the plasma lactate level did not statistically differ between the two study groups. Also, the logistic regression showed no relationship between the demographic variables and the lactate plasma level. It seems that the plasma level of lactate cannot be a diagnostic biomarker for EP.

Role of creatine phosphokinase as a diagnostic marker in tubal ectopic pregnancy.

Ectopic pregnancy (EP) is still one of the leading preventable causes of maternal morbidity and mortality in the first trimester. Amidst the use of sensitive assays for β-HCG and high-definition ultrasonography for the identification of EP, the search for a more reliable and sensitive marker remains a challenge till date. Our aim was to determine the validity of creatine phosphokinase (CPK) and its isoenzyme (CPK-MB) in the prediction of tubal EP. A prospective and comparative diagnostic accuracy study was conducted among 105 pregnant women in the first trimester who met the eligibility criteria in the Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS). The study included 35 patients each with tubal EP (EP), abortive intrauterine pregnancy (AP), and normal intrauterine pregnancy (NP). CPK, CPK-MB, and β-HCG were measured among all the participants, and the participants were followed up longitudinally. A total of 105 pregnant women were included. The mean CPK and CPK-MB levels were significantly higher among the women with EP when compared to NP (P < 0.05) and AP (P < 0.05) women; however, there was no significant difference between the NP and AP groups (P > 0.05). Moreover, the receiver operating characteristic (ROC) curve showed that both CPK and CPK-MB were good predictors of EP, with CPK (area under the curve [AUC] = 0.764) being a better predictor than CPK-MB (AUC: 0.650) in the diagnosis of EP. Early diagnosis of EP allows appropriate and timely management, which would not only reduce mortality and morbidity associated with the condition but also enable preservation of fertility and improve future pregnancy outcome. Hence, the need of the hour is a reliable biochemical diagnostic marker for EP, such as CPK.

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.

Early diagnosis of ectopic pregnancy using modern medical imaging techniques: prospective study

INTRODUCTION: The algorithm for diagnosing ectopic pregnancy (EP), including b-chorionic gonadotropin in the blood and ultrasound of the pelvic organs, does not allow detecting its localization in the next 7 days after treatment in 10% of women.OBJECTIVE: Тo improve the algorithm of diagnostics of EP by correcting the ultrasound protocol, as well as adding MRI studies.MATERIALS AND METHODS: 290 patients with suspected EP, of which 278 were operated on. Women were divided according to menstrual delay: up to 6 weeks (Group 1, n=119), 6–9 weeks (Group 2, n=135), more than 9 weeks (Group 3, n=36). Ultrasound studies were performed in dynamics up to 144 hours on the VOLUSON-730 expert (GE); MR studies — on a 1.5T tomograph «Magnetom Avanto» (Siemens). Statistics: Statistical analysis of the study results was performed using the Statistica for Windows 10.0 software package (StatSoft, Inc., USA).RESULTS: Ultrasound symptoms of EP: group 1 (n=94) — ectopic fetal egg (EPO) and tubal ring (TC) 5 times more often than hematosalpinx (HS) and heterogeneous adnexal formation (NPO) (χ12=14.28; p=0.0002 and χ22=13.75, р=0.0003); 2 (n=116) — EPO and TC 3 times more often than GS (χ121=4.8; р12=0.028 and χ222=8.1; р22=0.004) and NPO (χ12=6.65; р1=0.009 and χ22=10.4; р2=0.001); 3 (n=31) — TC and NPO more often than EPO (χ12=8.00; p1=0.004; χ22=14.28; p2=0.0002). Ultrasound is not informative: group 1 — more than half of the cases; 2 — 24.5%; 3 — 65% of cases. In pregnancies of unknown location (PUL, n=30), MR patterns of EP were studied : in 1⁄3 of cases, progressive early EP was found, in 1⁄3 — undilated fallopian tubes, and in 1⁄3 of cases of HS. Sensitivity of ultrasound in relation to EP: group 1 — 42%; 2 — 76.5%; 3 — 35%; it depends on the period of menstrual delay (r=0.507, p=0.01).DISCUSSION: In PUL, MRI is indicated for all patients who have a menstrual delay of more than 6 weeks, regardless of the level of b-HCG in their blood, and with a menstrual delay of up to 6 weeks, only if the increase in b-HCG in the blood is less than 50% of physiological values.CONCLUSION: The inclusion of MRI in the algorithm for diagnosing EP increases its sensitivity and specificity to almost 100%, regardless of the period of menstrual delay.

Ectopic pregnancy with implanted gestational sac in the cesarean scar

Introduction: Implantation of a pregnancy in the cesarean scar is considered a rarest presentation of ectopic pregnancy with high morbidity and mortality. The use of imaging tests is capable of early diagnosing such cases and assisting in the management of pregnancy. The present article reports two cases of ectopic pregnancy in the cesarean scar, illustrating the main aspects in ultrasound tomography (UST) and magnetic resonance imaging (MRI) exams. In addition, a bibliographic search was carried out in a database that presented data about this clinical condition. Case Series: Case 1: A 44-year-old patient, without comorbidities, G2P1cA0, with a pregnancy of 9w4d, admitted with bleeding for 03 days. Ultrasound tomography showed a single gestational sac with an embryo of anomalous morphology, with no heartbeat and in isthmic topography, in an exophytic position, over the topography of a scar from a previous cesarean section. The initial diagnosis was placental accreta. After MRI of the pelvis, an ectopic pregnancy with a gestational sac implanted in the cesarean section scar (type II—exogenous), with signs of trophoblast/placental accreta. Case 2: A 30-year-old patient, without comorbidities, G2P1c, with a 7w3d pregnancy, with abdominal pain. Ultrasound tomography showed a single gestational sac with a gestational sac implanted in the cesarean section scar, transmural type I (endogenous), which was later confirmed by pelvic MRI. Conclusion: It is necessary to highlight the importance of early diagnosis of ectopic pregnancy with implantation in a cesarean scar, given the possibility of making an appropriate therapeutic decision depending on the clinical context, aiming to reduce the possible complications of the condition.

The Utility of Monitoring Beta-Human Chorionic Gonadotropin Levels in an Ectopic Pregnancy.

Ectopic pregnancy, a rare complication involving embryo nidation outside the uterus, significantly impacts women's lives worldwide. About 95% of ectopic pregnancies occur in the Fallopian tubes. If not diagnosed early, the patient may suffer from tubal rupture, resulting in hemorrhage and lethal consequences. Transvaginal ultrasound (TVUS) is typically used to diagnose an ectopic pregnancy. However, over the last decade, monitoring beta-human chorionic gonadotropin (β-hCG) levels in ectopic pregnancy have evolved to detect ectopic pregnancy. But there are inconsistencies in its utility in monitoring or diagnosing ectopic pregnancy in clinical practice. This systematic review highlights the potential of monitoring β-hCG levels to accurately diagnose ectopic pregnancy. Furthermore, it showcases if β-hCG levels can determine effective treatment options to successfully resolve an ectopic pregnancy. We performed a literature search between January 2022 through December 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The clinical evidence demonstrated that monitoring β-hCG levels, combined with TVUS, accurately diagnosed an ectopic pregnancy. Moreover, pre-treatment β-hCG levels higher than 5000 international units per liter (IU/L), statistically significant, indicated surgical management for a successful resolution of an ectopic pregnancy. Whereas lower β-hCG levels showed successful management through expectant and methotrexate treatment. Interestingly, patients who failed non-surgical treatment developed increased β-hCG levels and required surgical intervention. However, there was conflicting evidence on whether β-hCG levels could indicate tubal rupture. Nevertheless, as highlighted in this review, monitoring β-hCG levels could be crucial in the early diagnosis of ectopic pregnancy. Besides, it might significantly aid in monitoring and deciding on effective treatment options for patients with ectopic pregnancy, which could be vital to saving their lives and preserving fertility.

Identification of noninvasive diagnostic biomarkers for ectopic pregnancy using data-independent acquisition (DIA)proteomics: a pilot study

At present, the diagnosis of ectopic pregnancy mainly depends on transvaginal ultrasound and β-hCG. However, these methods may delay diagnosis and treatment time. Therefore, we aimed to screen for serological molecular markers for the early diagnosis of ectopic pregnancy (EP).Using data-independent acquisition (DIA)proteomics, the differential proteins in serum were selected between the intrauterine pregnancy (IP) and EP groups. Then, the expression levels of these differential proteins were measured by enzyme-linked immunosorbent assay. The diagnostic value of the serum biomarkers was evaluated by receiver operating characteristic curve analysis.GSTO1, ECM-1 and β-hCG showed significant differences between the EP and IP groups (P < 0.05). The combination of GSTO1/ECM-1/β-hCG had an area under the curve of 0.93 (95% CI 0.88–0.99), a sensitivity of 88.89% (95% CI 73.94–96.89) and a specificity of 86.11% (95% CI 70.50–95.33) with a likelihood ratio of 6.40.The combination of GSTO1/ECM-1/β-hCG may be developed into a possible approach for the early diagnosis of EP.

A 10-Year Review of Methotrexate Treatment for Ectopic Pregnancy in a Malaysian Tertiary Referral Hospital.

Background Ectopic pregnancy was recorded as the fourth principal cause of maternal death in Malaysia in 2019. Early diagnosis and use of methotrexate treatment proved to be safe and effective alternatives to surgical treatment. This study investigates the success rate of methotrexate treatment for ectopic pregnancy in a tertiary hospital in Malaysia. Methods This was a retrospective review of 73 patients with ectopic pregnancies treated with methotrexate according to a single-dose protocol from January 2009 until November 2019. The diagnosis of ectopic pregnancy was made using a combination of transvaginal scan and serial serum β-hCG levels. Their clinical and demographic data were reviewed. Serum β-hCG levels were measured at pre- and post-treatment to determine the rate of successful resolution. Results The overall success rate was 87.7% (64/73 patients) with methotrexate treatment. Fifty-six patients (76.7%) were successfully treated with a single dose of methotrexate, and eight patients (11.0%) required a second dose of methotrexate. There was no relation between socio-demographic, pre-treatment β-hCG levels, ectopic mass size, and treatment efficacy. Smaller size of ectopic pregnancy (adjusted OR=29.23; 95% CI: 2.69, 317.90; P=0.006) and absence of free fluid at the pouch of Douglas (POD) (adjusted OR=27.31; 95% CI: 2.84, 262.32; P=0.004) was found to increase the likelihood of overall treatment success. Absence of fetal cardiac activities was found to increase the likelihood of first-dose methotrexate treatment success (OR=10.20; 95% CI: 1.93, 53.79; P=0.006). Conclusions Early diagnosis of ectopic pregnancy may reduce morbidity and mortality. In carefully selected cases, methotrexate treatment has been proven to be cost-effective and avoided risks associated with surgery and anaesthesia.

Comparison of the Value of Transvaginal Ultrasound and Abdominal Ultrasound in the Early Diagnosis of Ectopic Pregnancy

Comparison of the Value of Transvaginal Ultrasound and Abdominal Ultrasound in the Early Diagnosis of Ectopic Pregnancy

The Use of Beta-Human Chorionic Gonadotropin (β-hCG) Levels as a Predictor of Successful Medical Management of Ectopic Pregnancy.

ObjectivesThe early diagnosis of ectopic pregnancy is essential in determining the appropriate therapeutic approach. This study demonstrates the important factors considered in the prediction of a successful medical treatment, which will, in turn, improve the quality of patient counseling and guidance prior to the initiation of the treatment.MethodsThis was a retrospective cohort study of 58 ectopic pregnancies that were treated medically with methotrexate in Bahrain Defense Force (BDF) Hospital from January 2016 to January 2021. All patients that were offered medical treatment of ectopic pregnancy and completed the follow-up were included in the study. StatsDirect software was used to analyze the baseline characteristics of the successful and failed medical treatment of ectopic groups. Simple linear regression was used to correlate initial beta-human chorionic gonadotropin (β-hCG) levels and the drop of β-hCG levels after one week of medical treatment.ResultsPatients were divided into two outcomes: the primary outcome represented in the successful treatment group, 68.9% (40/58), and the secondary outcome represented in the unsuccessful treatment group 31% (18/58). The mean β-hCG level in the successful group was significantly lower than that of the unsuccessful treatment group (1403.6±1421 IU/L versus 2845.1±1705 IU/L, p=0.001). There were no differences between the two groups with regards to the size of the adnexal mass, presence of gestational sac, or size of the gestational sac. The cut-off value of the initial β-hCG level for successful medical treatment was 2,141 IU/L, with 72% sensitivity, 75% specificity, and receiver operator curve (ROC) of 0.76 [95% confidence interval (CI) = 0.63 to 0.89)]. The cut-off value of β-hCG fell between day four and day seven and was 37.2%, with 78% sensitivity, 68% specificity, and a ROC curve of 0.72 (95% CI = 0.55 to 0.89).ConclusionThis study found that low initial β-hCG levels can be used to predict successful methotrexate treatment of ectopic pregnancy. In this cohort of patients, the cut-off level of initial β-hCG for successful treatment was 2141 IU/L.

Medical management of ectopic pregnancy with two different regimens of methotrexate: A comparative study

Background: The timely and early diagnosis of ectopic pregnancy has made medical management of ectopic pregnancy the preferred treatment. Methotrexate is used in various regimens to treat ectopic pregnancy. A study was carried out to compare the effectiveness of double-dose and single-dose methotrexate regimen in medical management of unruptured ectopic pregnancy. Materials and Methods: The study included 80 hemodynamically stable patients with unruptured ectopic pregnancy. They were then randomly assigned in to two groups. Group A patients received two doses of methotrexate 50 mg/m2 on day 1 and day 4 whereas group B patients received single dose 50 mg/m2 methotrexate on the day 1. Serum β human chorionic gonadotropin (β-hCG) and blood parameters were measured in both the groups on day 4 and day 7 followed by serial serum β-hCG weekly till negative value was obtained. Outcome measures were success rate of treatment, need for extra dose of methotrexate, need of laparotomy, and side effects of methotrexate. Results: The two groups were comparable in demographic parameters, baseline serum β-hCG, and blood parameters. The treatment success rate was slightly more in group A (70%) than group B (65%); however, it was statistically insignificant. Need of extra dose of methotrexate was 5% in group A and 17.5% in group B, respectively. Ten patients in group A and seven patients in group B underwent laparotomy for rupture of the ectopic mass. The reported side effects of methotrexate was comparable in both the groups. Conclusion: Study shows that double-dose methotrexate is as effective as single dose in the medical management of ectopic pregnancy. It has slightly better success rate though statistically insignificant, with less need for extra dose and less duration of follow-up.

Effect of Transvaginal Color Doppler Ultrasonography and Transabdominal Ultrasonography in the Early Diagnosis of Ectopic Pregnancy

Effect of Transvaginal Color Doppler Ultrasonography and Transabdominal Ultrasonography in the Early Diagnosis of Ectopic Pregnancy

Risk Factors for Ectopic Pregnancy: A Case-Control Study in Tertiary Care Hospitals of Jammu and Kashmir

Introduction: An ectopic pregnancy occurs when a fertilized egg attaches somewhere outside the uterus.There are many risk factors for ectopic pregnancy. This study will help us to prepare a list of risk factors associated with ectopic pregnancy in our state. In addition, it will help implement a risk-reduction counseling program before conception, which will help us screen high-risk patients and reduce and manage ectopic pregnancy. Materials and methods: The present study was conducted in our department for two years, from August 2018 to July 2019. Cases included all patients with ectopic pregnancy admitted in labor. A total of 192 cases were taken, out of which 8 cases refused to participate in the study, so 184 patients were included in the study. Results: Patients with previous ectopic pregnancy have 6.34 times increased risk of a repeat ectopic pregnancy (odds ratio 6.34, confidence interval 1.40-28.77), and this association was highly significant (p = 0.006). The risk of ectopic pregnancy is 3.02 times increased (odds ratio 3.10; 95% confidence interval, 1.16-7.84) if the patient once had the pelvic inflammatory disease and is statistically significant (p = 0.01). The study also revealed that 17 (10.3%) patients with ectopic pregnancy had a history of tubal ligation or some other tubal surgery done in the past compared to 3 (2.2%) patients among controls, and this finding is statistically highly significant (p = 0.001). Conclusions: In the present study, we found that the main risk factors for incidence of ectopic pregnancy are prior ectopic pregnancy, prior tubal ligation, and prior pelvic/abdominal surgery. In addition, ectopic pregnancy was positively related to the previous history of ectopic pregnancy, abortion, cesarean section, and infertility. These findings can be helpful for early diagnosis of ectopic pregnancy to pursue proper medical therapy instead of unnecessarily surgical treatment.

ECTOPIC PREGNANCY SOCIAL MEDIA SUPPORT: AN ANALYSIS OF CONTENT AND ACCURACY OF FACEBOOK GROUPS FOR WOMAN EXPERIENCING ECTOPIC PREGNANCIES

Ectopic pregnancies (EP) occur in 2% of all pregnancies (1). Early diagnosis of ectopic pregnancy is imperative to reduce complications caused by a rupture or even death (2). Coping with an early pregnancy loss, and potentially loss of portions of the reproductive system, is a very emotional experience for a woman (2). In the current climate of social media use, there is evidence that women use social media groups for support, as well as seeking medical advice (3). There is little evidence as to what women are gaining from these groups.

Sonographic Diagnosis of Bilateral Tubal Pregnancies

Bilateral tubal pregnancy (BTP) is a very rare form of ectopic twin gestation. Many times, they occur after the use of assisted reproductive therapy. Most cases of BTP are diagnosed during laparoscopy. This case report demonstrates a rare preoperative, sonography diagnosis of a spontaneous BTP which occurred after a tubal ligation. The sonogram revealed two corpus luteal cysts, both located on the right ovary, which suggests that the left tubal pregnancy most likely occurred as a result of ovum transmigration. This case demonstrates the important role that sonography plays in the early diagnosis of ectopic pregnancies as well as the importance of thoroughly examining the entire pelvis during a pelvic sonogram.

Rapid β-human chorionic gonadotropin detection in urine with electric-double-layer gated field-effect transistor biosensors and a handheld device.

In this experimental study, a portable biosensor was developed to detect β-human chorionic gonadotropin (β-hCG), which is extensively used in pregnancy tests and serves as a biomarker for ectopic pregnancy. The sensor used is an electric-double-layer field-effect transistor biosensor with the extended-gate design. Bias voltage is applied on the sensor to measure the resulting drain current signals. Gold electrode surface is functionally activated with an anti-β-hCG antibody to capture β-hCG protein. Fluorescence imaging technique is utilized to confirm the surface functionalization. The biosensor demonstrates a dynamically wide range of molecules as detection targets at very low sample concentrations, which shows the potential to detect ectopic pregnancy in very early stages and easily keep track of its periodic changes. It can be produced en masse and does not use additional labels/reagents or pre-processing techniques for the sample. This biosensor can significantly reduce the manufacturing costs and is comparable with the currently available commercial ß-hCG assays. It is suitable for early diagnosis of ectopic pregnancy with low cost and easy operation at home with urine samples.

Clinical Study of Ectopic Pregnancy in Nepal

Introduction: Ectopic pregnancy is a global problem yet many women are unaware of this condition. In a low- income country like Nepal, women don’t seek timely antenatal care so early diagnosis of ectopic pregnancy becomes a challenge in our setting. Ectopic pregnancy if left untreated can result in maternal morbidity and mortality. Objective: The study was carried out to find out the incidence of ectopic pregnancy as well as to elucidate risk factors in such women which will help in identifying the high risk groups and making them aware about the condition. Methods: This hospital based observational study was carried out retrospectively between May 1, 2019 to April 30, 2020 in Gandaki Medical College. All confirmed 33 cases of ectopic pregnancy were included in the study. The total number of deliveries during this period was obtained from the labor ward registers. Data were analyzed usingdescriptive statistics. Results: In the present study, the incidence of ectopic pregnancy was 1.5%. Most ectopic pregnancies were in the age group 21-25 years and 31-35 years with 81.8% women being multiparous. 36.36% of ectopic pregnancies had gestational age of more than 8 weeks. Use of emergency pills and medical abortion were the most common identifiable risk factors. In 15.15% of patients, no cause was identified. The most common symptom was abdominal pain which was present in 100% of patients followed by amenorrhea(72.7%) and vaginal bleeding (45.4%). 97% of ectopic pregnancies were located in fallopian tube, ampulla being more common. Tubal rupture and hemoperitoneum were present in 75.75% of patients which were managed successfully by radical surgery. Conclusion: The incidence of ectopic pregnancy is on the rise due to various contributing factors. Timely detection and intervention can help to prevent maternal catastrophe. Hence knowledge regarding risk factors is necessary when we are counselling women about ectopic pregnancy. Keywords: Ectopic, Incidence, Maternal Mortality, Risk Factors, Symptoms

Relationship Between Polycystic Ovarian Morphology and Ectopic Pregnancy.

Background:The purpose of the current study was to investigate the presence of polycystic ovarian morphology (PCOM) in patients with ectopic pregnancy (EP) and to find out the value of sonographic appearance of ovaries on the earlier diagnosis of EP.Methods:In the current case-control study, thirty five patients with EP were recruited to evaluate ovarian sonographic morphology whereas 35 gestational age-matched women with healthy intrauterine pregnancy (IUP) were the controls. After ovarian sonography, ultrasound images were analyzed offline for ovarian area, ovarian volume, follicle number per cross section, and follicle distribution pattern. A questionnaire about the presence of hirsutism and menstrual irregularity prepared as well. Student’s t-test or Mann-Whitney U test were used to compare continuous variables between 2 groups and categorical data were evaluated by using Chi-square or Fisher’s exact test, where appropriate. Multiple logistic regression was used to find out the risk factors for EP.Results:Mean gravidity and parity were significantly higher in the EP group compared to IUP group (p<0.05). PCOM was found to be significantly higher in the study group (51.4% vs. 20%, p=0.006). Logistic regression analysis showed that multiparity (OR=8.635; 95% CI, 1.653–45.104) and PCOM image on ultrasound (OR=19.081; 95% CI, 1.139–319.560) were found to be significantly associated with EP.Conclusion:PCOM is more prevalent among women diagnosed with EP. This study demonstrates that PCOM assessed by transvaginal ultrasound may reflect EP in women with EP suspicion and may therefore serve as a clinical marker to assess EP.

Evaluation of serum biomarkers and efficacy of MTX in women with ectopic pregnancy.

Ectopic pregnancy occurs when a fertilized ovum attaches outside the uterus. As a complication in approximately 1‑2% of all pregnancies, ectopic pregnancies may cause catastrophic hemorrhage as a result of invading maternal blood vessels. Therefore, early diagnosis and timely treatment are crucial for women with ectopic pregnancy. In this study, we aimed to identify and determine the efficacy of serum biomarkers for the prompt diagnosis of ectopic pregnancy. For this purpose, the serum concentrations of progesterone, β human chorionic gonadotropin (β‑hCG) and cancer antigen‑125 (CA125) were detected by solid‑phase, competitive binding chemiluminescent enzyme immunoassays. Flow cytometry was used to analyze the percentage of CD3+ Tcells in women with ectopic pregnancy. Pathological analysis of tubal and villus tissues was performed by hematoxylin and eosin (H&E) staining. After receiving an injection of methotrexate (MTX), patients were examined by transvaginal ultrasound to detect the size of the echogenic mass. The results revealed that the serum levels of progesterone, β‑HCG and CA125 were significantly decreased in women with ectopic pregnancy, whereas the percentage of CD3+ T cells was increased in women with ectopic pregnancy. Histopathological examination revealed blood clots with small tissue fragments of a tubal‑type epithelium and incomplete pile structures. Five days after the MTX injection, an echogenic mass was found with a size of 1.7x1.2x1.6cm that contained a gestational sac‑like structure and a yolk sac. On the whole, the findings of this study indicate the at the joint detection of progesterone, β‑HCG, CA125 serum levels and the CD3+ T cell percentage could be applied as a reliable indicator for the early diagnosis of ectopic pregnancy. MTX administration was determined to be an efficacious approach for the treatment of ectopic pregnancy.

English

Women can still conceive naturally or through in vitro fertilization (IVF) with the one oviduct that is properly functioning if only one oviduct is blocked, however, the chances are decreased particularly if the blockage is close to the ovary (hydrosalpinx) because of wash out phenomena and toxic fluid produced by the fallopian tube that is blocked. In situations where only a single tube has hydrosalpinx specialists should advise patients appropriately and must be given options, to choose between undergoing salpingostomy, a surgical process that involves tubal reconstruction to expand their odds of getting pregnant naturally by removing the blockage or IVF treatment. For women with one working oviduct specialists must be on the lookout for ectopic pregnancy. This will enable early diagnosis of ectopic pregnancy and a treatment technique that spares the tube can be utilized. The patient is a woman of African origin with blood group O staying at Manyame Park Harare. She has never married before and has been trying to get pregnant from 2005. She eventually got a successful pregnancy in 2014 and delivered first child in 2015 after several interventions. Her infertility was initially due to the presence of hydrosalpinx on the left fallopian tube, scarring in the fimbriae of left tube, high prolactin level and was subsequently due to loss of the only working tube after ectopic pregnancy. The patient got pregnant whilst she was on bromocriptine, unfortunately the pregnancy did not last to full term. Chlomiphene was later added to her drug regiment and after six cycles she had an ectopic pregnancy which destroyed her only working tube. The patient then tried IVF treatments to achieve pregnancy. She underwent two IVF treatment cycles which failed to achieve pregnancy. The patient finally underwent tubal reconstruction microsurgery which enabled her to have two successful natural pregnancies. Gynaecologists must be vigilant in diagnosis of infertility factors and should give enough appropriate information to female patients when making decisions concerning fertility interventions. Key words: Fertility, in vitro fertilization (IVF), salpingostomy, hydrosalpinx, prolactin, fimbriae. &nbsp