Tubal Ectopic Pregnancy Research Articles

Sudden death due to right fallopian tube tear in ectopic pregnancy: An autopsy-based case report

Background: Ectopic pregnancy complications, particularly when they cause rupture, can lead to a sudden and critical situation. In cases of sudden death, it is important to approach it as an unnatural death until proven otherwise through scientific means. Autopsy, conducted by a forensic and medicolegal pathologist, is a key method for establishing the cause of death. Case presentation: We have reported a suspected case of unnatural death being investigated by the police. A young, unmarried woman living alone was found dead in her room, with no clear medical history. The forensic autopsy was performed to establish the cause of death in this case. The findings revealed an enlarged uterus, a tear in the right fallopian tube, and a blood β-hCG level of 5,224.07 mIU/mL. Supported by histopathological findings in the form of an overview that supports the existence of tubal ectopic pregnancy. There is severe internal bleeding in the abdominal cavity due to a tear in the right fallopian tube, leading to hemorrhagic shock because of a loss of 1,946.7 ml of blood. As a result, the patient experiences Multiple Organ Failure (MOF), indicated by lung edema and kidney and stomach necrosis observed in the histopathological examination. Conclusions: The victim's sudden death was a result of a natural cause. The cause of death is determined after eliminating other possibilities.

Serum human chorionic gonadotropin and ultrasound criteria in women with successful expectant management of tubal ectopic pregnancies: a retrospective cohort study

Serum human chorionic gonadotropin and ultrasound criteria in women with successful expectant management of tubal ectopic pregnancies: a retrospective cohort study

Risk factors for methotrexate treatment failure in tubal ectopic pregnancy: a retrospective cohort study

BackgroundEctopic pregnancy (EP) accounts for approximately 2% of all pregnancies, with tubal ectopic pregnancies (TEPs) being the most common type. Methotrexate (MTX) is a noninvasive and effective medical management option for TEP, but failure rates range from 10 to 36%, posing challenges in clinical practice. Identifying risk factors for MTX treatment failure is crucial to improve patient outcomes and guide clinical decision-making. This study aimed to determine the risk factors associated with MTX failure in TEP patients and support personalized treatment strategies.MethodsThis retrospective study included female patients who were diagnosed with TEP at Peking Union Medical College Hospital (PUMCH) between January 2016 and December 2022. Patients received MTX treatment initially, with dosing intervals and protocols varying according to clinical practice. MTX treatment failure was defined as the need for surgery after MTX administration. The study included two groups: patients who failed MTX treatment (n = 91) and those who succeeded in treatment (n = 268). Univariate and multivariate logistic regression analyses were performed to identify significant predictors of MTX treatment failure. A nomogram was developed to visualize the predictive factors.ResultsA total of 359 patients were included, with 268 (74.7%) succeeding with MTX and 91 (25.3%) required surgery. Specifically, 282 patients (78.6%) received 1-dose MTX, whereas 77 (21.4%) received 2-dose MTX. Univariate analysis revealed that gravidity, previous EP, gestational age, pretreatment β-human chorionic gonadotropin (β-hCG) level, number of MTX treatments, and presence of a visible yolk sac in ultrasound were significant predictors (all P < 0.05). Multivariate analysis confirmed that higher gravidity (odds ratio (OR) = 1.2487, 95% confidence interval (CI): 1.0103 – 1.5433, P = 0.040) and elevated pretreatment β-hCG levels (OR = 1.0006, 95% CI: 1.0004 – 1.0008, P < 0.001) were independent risk factors. Number of MTX treatments was a significant protective factor (OR = 0.4409, 95% CI: 0.2153 – 0.9025, P = 0.025). The nomogram incorporating these six risk factors was developed.ConclusionHigher gravidity and elevated β-hCG levels were significant predictors of MTX failure, while more MTX doses provided a protective effect. These findings underscore the importance of personalized MTX treatment strategies to improve outcomes in TEP. However, the limitations of this study, including its retrospective and single-center design, suggest that further prospective multicenter studies are needed to validate these results.Trial registrationThe trial is registered at http://www.chictr.org.cn. [registration number: ChiCTR2400081314; registration date: 2024–02-28 (prospectively registered)].

Enhancing decision-making in tubal ectopic pregnancy using a machine learning approach to expectant management: a clinical article

ObjectiveTo refine decision-making regarding expectant management for ectopic pregnancy (EP) using machine learning.MethodsThis retrospective study addressed expectant management in stable patients with ampullar EP, 2014–2022. Electronic medical record data included demographics, medical history, admission data, sonographic findings, and laboratory results. Follow-up data on βhCG levels and success rates were collected. Statistical analysis incorporated a Decision Tree Classifier, a decision tree-based machine learning model. The cohort was divided into training and testing groups for the machine learning model. This model was evaluated for accuracy, precision, recall, and F1 score to predict success of expectant management.ResultsAmong 878 cases of EP, the expectant management cohort, comprising 221 cases, exhibited a success rate of 79.6%, with 20.4% requiring subsequent intervention. Mean βhCG levels on admission were 1056.8 ± 1323.5 mIU. The Decision Tree Classifier demonstrated an accuracy of 89%, with precision, recall, and F1 scores of 92%, 95%, and 94%, respectively. Factors for predicting success included clinical symptoms such as pain, the percentage decrease in βhCG levels, gestational age and βhCG level at decision day. Moderate impactful features were white blood cell count, gravidity and maximum tubal dimensions. Smoking status, duration (hours) from time of EP diagnosis to second βhCG test and marital status were minimal significant predictors of success.ConclusionThe Decision Tree-Based classifier model, with 92% precision and 95% recall, may be a valuable tool for predicting treatment success in hemodynamically stable patients with EP, particularly within the initial 24 h of βhCG follow-up.

Is expectant management feasible for select patients diagnosed with a heterotopic tubal pregnancy following in vitro fertilization/intracytoplasmic sperm injection?

BackgroundHeterotopic pregnancy (HP) is a rare type of pathological pregnancy, and the most common site of concomitant ectopic pregnancy (EP) is the fallopian tube. Some studies have shown that expectant treatment could be considered because some EPs tend to regress spontaneously. However, data on the expectant treatment of HP are lacking. This study aimed to examine the outcomes of eutopic pregnancies following expectant management of concomitant tubal EP after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).MethodsThis was a retrospective, observational matched cohort study. All patients who conceived with tubal HP (HTP) via IVF/ICSI and were treated expectantly between January 2010 and December 2021 were enrolled. Each HTP patient managed expectantly (A) was randomly matched with one control patient who conceived with a solely eutopic pregnancy (B) and one HTP patient who underwent surgical therapy (C) from our clinical database according to predefined criteria. The expectant group and the control groups were matched for maternal age (MA; ±1 year), gravidity (0; ≥1) and gestational age (GA) at presentation (± 2 days). The pregnancy outcomes of the study group and the control groups were compared.ResultsMore than three-quarters of the EPs in patients treated expectantly were inhomogeneous solid masses (n = 95, 76.6%), and an empty gestational sac was the second most common (n = 18, 14.5%). The rates of live birth (76.6%, 79.0%, 73.4%; P = 0.647 (A versus B); P = 0.557 (A versus C)) and early miscarriage (21.8%, 19.4%, 25.8%; P = 0.637 (A versus B); P = 0.456 (A versus C)) in the expectant group were similar to those in the eutopic group and those in the surgical group. There were no significant differences in of the preterm birth rate (7.3%, 7.3%, 7.3%; P = 1.000 (A versus B); P = 1.000 (A versus C)), perinatal mortality (1.0%, 1.0%, 1.1%; P = 1.000 (A versus B); P = 1.000 (A versus C)), GA at delivery (38.7 ± 2.1, 38.4 ± 2.4, 38.5 ± 2.3 weeks; P = 0.286 (A versus B); P = 0.425 (A versus C)) or birth weight (3294.8 ± 507.2, 3238.2 ± 646.1, 3194.5 ± 452.9 g; P = 0.498 (A versus B); P = 0.157 (A versus C)).ConclusionExpectant management was an option for select women with HTP. The prognoses of the concomitant eutopic pregnancies were comparable to those of the solely eutopic singleton pregnancies and the HTPs managed surgically. The application of this protocol in clinical practice significantly reduces the need for surgical or medical treatment of EP. Notably, close follow-up is required, and patients need to be vigilant and have immediate access to medical resources in case of an emergency.

The role of inflammatory markers and βhCG levels in predicting the success of single-dose methotrexate treatment in tubal ectopic pregnancy.

To evaluate the predictive ability of serum beta human chorionic gonadotropin (βhCG) levels and inflammatory markers derived from hemogram parameters in the success of methotrexate (MTX) treatment for tubal ectopic pregnancy. This retrospective study involved the examination of patients diagnosed with tubal ectopic pregnancy and treated with a single dose of MTX at our clinic between 2018 and 2023. The monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated from blood samples taken at the time of presentation. βhCG levels were recorded on days 1, 4, and 7 of treatment. The patients were categorized into successful and unsuccessful treatment groups based on their response to MTX. No statistically significant differences were found between the two groups regarding MLR, NLR, PLR, or SII values (P = 0.284, P = 0.097, P = 0.455, and P = 0.061, respectively). In the receiver operating characteristic analysis of serum βhCG from day 1 to day 4, the area under the curve value was calculated as 0.832. The cutoff value for the serum βhCG change from days 1 to 4 was -0.093 (-9.3%), with a sensitivity of 85.53% and specificity of 74.14%, and a positive predictive value (PPV) of 87.5%. There were no significant differences in inflammatory markers (MLR, NLR, PLR, and SII) between the successful and unsuccessful MTX treatment groups. The change in serum βhCG levels between days 1 and 4 can be used as an early predictor of MTX treatment success in tubal ectopic pregnancy.

THE IMPACT OF THE COVID-19 PANDEMIC ON THE DIAGNOSIS AND TREATMENT OF ECTOPIC PREGNANCY: A RETROSPECTIVE COMPARISON

Objective: To investigate the impact of the COVID-19 pandemic on the diagnosis and treatment processes of ectopic pregnancies (EP) at a tertiary hospital in Turkey. Methods: This retrospective study compared 221 cases of tubal EP diagnosed after March 15, 2020, with 217 cases diagnosed before this date. Patient demographics, clinical characteristics, and treatment modalities were analyzed. Statistical analyses, including independent t-tests, Chi-square tests, and multinomial logistic regression, were conducted to assess differences between the COVID and pre-COVID periods. Results: The study found no significant differences in maternal age, gravidity, parity, or gestational weeks between the COVID and pre-COVID periods. However, there was a notable increase in patients presenting with abdominal pain (52.5% vs. 37.8%) and intraperitoneal hemorrhage (26.7% vs. 7.4%) during the COVID period. Despite the higher frequency of abdominal pain, vaginal bleeding was less common during the pandemic. Treatment approaches also shifted, with a significant increase in medical management (41.2% vs. 29.0%) and a slight decrease in surgical interventions during the COVID period. Multinomial logistic regression revealed that parity, gestational week, presence of Douglas fluid, and the period of diagnosis (COVID vs. pre-COVID) were significant predictors of treatment modality. Conclusion: The COVID-19 pandemic influenced the clinical presentation and management of ectopic pregnancies in our hospital. While there were no significant differences in key demographic or laboratory parameters, the increased presence of abdominal fluid and a shift towards medical management during the pandemic period suggest changes in patient presentation and treatment preferences. This study underscores the importance of maintaining vigilant diagnostic and therapeutic approaches for EP, even during global health crises.

Determining treatment success in tubal ectopic pregnancies – the predictive value of the delta neutrophil index in single-dose methotrexate therapy

Introduction and aim. This study assessed the significance of the Delta neutrophil index (DNI) in predicting the effectiveness of single-dose methotrexate (MTX) treatment for tubal ectopic pregnancy. Material and methods. In this retrospective study, 214 women diagnosed with tubal ectopic pregnancies and treated with MTX between 2019 and 2022 were included. Group 1 comprised 88 MTX responders, while group 2 consisted of 86 non-re sponders necessitating surgery. HCG and DNI levels were monitored on day 1, 4, and 7 of MTX treatment and compared be tween the groups. Results. Group 1 exhibited significantly lower HCG and DNI levels compared to group 2 on days 1, 4, and 7 (p&lt;0.001). Both HCG and DNI levels on days 1 and 4 of MTX treatment were significant predictors of treatment failure, with the highest AUC observed for DNI was on day 4. In multivariate logistic regression analysis, elevated DNI levels on day 1 of MTX treatment were associated with a 5.8-fold increased risk, and DNI levels on day 4 were associated with a 4.44-fold increased risk of MTX treatment failure. Conclusion. DNI emerges as a valuable marker for predicting the success of single-dose methotrexate treatment in tubal ecto pic pregnancies, demonstrating superior predictive power compared to HCG.

Clinical Dilemma Of Bilateral Hematosalpinx In Ectopic Pregnancy: Case Report

Background: Blastocyst implantation outside the uterine cavity leads to ectopic pregnancy. About 96% of ectopic pregnancies occur in the fallopian tubes, where it most frequently occurs; the fimbrial end accounts for 11% of all ectopic pregnancies. There was an uncommon type of ectopic pregnancy called bilateral tubal ectopic pregnancy. Bilateral tubal ectopic pregnancy is estimated to affect 1 out of 725 - 1580 ectopic pregnancies or 1 out of 200,000 live births. However, the villi quickly penetrate the endosalpinx once the implantation of the ectopic pregnancy has occurred before reaching the tubal wall and peritoneum. Vascular growth and a peritubal hematoma or hematosalpinx, which frequently involves the contralateral tubal section, are also present with this penetration. The purpose of this article is to report on the dilemmas that often occur in the case of bilateral hematosalpinx in ectopic pregnancy. Case Description: In this report, we discuss a 33-year-old woman with a positive pregnancy test and transvaginal ultrasound result that was suggestive of ectopic pregnancy in a stable hemodynamic state. The patient underwent an exploratory laparotomy, which showed bilateral hematosalpinx with right ectopic pregnancy with damaged fimbria. The left fallopian tube had a blue-purple bulge that suggested hematosalpinx secondary to ectopic pregnancy rather than bilateral ectopic pregnancy condition. The decision for definitive management was made, right salpingectomy puncture and drainage of the hematosalpinx were performed without complication. The final diagnosis was confirmed on pathology examination that showing chorionic villi within the right damaged fimbria, focal decidua, a few trophoblast-like cells that indicated ectopic pregnancy in the left tubal cavity. Conclusion: This approach encourages both shared decision-making and preparedness, both of which are required to provide patient-centered and comprehensive caremanagement such as bilateral hematosalpinx in ectopic pregnancy case, that must always be individualized, and patient's desire for future conception must be taken into account.

Posterior Colpotomy in Ectopic Pregnancy Management: A 12-Year Surgical Analysis.

The management of ectopic pregnancies has evolved from traditional laparotomy to minimally invasive techniques, with posterior colpotomy emerging as a viable alternative. This study explores the safety and efficacy of posterior colpotomy in tubal ectopic pregnancy management. A retrospective analysis of 16 cases employing posterior colpotomy for ectopic pregnancy treatment was conducted from 2009 to 2021. Posterior colpotomy demonstrated success in all 16 cases, with no intraoperative complications, short surgical times (15-65 minutes), and minimal blood loss. One patient (6.25%) experienced postoperative complications, necessitating transfusion. Most patients (87.5%) were discharged the following day, expressing high satisfaction. The 12-year surgical analysis supports posterior colpotomy as a safe and effective technique for managing tubal ectopic pregnancies. Its benefits, including minimized trauma, short operating times, and favorable patient outcomes, affirm its contemporary relevance. The practical advantages further emphasize its viability in the evolving landscape of ectopic pregnancy management. Larger-scale research is recommended for comprehensive comparisons with laparoscopy and laparotomy.

Transuterine relocation of pregnant uterine horn segment in an exploratory rat model with implications for tubal ectopic pregnancy

Ectopic pregnancy affects ~ 2% of pregnancies annually in the United States, with no current treatments allowing for the continuation of the pregnancy. Thus, this study sought to initiate an investigation into the potential design of a surgical technique, in an animal model, that could serve as a foundation for future research into the potential of relocating an ectopic embryo into the uterus at the human level. Female Long-Evans rats were randomly assigned to one of two groups: Embryo Relocation (ER; n = 12; underwent embryo relocation surgery) and Normal Pregnancy (NP; n = 12; carried a normal pregnancy; no surgery). Eight rats/group were allowed to carry their pregnancy to term and deliver, while four had their uteri collected at the end of gestation. Briefly, for the ER group, a uterine horn containing 1–2 embryos was translocated to the contralateral horn, which had been incised and cleared of its contents, prior to being wrapped around the relocated horn. Rat weight, food consumption and vaginal impedance of the mothers were measured throughout the experiment. Ultrasounds were performed and fetal heart rates measured on day 20–21 of gestation. Additionally, rat weight of all offspring was measured at adulthood. Our findings indicate that, in the ER group, 15/15 (100%) of the relocated embryos had detectable heart rates at the end of gestation (within the normal range), 14/15 (93%) were delivered vaginally, and 12/14 (86%) survived until adulthood. A significant decrease in rat weight and food consumption was observed only on the day following surgery. Fertility, as measured by vaginal impedance, was minimally impacted by surgery. Moreover, there was no significant difference between groups in average body weight of offspring at adulthood. Histological analysis indicated a thicker placenta in the ER group, attributable to the fetal part of the placenta, potentially indicating compensatory mechanisms. Our findings reflect a successful transuterine embryo relocation followed by vaginal birth and survival of offspring to adulthood, in a rat model. Such findings lay the foundation for future preclinical research in higher animals, with potential implications on a procedure relevant to human ectopic embryo relocation.

Evaluating Lipiodol Efficacy in Proximal Tubal Occlusion Treatment: Single-Center Experience and Literature Review.

BACKGROUND Tubal infertility caused by proximal occlusion of fallopian tubes is a common cause of female infertility. Lipiodol (ethiodized oil) is an oil-based iodinated contrast medium, previously used in hysterosalpingography, and is now used as a therapeutic agent. This single-center study aimed to evaluate the experience of outcomes from the use of Lipiodol in 96 women with infertility due to fallopian tube occlusion. MATERIAL AND METHODS In total, 96 women with infertility caused by tubal obstruction, confirmed in hysterosalpingography and/or laparoscopy, who underwent tubal recanalization followed by Lipiodol injection were enrolled. Information regarding the reproductive outcome at a minimum of 6 months following the treatment was collected by a telephone survey or direct contact. Pregnancy rate was calculated. RESULTS Average age on admission was 33±4.1 years. In most cases (79%, 76/96), infertility was primary. Average duration of infertility was 2.8 years. Comorbidities included endocrinopathies and endometriosis. Complete patency was achieved in 96% of cases (92/96 patients). In 4 cases (4%), distal occlusion of 1 ovary was observed, resulting in partial procedural success. Tubal catheterization was needed in 29 patients (30%). No procedural complications were noted. Thirty-four patients conceived, resulting in a 35.8% pregnancy rate. Miscarriage was noted in 5 patients, and tubal ectopic pregnancy in 1 patient. No long-term complications were reported. CONCLUSIONS Our results show that use of oil-based contrast for tubal recanalization is safe and effective treatment for proximal tubal occlusion, with a relatively high pregnancy rate (36%). Further studies are required to fully discover its potential benefits.

Management of nontubal ectopic pregnancies - single center experience

Aims: Ectopic pregnancies can be defined as pregnancies in which the growing blastocyst implants outside the endometrial cavity. However, it is assumed that 0.5-1% of all pregnancies are ectopic pregnancies. The most common extrauterine implantation site is the fallopian tube. Non-tubal pregnancies (NTG Non-tubal pregnancies) account for less than 5% of all ectopic pregnancies but cause 8 times higher maternal mortality than tubal pregnancies. The study aimed to determine the frequency of nontubal ectopic pregnancies in a tertiary care unit in Turkey and the differences that may differentiate patients from tubal ectopic pregnancies. Methods: The purpose of this retrospective study was to analyze and describe the treatments of patients who were hospitalized for ectopic pregnancy in the Gynecology and Obstetrics Clinic of Mengücekgazi Training and Research Hospital from May 2014 to May 2024. Obstetric/gynecologic history, risk factors for previous ectopic non-tubal pregnancy, serum-hCG levels at the moment of diagnosis, ultrasound findings, surgical or medical treatment and treatment outcomes were presented. Results: In our institutional records, 240 patients received an ectopic pregnancy diagnosis. and n=23 nontubal ectopic pregnancies were identified. Cervical pregnancy (CP) (n=2), interstitial pregnancy (IP) (n=2), cesarean scar pregnancy (ScP) (n=10), ovarian pregnancy (OvP) (n=9) were detected. Conclusion: It emerges from our sample that NT-EP needs to be diagnosed quickly. This can assist in the conservative use of a medical or minimally invasive method. The significant advance in imaging technologies allows for a faster diagnosis, allowing the patient to be transferred to a referred center from where the best procedures can be selected, reducing the potential impact of surgery on the patient’s fertility.

Is it necessary to check β-hCG levels on day 4 after single-dose methotrexate treatment of ectopic pregnancy? A retrospective cohort study

Aim: This study aimed to investigate the usefulness of the percentage change in serum β-hCG levels from days 1 to 7 for predicting treatment success in patients treated with a single dose of methotrexate for tubal ectopic pregnancy. Materials and Method: This retrospective observational study investigated 74 patients treated with a single-dose methotrexate regimen for tubal ectopic pregnancy at a tertiary hospital between January 2020 and December 2023. Patients were subdivided into two groups based on reduction in serum β-hCG levels between days 4 and 7:

A Comprehensive Study on the Risk Factors of Tubal Ectopic Pregnancy in a Tertiary Care Centre

A Comprehensive Study on the Risk Factors of Tubal Ectopic Pregnancy in a Tertiary Care Centre

Laparoscopic Management for Bilateral Tubal Ectopic Pregnancies Following Intrauterine Insemination

Laparoscopic Management for Bilateral Tubal Ectopic Pregnancies Following Intrauterine Insemination

Comparison of 2-year reproductive outcomes of tubal ectopic pregnancies treated with surgery, methotrexate or expectant management.

To compare the 2-year reproductive outcomes of tubal ectopic pregnancies (EP) treated with surgery, methotrexate (MTX) or expectant management. This case-control study was conducted retrospectively at the Obstetrics-Gynecology and Perinatology Clinics of Etlik Zubeyde Hanim Women's Health Education and Training Hospital. 985 of 1156 patients, who were managed between January 2015 and December 2019 for a tubal EP, tried to conceive in 2years after treatment: 366 patients underwent surgical treatment; 549 patients were treated with MTX, and 70 patients had expectant management. Clinical data and fertility outcomes were retrieved by medical and hospital records. We compared the three groups based on the 2-year reproductive outcomes of three treatment modalities of tubal EP. There was a significant difference in the frequency of no pregnancy in patients who underwent surgery compared to patients who received expectant management and MTX therapy (p < 0.001). The frequency of no pregnancy was higher in patients who underwent surgery. There was no significant difference between expectant management and MTX therapy (p = 0.411). In the reproductive outcomes of patients who underwent surgery, the incidence of viable pregnancies was statistically lower than in the group treated with expectant management and MTX therapy (p = 0.003). Patients with an EP often have a future desire to have children, the treatment options are also important. The earlier the diagnosis is made, the more likely it is that expectant management or MTX treatment will be considered. With these two treatment methods, the likelihood of having a child in the future is higher than with surgical treatment.

Nomogram to predict methotrexate treatment success in ectopic pregnancy.

To evaluate clinical factors prior to methotrexate (MTX) treatment for tubal ectopic pregnancy and to apply the data to a prediction model for treatment success. A retrospective cohort study was conducted during 2014-2022. Of the 808 patients with a tubal ectopic pregnancy, 372 with a β-hCG level less than 5000 IU/L were treated with a single dose of MTX and were included in this study. Pretreatment factors, including patient characteristics, initial β-hCG level, and sonographic parameters, were compared between those who achieved complete resolution and those who needed additional MTX or surgical intervention. A logistic regression model and multivariable analysis were used to predict success. A graphic nomogram was generated to represent the model. Complete resolution of the ectopic pregnancy was achieved in 290 (77.9%) patients after a single dose of MTX. A second dose or surgical intervention was required for 82 (22.0%): 49 (13.2%) received a second dose of MTX and 33 (8.9%) underwent laparoscopic salpingectomy. In the MTX Success group compared to the MTX Failure group, the median β-hCG levels were lower (746 vs 1347 IU/L, P < 0.001) and the presence of a yolk sac and a fetal pole were less frequent. The predictive model, based on significant variables, includes initial β-hCG concentration and the visibility of a yolk sac or fetal pole. Analysis with cross-validation techniques revealed that the model was both accurate and discriminative. A predictive nomogram was developed to predict the success of single-dose MTX treatment for tubal ectopic pregnancy.

Untargeted Metabolomic Biomarker Discovery for the Detection of Ectopic Pregnancy.

Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester. Using an untargeted metabolomic approach, we sought to identify putative plasma biomarkers using tandem liquid chromatography-mass spectrometry for the detection of tubal EP. This case-control study included the prospective recruitment of 50 tubal EP cases and 50 early intrauterine pregnancy controls. To avoid over-fitting, logistic regression models were developed in a randomly selected discovery group (30 cases vs. 30 controls) and validated in the test group (20 cases vs. 20 controls). In total, 585 mass spectral features were detected, of which 221 molecular features were significantly altered in EP plasma (p < 0.05). Molecular networking and metabolite identification was employed using the Global Natural Products Social Molecular Networking (GNPS) database, which identified 97 metabolites at a high confidence level. Top significant metabolites include subclasses of sphingolipids, carnitines, glycerophosphocholines, and tryptophan metabolism. The top regression model, consisting of D-erythro-sphingosine and oleoyl-carnitine, was validated in a test group and achieved an area under receiving operating curve (AUC) (95% CI) = 0.962 (0.910-1) with a sensitivity of 100% and specificity of 95.9%. Metabolite alterations indicate alterations related to inflammation and abnormal placentation in EP. The validation of these metabolite biomarkers in the future could potentially result in improved early diagnosis.

Rupture of fetal membrane in ectopic tubal pregnancy: A case report and literature review.

Ruptured tubal pregnancies occurring in the second trimester are rare; yet, they pose a critical risk of life-threatening hemorrhage. This study aims to highlight the importance of timely surgical intervention in such cases to prevent fatal outcomes. The case underscores the diagnostic and therapeutic challenges that arise when distinguishing between tubal and abdominal pregnancies, particularly in the presence of hemoperitoneum, which can obscure imaging results. We present a case involving the spontaneous rupture of a tubal pregnancy at 15 weeks and 3 days of gestation. The patient exhibited elevated beta-human chorionic gonadotropin levels. Initial transabdominal ultrasound suggested an abdominal pregnancy, and computed tomography scans supported these findings. Urgent midline laparotomy revealed the condition to be a tubal pregnancy, contrary to initial imaging. The surgical procedure included the removal of the gestational sac and the affected fallopian tube, followed by abdominal closure. Hemoperitoneum was noted to compromise the accuracy of imaging modalities, complicating the preoperative diagnosis. Histopathological examination confirmed the diagnosis of tubal pregnancy. The patient had an uneventful recovery and was discharged 7 days post-surgery with stable hemoglobin levels. This case underscores the importance of considering the differential diagnosis of abdominal versus tubal pregnancy in the presence of hemoperitoneum, due to their differing clinical management needs. It offers insights that may guide clinicians in the timely diagnosis and treatment of advanced tubal pregnancies, where prompt surgical intervention is critical.