Evaluation Of Ectopic Pregnancy Research Articles

Evaluation of ectopic pregnancy in Al- Salam hospital in Mosul, Iraq

Objective: This study aimed to evaluate the ectopic pregnancy in Mosul city.
 Methods: A cross sectional study in which 88 females attended to Al- Salam hospital in Mosul city from 2017 - 2019. All females with current ectopic pregnancy included and any women with no EP has been excluded.
 Results: mean age (28.7 ± 6) years old, 59% of females at age group 21 – 30 years old 27% of them at age group 31 – 40 years old and 10 % in age group 11 – 20 years old, the main complain of females: abdominal pain (31.8%), abdominal pain and bleeding (23.9%), irregular bleeding (17%) and other complain. Type of infertility of females: no infertility (61.4 %), primary (21.6 %) and secondary (17.0%). 45.5 % of females had infection and all females history of operation was ovarian cyst (6.8%), appendicitis (11.4 %), ART (13.6%) and 55.7% of them with no any history of previous operation. 86% of females get pregnancy by normal ways and 14% get by IVF. 97% of females with no history of previous EP. 14% of them use contraception ( pills 3%, IUCDS 7%, injectable 4%). 37.5% of females in our study with no baby while 24% with 1 baby and 19% with 2 and above 3 babies respectively. 35% of females with history of previous abortion ( 24% 1 abortion, 8% 2 abortion, 2% 3 abortion and 1% 4 abortion). 91% of females with destruction of fallopian tube (53% left side, 43% right side and 4% other part). 98% of females with surgical treatment (Salpingectomy) while other 2% of them treated as medical treatment.
 Conclusion: There are increase in incidence of EP and decrease in mother death, main manifestations are abdominal pain, abdominal pain and bleeding and irregular bleeding so early diagnosis of females lead to decrease mortality and rapid surgical intervention decrease mortality and complication.

Term Broad Ligament Pregnancy with a Healthy Newborn

Introduction: Broad ligament pregnancy also known as inter ligamentous pregnancy is a rare type of ectopic pregnancy. It is one type of secondary abdominal pregnancy. Although ultrasonography is usually helpful in making the diagnosis but it is mostly established during laparotomy. Very few successful live births have been reported in this condition, where such pregnancies reached term and with live birth of a baby.
 Case Report: A case of 30 year old 2nd gravida of 38 weeks gestation with lower abdominal pain for 20 hours was admitted into Sher-E-Bangla Medical College Hospital, Barishal; Bangladesh. She was suggested for caesarean section as the ultrasonogram revealed transverse lie with complete placenta praevia. Intraoperative diagnosis of right sided broad ligament pregnancy was made and an incision was given on the anterior leaf of the broad ligament and a male live fetus was extracted. Post operative period was uneventful. Both mother and baby were discharged on seventh postoperative day in good health condition.
 Discussion: Broad ligament pregnancy usually results from rupture of tubal pregnancy through the tubal serosa and the mesosalpinx, with secondary implantation of trophoblast between the leaves of broad ligament. Incidence of broad ligament pregnancy is reported as 1 in 300 ectopic pregnancies. The prognosis is poor with the risk of dying from an abdominal pregnancy is 7.7 times higher than from other forms of ectopic pregnancy and often results from a delay in diagnosis. Trans-vaginal rather than transabdominal ultrasonography is superior in the evaluation of ectopic pregnancy. If there is no intrauterine pregnancy on ultrasonography and the ectopic sac is beside the lower part of the uterus a strong suspicion of broad ligament ectopic should be considered. Very rarely such pregnancy may reach up to term. Bleeding from placental implantation site is the most life-threatening complication during laparotomy.
 Conclusion: Abdominal pregnancy with resultant healthy newborn is very rare. High level of suspicion, careful clinical and ultrasound examinations are the routine means of diagnosis. Bleeding is the single most important life-threatening complication for the mother. Early diagnosis and proper management are vital in order to decrease maternal morbidity.
 Medicine Today 2019 Vol.31(1): 60-63

Fertility outcomes after laparoscopic salpingectomy or salpingotomy for tubal ectopic pregnancy: A retrospective cohort study of 95 patients

ObjectiveThis study presents our experience with laparoscopic surgery for tubal ectopic pregnancy (EP), sums up the different features of two commonly utilized laparoscopic surgeries, and compares subsequent post-salpingectomy or –salpingotomy reproductive outcomes in women with tubal EPs. Study designMedical history data of 95 patients diagnosed with tubal EP between January 2013 and December 2014 were analyzed in a retrospective, observational manner. All patients studied were offered two surgical management options: salpingectomy (removal of the entire fallopian tube), or salpingotomy (removal of products of gestation only, leaving the remainder of the tube intact). All 95 cases included in the study desired to preserve future fertility, and were followed up for 36 months after surgery. Follow-up data included evaluation for crude intrauterine pregnancy (IUP), recurrent EP and infertility. ResultsPatients that underwent salpingectomy were noted to be significantly older than those that underwent salpingotomy (P < 0.05). In addition, childbearing rates were noted to be significantly higher in the salpingectomy group when compared to patients that underwent salpingotomy (P < 0.05). No significant differences were noted in mean dimension of mass, pregnancy rates, cesarean section rates and previous abortion rates between the two groups. We did not find a significant difference in fertility outcomes between the two groups. ConclusionsSurgical management options for EP should be comprehensively evaluated in the clinical setting as numerous factors influence the decision making process. This paper provides a foundation for further studies upon which reliable surgical treatment guidelines for patients with tubal EP can be established.

Role of transabdominal Ultrasonography in the evaluation of suspected ectopic pregnancy

The study was carried out to assess the diagnostic accuracy of transabdominal ultrasonography in the evaluation of clinically suspected ectopic pregnancy patients . This cross sectional study was carried out in the department of Radiology and Imaging, Dhaka Medical College Hospital, Dhaka, from July 2006 to June 2008. 50 patients were selected purposively and transabdominal ultrasonography was done in each patient by 3.5 MHz frequency curvilinearprobe. Findings of transabdominal ultrasonography were then compared with the peroperative findings. Transabdominal ultrasonography in the diagnosis of ectopic pregnancy showed a sensitivity of 79.5%, specificity of 83.3%, and accuracy of 80%. Positive predictive value was 97.2% and negativepredictive value was 55.6%. . This study shows thattransabdominal ultrasonographyis an effective modality in the evaluation of ectopic pregnancy and should be used as a routine first-step procedure in patients of suspected ectopic pregnancy. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21529 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 167-172

250: The Utility of Formal Radiology Ultrasonography After Indeterminate Emergency Physician Pelvic Ultrasonography In the Evaluation of Ectopic Pregnancy

250: The Utility of Formal Radiology Ultrasonography After Indeterminate Emergency Physician Pelvic Ultrasonography In the Evaluation of Ectopic Pregnancy

Methotrexate failure in women with prior ectopic: our experience with the two-dose methotrexate protocol

OBJECTIVE: Methotrexate (MTX) therapy of ectopic pregnancy (EP) is safe and effective in appropriate cases. Previous data suggest that women with previous EP have an increased failure rate when treated with a single-dose MTX protocol. Our objective was to investigate if previous EP remained a risk factor for MTX failure in our population where most women receive a two-dose MTX protocol. DESIGN: Retrospective cohort MATERIALS AND METHODS: Data were abstracted from all cases of confirmed EP between 1999 and 2007 regarding presentation, evaluation, treatment, and history of EP. Parametric and non-parametric methods were used to compare variables; multivariable logistic regression was used to assess the effect of prior EP on MTX failure. RESULTS: We identified 202 cases primarily treated with MTX; 17.3% had a history of EP, 83% received 2-dose MTX therapy. There was no difference between women with and without previous EP in bleeding, pain, or gestational age at presentation, or days from presentation to MTX. The overall risk of MTX failure was 16.3%. The unadjusted OR for MTX failure in women with prior EP vs no EP was 2.06 (95%CI 0.75,5.24; p=0.10). In adjusted models the association between MTX failure and prior EP differed depending on the ultrasound (u/s) at presentation (interaction p =0.04). When the u/s was suspicious for EP (free fluid, mass) no increased risk of MTX failure with prior EP was observed (OR=0.44, 95%CI: 0.07, 2.77; p=0.38). However, in those with a non-diagnostic u/s, prior EP increased the odds of MTX failure by 5.65 (95%CI: 1.16, 27.48; p=0.03). HCG level at treatment also carried an increased odds of MTX failure (p=0.002). CONCLUSIONS: Prior EP is a risk factor for MTX failure in women in our population who present with a non-diagnostic u/s. It is important to recognize these women as higher risk, and both monitor and counsel these patients accordingly.

221: Evaluation of Ectopic Pregnancy With Bedside Ultrasound by Emergency Physicians: A Meta-Analysis

221: Evaluation of Ectopic Pregnancy With Bedside Ultrasound by Emergency Physicians: A Meta-Analysis

Commentary on "Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy". Kadar N, DeVore G, Romero R. Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynecol 1981;58:156-61.

Commentary on "Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy". Kadar N, DeVore G, Romero R. Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynecol 1981;58:156-61.

The utility of maternal creatine kinase in the evaluation of ectopic pregnancy

This investigation was designed to evaluate the utility of maternal creatine phosphokinase (CPK) in predicting the presence of an ectopic pregnancy (EP) in an emergency department (ED) setting. Twenty-one patients with the diagnosis of EP were randomly matched (1:1) with pregnant patients who subsequently ruled-out for EP. Serum CPK values at presentation were compared between the groups using two-tailed ANOVA, odds ratio, and frequency tables were generated using our a priori hypothesis that a serum CPK of > 70 mIU/dL may be useful as a predictor of EP. The mean serum CPK was 118mIU/dL in the EP group and 64 mIU/dL in the non-EP group (P < .0031). Controlling for age, race, and gestational age, there was an association between elevated serum CPK and EP in our study population (with an odds ratio of 6.5). The categorical evaluation (with 95% confidence interval [CI]) of CPK (>70 mIU/dL) as a predictor of EP follows: sensitivity − 100% (80.8 to 100); specificity − 61.9% (38.7 to 81); PV(+) − 72.4% (52.5 to 88.6); PV(−) − 100% (71.7 to 100). We therefore conclude that a CPK level > 70 mIU/dL may serve as an important adjuvant diagnostic tool in ruling-out EP. (Am J Emerg Med 2000;18:695-697.

Ultrasound availability in the evaluation of ectopic pregnancy in the ED: Comparison of quality and cost-effectiveness with different approaches

The liberal use of ultrasonography has been advocated in patients with first trimester cramping or bleeding to avoid misdiagnosis of ectopic pregnancy in the emergency department (ED). The cost-effectiveness of different approaches to ultrasound availability has not been previously reported. In this study, we investigated measures of quality and cost-effectiveness in detecting ectopic pregnancy in the ED over a 6-year period, divided into three approximately equal epochs with three distinct approaches to ultrasound availability. The study retrospectively identified 120 cases of ectopic pregnancy seen in the ED over 6 years. There was significant improvement in the percentage of patients with ectopic pregnancy who were documented to have absence of intrauterine pregnancy (IUP) at the first visit from 76% during Epoch 1, when there was limited availability of ultrasound through medical imaging (MI Sono), to 88% in Epoch 2, when MI Sono was readily available, to 96% in Epoch 3, when both MI Sono and ultrasound by emergency physicians (ED Sono) were readily available ( P = .02). The estimated number of MI Sonos ordered by emergency physicians in patients at risk for ectopic pregnancy increased from 5.2 per ectopic pregnancy in Epoch 1 to 11.8 per ectopic pregnancy in Epoch 2, and declined to 5.5 per ectopic pregnancy in Epoch 3, when 19.9 ED Sonos per ectopic pregnancy were also done. The cost of ED Sono in Epoch 3 was more than offset by savings from avoiding calling in ultrasound technicians after regular medical imaging department hours. The specificity of ED Sono in ruling in an IUP was 100% (95% CI 98.3 to 100%), but analysis of secondary quality indicators reflecting times from first ED visit to treatment in Epoch 3 raised the possibility that an adnexal mass or signs of tubal rupture may have been missed on some ED Sonos. We conclude that increased availability of ultrasonography leads to improved quality in the detection of ectopic pregnancy in the ED, but at the expense of a disproportionate increase in the number of ultrasound studies done per ectopic pregnancy detected. Our study suggests that the most cost-effective strategy is for emergency physicians to screen all patients with first trimester cramping and bleeding with ED Sonos, and to obtain MI Sonos at the time of the initial ED visit in all cases in which the ED Sono is indeterminate or shows no IUP. (Am J Emerg Med 2000;18:408-417.

Sonographic evaluation for ectopic pregnancy: transabdominal scanning of patients with nondistended urinary bladders as a complement to transvaginal sonography.

T he sonographic evaluation for cctopic pregnancy initially depended on observations from the transabdominal perspective. With the advent of transvaginal techniques, however, the necessity for transabdominal scanning has been called into question. The transvaginal approach increases sensitivity and specificity for both identifying cctopic pregnancy and diagnosing early intrauterinc pregnancy [1-4], and this technique can be performed with greater speed and convenience because it does not require the patient to have a full urinary bladder. Consequently, transabdominal sonography has been supplanted by transvaginal scanning in a growing number of practices, in which transvaginal scanning alone is performed to evaluate for ectopic pregnancy [5-7]. Despite the central role of tnsnsvaginal scanning, numerous cases in which crucial findings were appreciated only from the transabdominal perspective have been documented [1-4, 8, 9]. The dilemma is that transabdominal scanning through a full bladder causes an inevitable delay while the bladder fills or a Foley catheter is introduced, but a transabdominal scan provides a more comprehensive view of the pelvis, one that may be cmcial for accurate diagnosis, particularly in patients with abnormalities that are large or beyond the range of the transvaginal transducer. This article describes a compromise solution in which an abdominal scan is obtained for patients with an empty or incompletely distended bladder as a prelude to transvaginal examination. This approach provides an expeditious means of detecting the sonographic manifestations of cctopic pregnancy that are at greatest risk to be missed with transvaginal scanning.

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.

Sonographic Detection of Echogenic Fluid and Correlation with Culdocentesis in the Evaluation of Ectopic Pregnancy

Sonographic Detection of Echogenic Fluid and Correlation with Culdocentesis in the Evaluation of Ectopic Pregnancy

Serum progesterone and endovaginal sonography by emergency physicians in the evaluation of ectopic pregnancy.

To determine a discriminatory level for serum progesterone (SP) in pregnant patients with no definite intrauterine pregnancy (IUP) on endovaginal ultrasonography (US) in the differentiation of ectopic pregnancy from normal IUPs. A prospective observational study in a convenience sample of women at risk for ectopic pregnancy was performed at an urban teaching hospital from May 1991 until May 1994. Women aged > or =18 years presenting to the ED with a positive pregnancy test in combination with pelvic or abdominal pain, vaginal bleeding, orthostasis, adnexal mass or tenderness, or any historical risk factor for ectopic pregnancy were eligible. Hypotensive or unstable patients were excluded. Endovaginal US was performed and patients with no definite IUP had a serum beta-hCG and SP measured. 314 patients were enrolled, with 14 excluded for lack of follow-up or incomplete SP data, yielding 300 patients. The initial endovaginal US diagnoses included 169 definite IUP, 31 abnormal IUP, 5 definite ectopic pregnancy, and 95 no definite IUP. 68/95 had SP measured, with values of 22.8 +/- 13.4 ng/mL (mean +/- SD) for IUP; 4.9 +/- 6.5 for spontaneous abortion, and 7.5 +/- 7.2 for ectopic pregnancy. The mean values were significantly different (2-tailed t-test) for ectopic pregnancy vs IUP and for spontaneous abortion vs IUP. An SP of > or =11 ng/mL (sensitivity 91%; specificity 84%) was post hoc the best cutoff value for suggesting an IUP when the endovaginal US was not definite for IUP. SP cannot reliably discriminate ectopic pregnancy vs spontaneous abortion in pregnant patients with no definite IUP on endovaginal US; however, a low SP (<11 ng/mL) in this sonographic category suggests an abnormal pregnancy.

Maternal serum creatine kinase does not predict tubal pregnancy.

Our purpose was to validate prospectively the predictive value of maternal serum creatine kinase in the evaluation of ectopic pregnancy. Fifty-one consecutive pregnant first-trimester patients who presented for suspected abnormal pregnancy were enrolled. Maternal serum samples were obtained and assayed for creatine kinase. Patients were subsequently evaluated for abnormal pregnancy by serial quantitative hCG levels, transvaginal ultrasonography, and surgery when appropriate. A receiver operating characteristic (ROC) curve was generated comparing intrauterine to extrauterine (ectopic) pregnancy. Of 51 patients, 18 had an ectopic pregnancy, 16 had a spontaneous abortion, and 17 had an ongoing intrauterine pregnancy. The ROC curve revealed that maternal serum creatine kinase had no ability to predict ectopic pregnancy. Maternal serum creatine kinase is not a reliable predictor of tubal pregnancy.

Reevaluation of the role of culdocentesis in the management of ectopic pregnancy

Culdocentesis has been used routinely in the evaluation of ectopic pregnancy. To determine whether culdocentesis continues to play an important role, we reviewed the operative findings of 297 women undergoing an operative procedure because of ectopic pregnancy. Culdocentesis was performed before surgery in 252 cases. Of those, 210 (83%) had positive test results and 42 (17%) had negative results. Positive results accurately predicted a ruptured ectopic pregnancy in 50% of cases, whereas negative test results were predictive of an unruptured ectopic pregnancy in 58% of cases. Six patients without an ectopic pregnancy underwent unnecessary laparotomy because of positive culdocentesis test results, whereas 27 patients who were discharged from the emergency room after negative test results were obtained subsequently were found to have ectopic pregnancies. The results of this study imply that culdocentesis is of limited value in a clinical setting in which sensitive and rapid testing and pelvic ultrasonography are used.

Effects of IV Hydration on Levels of hCG in the Serum and Urine of Women With Possible Ectopic Pregnancy

We examined the effects intravenous (IV) hydration on human chorionic gonadotropin (hCG) concentrations in serum and urine during early gestation. Such hydration commonly occurs during the initial evaluation for ectopic pregnancy and has been suggested to cause falsenegative urinary hCG test results. However, previous studies have not included data for specimens taken before and after hydration. Twenty-four patients were studied; 14 had ectopic pregnancies eventually confirmed histologically. All received IV saline (mean volume, 900 mL) over an average of 75 minutes. Serum and urine samples were obtained before and after hydration. Hydration caused a greater decrease (percentage of mean change ± SEM) ofhCG levels in the urine than in the serum, −44% ± 6% vs −13% ± 3%, respectively (P<.05). For serum or urine levels ofhCG, no significant difference in the effects of hydration were found between seven patients with intrauterine pregnancies and the 14 patients with ectopic pregnancies. In no patient did hydration cause a dilution of urinary hCG to below the threshold levels for detection by three rapid bench top immunoabsorption-immunoenzymatic pregnancy tests. A less sensitive pregnancy test, of the agglutination-inhibition type performed on a glass slide, failed to detect six pregnancies initially and eight pregnancies after hydration.

Vaginal sonography in ectopic pregnancy. A prospective evaluation.

Among 404 first-trimester pregnancies examined with vaginal sonography in a prospective study, there were 21 ectopic gestations. Considering only the initial scans, the endometrial canal showed a linear echo surrounded by an echogenic zone in 18 cases, but in three cases the uterine cavity demonstrated a small echo-free area representing blood. Free fluid within the cul-de-sac was seen in 17 patients. An adnexal tumor representing the extrauterine gestation, was detected in 19 cases. Fifteen of these masses exhibited a thick-walled ring characteristic of a gestational sac with a viable embryo in five cases and a yolk sac in one. Other cystic adnexal masses, such as corpus luteum cysts, seen in 14 of the 21 patients were not confused with the ectopic pregnancy. A correct tentative diagnosis of ectopic gestation was made in 18 patients (86%) after the initial scan and in 20 cases (95%) including four controls. There was one false-positive suspicion of ectopic gestation in a patient who actually had a spontaneous abortion. Interpretation of the sonographic image should generally be done in correlation with laboratory and clinical data. The results of the study indicate that vaginal sonography is a valuable diagnostic procedure in the evaluation for ectopic pregnancy.

Sonographic evaluation of ectopic pregnancy.

To assess sonographic findings in the evaluation for ectopic pregnancy, all women referred over a two-year period were prospectively evaluated. The incidence of intrauterine as well as adnexal findings was assessed in an attempt to optimize sonographic evaluation. Visualization of a double decidual sac sign (DDSS) within the uterus provided an accurate means of confirming an intrauterine pregnancy (IUP) prior to embryo visualization. Forty-two of 130 women with IUP were diagnosable only by the DDSS. As a screening test for ectopic pregnancy, sonographic documentation of an IUP provided the only convincing evidence for the absence of an ectopic gestation. Any woman clinically at risk for ectopic pregnancy whose sonogram did not confirm the presence of an intrauterine pregnancy was at relatively high risk (43 per cent) for having an ectopic gestation. Characterization of adnexal findings increased the level of risk for ectopic pregnancy in these women to 70-100 per cent. However, 20 per cent of women with a surgically confirmed ectopic pregnancy had normal adnexal findings.

The timing of a repeat ultrasound examination in the evaluation for ectopic pregnancy.

A method is described for timing a repeat ultrasound examination in patients evaluated for ectopic pregnancy in whom the findings are initially non-diagnostic. This method is based on measuring the serum hCG at the time of the initial ultrasound examination, which allows the time interval required for the serum hCG to exceed 6500 mIU/ml to be calculated. When the serum hCG is above this level, the gestational sac of an intrauterine pregnancy can be reliably identified, and failure to do so signifies ectopic gestation. Seven patients referred for ultrasound to rule out ectopic pregnancy had initially nondiagnostic findings. In each case, a correctly-timed repeat examination, demonstrating a gestational sac, enabled the diagnosis to be excluded.