Incidence Of Ectopic Pregnancy Research Articles

P-398 Lower ectopic pregnancy prevalence with natural endometrial preparation in single euploid frozen embryo transfers

Abstract Study question Does the endometrial preparation approach for an euploid-frozen embryo transfer have an impact on the incidence of an ectopic pregnancy? Summary answer The natural cycle endometrial preparation approach seems to have a lower incidence of ectopic pregnancies compared to a hormonal replacement therapy cycle. What is known already Ectopic pregnancy (EP) is an uncommon complication of pregnancy and is associated with significant morbidity. IVF pregnancies have been implicated as a risk factor, but this finding is mostly confounded by multiple embryo transfer and complicated medical history of women undergoing IVF treatment (tubal disease, surgery, endometriosis, etc.). Recent studies have suggested that frozen embryo transfer may reduce the risk of EP, but it is not yet known whether embryo ploidy status and different endometrial preparation regimens affect the risk of EP. Study design, size, duration Retrospective cohort of 1517 pregnancies from 2607 single euploid frozen embryo transfers. Comparator estimates were estimated using multiple large cohort studies in the literature including 58,203,239 pregnancies from unselected cohorts and 220,167 pregnancies from IVF-treated women with the transfer of non-tested embryos. Participants/materials, setting, methods The rate of ectopic per pregnancies were compared to ectopic rate derived from multiple cohorts of IVF-treated women and population level reports of unselected pregnancies (natural conception and IVF). Comparator estimates were obtained with proportion meta-analyses using generalized linear mixed models. Factors associated with ectopic pregnancies were investigated with mixed-effects logistic regression analyses. Main results and the role of chance EP rate in our cohort was 10/1000 pregnancies (95% CI: 5 to 16 per 1000) resulting from single euploid embryo transfers (1.1%, 16/1517). The observed prevalence of EP was 12/1000 pregnancies (95% CI: 6.8 to 21 per 1000) in unselected cohorts and 14/1000 pregnancies (95% CI: 13 to 15 per 1000) after IVF-treatment. Ectopic rate in our study was not significantly different than rates reported in the literature from unselected and IVF pregnancies (P = 0.579 and 0.223, respectively). There were no significant differences between women with ectopic pregnancies and those with clinical pregnancies in terms of age (33.6±5.5 vs. 35.1±5.2 years, P = 0.290), BMI (26.7±4.8 vs. 25.8±4.6 kg/m2, P = 0.475) and serum AMH levels (3.3±2.9 vs. 3.4±3.9 ng/mL, P = 0.854), nor between the quality of embryo transferred between top, good, fair and poor (1.8% vs 0.7% vs 1.9% vs 0.9%, p = 0.088, 0.997 and 0.508 respectively). Ectopic rates were also similar between women with history of cesarean section (1.1% vs 1.0%, P = 0.847) or isthmocele (1.0 vs 1.1%, P = 0.857). There were less ectopic pregnancies following transfers with natural endometrial preparation (0.5 vs 1.5%, natural vs programmed) and the effect showed statistical significance in multivariable analyses (OR: 0.28, 95% CI: 0.06 – 0.88, P = 0.049). Limitations, reasons for caution Small sample size as well as infrequent occurrence of the studied event reduces the power of our study to detect small but clinically meaningful effects with statistical significance. Wider implications of the findings We did not observe a lower than reported prevalence of EP among euploid embryo transfer. However, rate of EP was significantly lower in natural endometrial preparation cycles compared to preparation with exogenous hormones, indicating that a natural cycle might have a protective effect against the development of an ectopic pregnancy. Trial registration number Not applicable

Study on the optimal time limit of frozen embryo transfer and the effect of a long-term frozen embryo on pregnancy outcome.

In this retrospective study conducted at Sichuan Jinxin Xinan Women and Children's Hospital spanning January 2015 to December 2021, our objective was to investigate the impact of embryo cryopreservation duration on outcomes in frozen embryo transfer. Participants, totaling 47,006 cycles, were classified into 3 groups based on cryopreservation duration: ≤1 year (Group 1), 1 to 6 years (Group 2), and ≥6 years (Group 3). Employing various statistical analyses, including 1-way ANOVA, Kruskal-Wallis test, chi-square test, and a generalized estimating equation model, we rigorously adjusted for confounding factors. Primary outcomes encompassed clinical pregnancy rate and Live Birth Rate (LBR), while secondary outcomes included biochemical pregnancy rate, multiple pregnancy rate, ectopic pregnancy rate, early and late miscarriage rates, preterm birth rate, neonatal birth weight, weeks at birth, and newborn sex. Patient distribution across cryopreservation duration groups was as follows: Group 1 (40,461 cycles), Group 2 (6337 cycles), and Group 3 (208 cycles). Postcontrolling for confounding factors, Group 1 exhibited a decreased likelihood of achieving biochemical pregnancy rate, clinical pregnancy rate, and LBR (OR < 1, aOR < 1, P < .05). Furthermore, an elevated incidence of ectopic pregnancy was observed (OR > 1, aOR > 1), notably significant after 6 years of freezing time [aOR = 4.141, 95% confidence intervals (1.013-16.921), P = .05]. Cryopreservation exceeding 1 year was associated with an increased risk of early miscarriage and preterm birth (OR > 1, aOR > 1). No statistically significant differences were observed in birth weight or sex between groups. However, male infant birth rates were consistently higher than those of female infants across all groups. In conclusion, favorable pregnancy outcomes align with embryo cryopreservation durations within 1 year, while freezing for more than 1 year may diminish clinical pregnancy and LBRs, concurrently elevating the risk of ectopic pregnancy and preterm birth.

The body mass index and the risk of ectopic pregnancy: a 5-year retrospective case-control study

PurposeAcknowledging the associated risk factors may have a positive impact on reducing the incidence of ectopic pregnancy (EP). In recent years, body mass index (BMI) has been mentioned in research. However, few studies are available and controversial on the relationship between EP and BMI.MethodsWe retrospectively studied the EP women as a case group and the deliveries as a control group in the central hospital of Wuhan during 2017 ~ 2021. χ2 test of variables associated with ectopic pregnancy was performed to find differences. Univariate and multivariate binary logistic regression analysis was conducted to analyze the association of the variables of age, parity, history of induced abortion, history of ectopic pregnancy, history of spontaneous abortion, history of appendectomy surgery and BMI (< 18.5 kg/m2, 18.5 ~ 24.9 kg/m2, 25 kg/m2 ~ 29.9 kg/m2, ≥ 30 kg /m2) with EP.ResultsThey were 659 EP and 1460 deliveries. The variables of age, parity, history of induced abortion, history of ectopic pregnancy and BMI were different significantly(P < 0.05). Multivariate analysis showed that the variables of age > 35 years old [(OR (Odds Ratio), 5.415; 95%CI (Confidence Interval), 4.006 ~ 7.320, P < 0.001], history of ectopic pregnancy (OR, 3.944; 95%CI, 2.405 ~ 6.467; P < 0.001), history of induced abortion(OR, 3.365; 95%CI, 2.724 ~ 4.158, P < 0.001) and low BMI (< 18.5 kg/m2) (OR, 1.929; 95%CI, 1.416 ~ 2.628, P < 0.001])increased the risk of EP.ConclusionThe history of ectopic pregnancy, history of induced abortion and age > 35 years old were the risk factors with EP. In addition to these traditional factors, we found low BMI (< 18.5 kg/m2) with women may increase the risk to EP.

Diagnosis and Management of Ectopic Pregnancy

Ectopic pregnancy (EP) is a serious obstetric complication that can be life-threatening. Age-adjusted incidence of ectopic pregnancy is roughly 15.8 pregnancies per 1000. Despite this seemingly low value, EP remains one of the largest contributors to maternal mortality in the first trimester. While some patients require urgent surgery, there is a role for medical and conservative management in patients who are hemodynamically stable. In cases where medical or conservative management is appropriate, family physicians can choose to manage this condition with collaboration from the patient’s obstetrician. Particularly for residents in the 50% of US counties with no obstetrician, it is imperative for family doctors to diagnose EP quickly and accurately

Prophylactic Single-Dose Systemic Methotrexate Therapy for High-Risk Group in Persistent Ectopic Pregnancy After Laparoscopic Conservative Surgery of Tubal Pregnancy

Backgroud: to evaluate whether the incidence of persistent ectopic pregnancy after laparoscopic conservative surgery can be reduced or prevented by prophylactic single-dose systemic methotrexate (MTX) in high-risk group. Methods: Women who underwent laparoscopic conservative surgery for treatment of unruptured ectopic pregnancy, who agreed to participate in the study and who had risk factors for persistent ectopic pregnancy (n = 112) were randomly assigned to the prophylaxis or control group. In the prophylaxis group (n = 72), patients received a single dose of MTX, 1.0mg/kg intramuscularly, within 24 hours postoperatively. No treatment was used in the control group (n = 40). Both groups were followed with serial serum b-hCG titers; titers were measured on the frist postoperative day, then every 72 hours until levels were lower than 5mIU/ml. Results: Four women had persistent ectopic pregnancy, no in the prophylaxis group (0%) and four among the controls (10%); this difference was statistically significant (P &lt; 0.01). One women (1.4%) reported mild side effects after MTX, but these resolved spontaneously. Conclusions: The incidence of persistent ectopic pregnancy was significantly reduced after a single prophylactic dose of systemic MTX administered postoperatively in high-risk group. This regimen is safe and can be used to decrease the extent of postoperative monitoring after conservative treatment of unruptured ectopic pregnancy.

Tubal Stump Ectopic Pregnancy with Acute Abdomen: A Rare Case Report

Ectopic pregnancy, characterized by the implantation of the gestational sac outside the uterine cavity, is a grave condition. The objective of this study is to report a case of recurrent ectopic pregnancy in the residual site of the same fallopian tube, which had undergone unilateral salpingectomy due to ectopic pregnancy five years prior. Despite its rarity in the literature, tubal stump ectopic pregnancy poses higher risks of maternal mortality and morbidity compared to other types of tubal ectopic pregnancies. It is important to note that a history of salpingectomy does not exclude the possibility of ipsilateral recurrent ectopic pregnancy. Furthermore, this is the first documented case of stump tubal ectopic pregnancy from Turkey.

Establishment of a prediction model for the impact of endometrial thickness on the day of embryo transfer on ectopic pregnancy in frozen-thawed embryo transfer cycle.

This study aims to investigate the factors affecting the ectopic pregnancy (EP) rate in the frozen-thawed embryo transfer (FET) cycle. This study retrospectively analyzed 5606 FET cycles, including 5496 cycles resulting in intrauterine pregnancy and 110 cycles resulting in EP. Smooth curve fitting and piece-wise linear regression were utilized to evaluate a non-linear association between endometrial thickness (EMT) and EP. Multiple logistic regression analysis was used to study the effect of EMT on the embryo transfer (ET) day and other indexes on EP rate after adjusting for confounding factors. A nomographic prediction model was employed to predict EP occurrence. The predictive efficacy of the model was assessed using the area under the receiver operating characteristic (ROC) curve (AUC), utilizing the bootstrap sampling method for internal validation. After accounting for the confounding factors, the segmented linear regression analysis indicated that the EMT inflection point was 9mm; the EP rate significantly decreased by 28% with each additional millimeter of EMT up to 9mm (odds ratio (OR) = 0.72; 95% confidence interval (CI), 0.53-0.99; P = 0.0412) while insignificantly decreased when the EMT was greater than 9mm (OR = 0.91; 95% CI, 0.76-1.08; P = 0.2487). Multivariate logistic regression analysis revealed that after adjusting for confounders, EP risk significantly increased in the number of previous EPs ≥ 1 (OR = 2.29; 95% CI, 1.26-4.16; P = 0.0064) and tubal factor infertility (OR = 3.86; 95% CI, 2.06-7.24; P < 0.0001). Conversely, EP risk was significantly reduced by the increased EMT (OR = 0.84; 95% CI, 0.74-0.96; P = 0.0078) and the blastocyst transfer (OR = 0.45; 95% CI, 0.27-0.76; P = 0.0027). These variables were used as independent variables in a nomogram prediction model, resulting in an AUC of 0.685. The nomination models were internally verified using self-sampling (bootstrap sampling resampling times = 500). This validation yielded an AUC of 0.689, with a sensitivity of 0.6915 and a specificity of 0.5790. The internal validation indicated minimal fluctuations in the AUC, signifying a relatively stable model. Undergoing EMT on the day of ET poses a separate EP risk in the FET cycle; to mitigate the EP incidence, the EMT should exceed 9mm before ET. Furthermore, previous EPs and tubal factor infertility were additional factors independently increasing EP risk. Furthermore, implementing blastocyst transfer demonstrated that EP incidence was significantly reduced. Utilizing a nomogram predicting system enables EP risk evaluation before ET for individual patients, establishing a basis for devising clinical strategies for ET.

Preservation of fallopian tubes in ectopic pregnancy

This study covers the application of laparoscopic partial tubal resection with end-to-end anastomosis can reduce the incidence of persistent ectopic pregnancy. In a normal pregnancy, the fertilised egg spends 4 to 5 days travelling down the fallopian tube before moving to the cavity of the uterus where it implants about 6 to 7 days after being fertilised. Most, but not all, ectopic pregnancies take place in the fallopian tube. Early detection of an ectopic pregnancy can prevent serious medical complications and may save the fallopian tube from permanent damage.

Global burden of pelvic inflammatory disease and ectopic pregnancy from 1990 to 2019

BackgroundPelvic inflammatory disease (PID) is a widespread female public problem worldwide. And it could lead to infertility, preterm labor, chronic pelvic pain, and ectopic pregnancy (EP) among reproductive-aged women. This study aimed to assess the global burden and trends as well as the chaning correlation between PID and EP in reproductive-aged women from 1990 to 2019.MethodsThe data of PID and EP among reproductive-aged women (15 to 49 years old) were extracted from the Global Burden of Disease study 2019. The disease burden was assessed by calculating the case numbers and age-standardized rates (ASR). The changing trends and correlation were evaluated by calculating the estimated annual percentage changes (EAPC) and Pearson’s correlation coefficient.ResultsIn 2019, the ASR of PID prevalence was 53.19 per 100,000 population with a decreasing trend from 1990 (EAPC: − 0.50), while the ASR of EP incidence was 342.44 per 100,000 population with a decreasing trend from 1990 (EAPC: − 1.15). Globally, PID and EP burdens changed with a strong positive correlation (Cor = 0.89) globally from 1990 to 2019. In 2019, Western Sub-Saharan Africa, Australasia, and Central Sub-Saharan Africa had the highest ASR of PID prevalence, and Oceania, Eastern Europe, and Southern Latin America had the highest ASR of EP incidence. Only Western Europe saw significant increasing PID trends, while Eastern Europe and Western Europe saw increasing EP trends. The highest correlations between PID and EP burden were observed in Burkina Faso, Laos, and Bhutan. General negative correlations between the socio-demographic index and the ASR of PID prevalence and the ASR of EP incidence were observed at the national levels.ConclusionPID and EP continue to be public health burdens with a strong correlation despite slightly decreasing trends detected in ASRs globally. Effective interventions and strategies should be established according to the local situation by policymakers.

Ectopic Pregnancy Risk Factors Presentation and Management Outcomes

Background: Ectopic pregnancy (EP) is a common and serious early pregnancy problem with a significant morbidity rate and the potential for maternal death. Women commonly present with minimal vaginal bleeding and abdominal pain. Objective: The main objective of the study was to evaluate the risk factors, clinical presentation, sites, and management outcomes of ectopic pregnancies. Methodology: It was a prospective descriptive, cross-sectional hospital-based study conducted at Bashair Teaching Hospital during the period January 2021–June 2021. An interview questionnaire was used, and eighty-two (82) women were included after informed consent. Demographic and clinical data concerning personal history, symptoms of presentation, risk, site, and type of management were recorded. Results: Ectopic pregnancy incidence was 2% and most risk factors were infection 29.3%, surgery 15.9%, miscarriage 13.4%, infertility 12.2%, tubal surgery 4.9%, previous ectopic pregnancy 4.9%, intrauterine contraceptive device (IUCD) 3.6%, and tubal ligation 2.4%. Women presented with bleeding and abdominal pain at 47.5%, bleeding at 18.3%, abdominal pain at 9.7%, and shock at 8.5%. The sites are ampullary (57.3%), fimbria (9.7%), interstitial (8.5%), isthmus (8.5%), ovarian (7.3%), cervical (4.8%), and abdominal (3.6%). Surgical management was 93.9%, medical and surgical management was 3.6% and medical management was 2.4%. A blood transfusion was received at 37.8%. Conclusion: The study concluded that women of reproductive age are at risk of ectopic pregnancy, so healthcare providers and doctors should have a high index of suspicion, prompt diagnosis, and intervention for ectopic pregnancy. Assessment of women at risk factors and modifications will reduce incidence.

Medication Abortion and Uterine Aspiration for Undesired Pregnancy of Unknown Location: A Retrospective Cohort Study

ABSTRACT Uncertain diagnosis can complicate the evaluation and treatment of patients presenting for undesired pregnancy termination at early gestational ages. Pregnant patients with no ultrasonography-identifiable pregnancy location receive classification of pregnancy of unknown location (PUL). Until receiving a definitive intrauterine pregnancy (IUP), ectopic pregnancy, or early pregnancy loss diagnosis, these patients are often managed expectantly with serial serum human chorionic gonadotropin (hCG) measurements and ultrasonography. Immediate treatment of undesired PUL with low-risk for ectopic pregnancy can be performed in ways that minimize the risk. This retrospective cohort study reviewed outcomes of pregnancies for PUL-diagnosed patients presenting at Planned Parenthood in Minnesota, North Dakota, and South Dakota to receive induced abortions between July 1, 2016, and December 31, 2019. Care of patients with PUL included assessment of health history, counseling, and ectopic pregnancy precaution reviews. Clinicians then proceeded to triage patients into low- and high-risk groups based on transvaginal ultrasonography findings and patient symptoms. For PUL patients deemed low risk for ectopic pregnancy, the choices of expectant management or induced abortion were given. Patients proceeding with induced abortions then proceeded with uterine aspiration or medication abortion. The primary objective compared the diagnosis of pregnancy location to time for 3 groups, which included the groups of patients choosing immediate treatment (via uterine aspiration or medical management), and the group of patients who initially chose expectant management (delay for diagnosis). Time to diagnosis, as measured in days, was recorded from initial PUL diagnosis until final pregnancy location diagnosis. A spontaneous decline of serum hCG after 48–72 hours in the delay-for-diagnosis group was recorded as a spontaneously resolved PUL consistent with spontaneous abortion. Incidence of ectopic pregnancies, complications such as transfusion-requiring hemorrhages, and failure to adhere with follow-up guidelines (greater than 60 days from PUL diagnosis without clinical contact and/or a pregnancy diagnosis) were also recorded. From a total of 19,151 abortion counters across the study period, 2.9% of patients (553) were diagnosed with PUL. High-risk diagnoses were given to 9.4% of patients (52), based on concerns from symptoms and ultrasounds (27 of these had ectopic pregnancies [51.9%]). Low-risk diagnoses were given to 90.6% of the remaining patients (501), who were given a choice of management. When compared with expectant management, results indicated that low-risk patients with undesired PUL experienced fewer days to diagnosis with immediate treatment by uterine aspiration (and a similar time frame to diagnosis with abortion via medication). For uterine aspiration, abortion treatment using simultaneous serial hCG trending was effective. Although this study lacked statistical power to detect differences between groups, there was an overall low complication rate (0.2%). Strengths of the study include the exclusive focus on true-PUL patients, as well as the large sample size. Generalizability was potentially increased by the fact that various physicians triaged PUL patients in the study setting without increases in complications. A weakness of the study was that even with a 60-day follow-up window, the 27% follow-up nonadherence rate was higher than the 16% of Goldberg et al. In addition, the retrospective nature of the study was also a weakness. Finally, given the inability to observe direct comparison for efficacy of delayed medication versus immediate abortion due to higher rates of spontaneous abortion in the delay-for-diagnosis group, the outcomes of the study are limited by small numbers. This study shows that proceeding with an induced abortion in patients with PUL and undesired pregnancy are effective and safe as long as a plan for close follow-up with hCG is in place.

Unpacking the importance of histopathology in ectopic pregnancy: Vital for follow up.

The incidence of ectopic molar pregnancy is very rare with an incidence estimated to be 1.5 per 1,000,000 pregnancies. The pre-operative diagnosis is rare and needs careful histopathological examination of salpingectomy specimen. A case of a 34-year-old female is discussed who presented in shock with clinical and radiological diagnosis of ruptured ectopic pregnancy and histopathology report revealed partial mole in ectopic specimen.

Evidence-based complementary and alternative medicine conventional surgery combined with traditional Chinese medicinal retention enema for tubal obstructive infertility: A systematic review and meta-analysis.

Chinese medicinal retention enemas have gradually attracted the attention of clinicians as an alternative approach for tubal obstructive infertility. The purpose of this study was to investigate the efficacy and safety of conventional surgery combined with traditional Chinese medicinal retention enemas for the treatment of tubal obstructive infertility. Eight electronic databases were searched from their inception to November 30, 2022. To assess the efficacy and safety of different treatments, following outcomes were measured: clinical pregnancy rate, clinical total effective rate, incidence of ectopic pregnancy, the improvement of Traditional Chinese Medicinal (TCM) symptoms, the improvement of the signs of obstructive tubal infertility and side effects. A total of 23 Randomized Controlled Trials (RCTs) with 1909 patients met the inclusion criteria. The pooled results showed a higher pregnancy rate in the experimental group than in the control group (RR 1.75, 95% CI [1.58, 1.94], Z = 10.55, P<0.00001). The clinical total effective rate in the experimental group was higher than that in the control group (RR 1.28, 95% CI [1.23, 1.34], Z = 11.07, P<0.00001). The incidence of ectopic pregnancy in the experimental group was lower than that in the control group (RR 0.40, 95% CI [0.20, 0.77], Z = -2.73, P = 0.01). Based on current evidence, we concluded that conventional surgery combined with traditional Chinese medicinal retention enema for tubal obstructive infertility was superior to conventional surgery alone in improving the clinical pregnancy rate, improving clinical total effective rate, improving TCM symptoms, improving the signs of obstructive tubal infertility and lowering the incidence of ectopic pregnancy. However, further clinical trials with high-quality methodologies need to be conducted.

Ruptured Ectopic Pregnancy at Tertiary Care Centre: A Cross-sectional Study

Objectives: Ectopic pregnancy (EP) is the leading cause of early pregnancy accounting for 10-15% of pregnancy-related deaths. It is life-threatening condition where the majority of them present late. This study aims to evaluate the incidence, risk factors, clinical features, diagnosis, and management of EP in the tertiary care center. Materials and Methods: This study conducted a retrospective analysis of electronic medical records from June 2015 to June 2020, focusing on participants in the age group of 18 to 45 years, to examine the occurrence of EP. The data were analysed with simple descriptive statistics and presented in frequency tables and charts of age group, parity, anemia grades, risk factors and presenting symptoms. Results: The incidence of EP in the current study was 0.38%. In the present study, 73.8% of women were of 20–30-year-old. In this study, 54.1% of women had a history of pelvic inflammatory disease (PID). Prior EP was seen in 19.7 % of cases. 16.4% of participants had a prior history of tubectomy and 19.7% had a previous history of infertility treatment, and 21.3% had a previous history of lower segment caesarean section (LSCS). In the present study, 65.5% of women presented with amenorrhea of 4-8 week, and 95% had abdominal pain. In the present study, common site was the right fallopian tube in 73.9% of cases. In this study, all cases need surgical management most common procedure carried out was salpingectomy. intensive care unit (ICU) admission was needed in 26.2% of cases, and no mortality was seen in our study. Conclusions: EP is a serious and potentially life-threatening condition. Early diagnosis and prompt management are crucial in reducing maternal mortality and morbidity rates.

A clinical analysis of ectopic pregnancies in a tertiary care centre: A one year retrospective study

Following fertilization and fallopian tube transit, the blastocyst normally implants in the endometrial lining of the uterine cavity. An ectopic pregnancy occurs when a fertilized ovum implants outside the normal uterine cavity. Fortunately, beta-human chorionic gonadotropin (β-hCG) assays and transvaginal sonography (TVS) aid earlier diagnosis, maternal survival, and fertility conservation. Ruptured ectopic is a surgical emergency.To study and analyse ectopic pregnancies in a tertiary care centre.To determine the incidence, risk factors, clinical presentation, management, morbidity and mortality of ectopic pregnancy.: A retrospective analysis of ectopic pregnancies was done in Gandhi hospital, Secunderabad from October 2021 to September 2022 (1 year duration) with a sample of 97 cases of suspected ectopic pregnancies observed and treated, out of total 11252 pregnant women admitted.The incidence of ectopic pregnancy was 8 per 1000(0.81%) pregnancies, majority between the age of 20-30yrs (87.5%) and in higher order pregnancies (3or&amp;#62;3 pregnancies) (50.4%). Risk factors were multiparity (50.5%), h/o infertility treatment (12.3%), tubal sterilisation (7.2%). The typical triad of amenorrhoea, pain abdomen and bleeding p/v was observed in 69% of cases. In 16.4% cases the haemoglobin was &amp;#60;7gm% at presentation. Among 97 suspected cases of ectopic pregnancies, 90(92.7%) cases were found to have ectopic pregnancy. 27.8% of cases were presented in class 2 or more haemorrhagic shock. 79% cases were ruptured ectopic pregnancies. Ampullary ectopic pregnancies were predominant(62.9%) followed by corneal (14.6%) &amp;#62; fimbrial(13.4%) &amp;#62; ovarian(4.4%)&amp;#62; isthmus (2.2%). 2 women among 97 cases of suspected ectopic pregnancies were found to have Heterotopic pregnancy {tubal+intrauterine [missed abortion]}. Unilateral salpingectomy was done in 90.5% cases. Medical management was done successfully with single dose of methotrexate in 1 case. Blood transfusions were given in 69.9% cases. Post op wound complications were observed in 3.1% cases. Mortality is zero in present study.Clinicians should be aware of the fact that any women in reproductive age group presenting with pain in lower abdomen or vaginal bleeding, ectopic pregnancy should be suspected irrespective of presence or absence of amenorrhoea, whether or not she has undergone sterilization, because early diagnosis is critical in reducing maternal morbidity and mortality and improving treatment success rates.

Ectopic Pregnancy After Hysterectomy: A Case Report and Review of the Literature

Ectopic pregnancy occurs in 1-2% of all pregnancies and involves an ovum implanting outside of the uterus. The most frequent site of ectopic pregnancy is the fallopian tubes, followed by the ovary, and occasionally can occur within the abdomen. Ectopic pregnancy after hysterectomy has been reported but is extremely rare, making it a diagnostic challenge and increasing the risk of morbidity and mortality. Herein we report the case of a 39-year-old woman who developed an ectopic pregnancy nine years after a sub-total hysterectomy. A literature review was also conducted to explore the available research on this extremely scarce event. The review suggests that the incidence of ectopic pregnancy after hysterectomy is extremely low, but it is a severe and life-threatening condition and requires a high index of suspicion to diagnose it. There is a need to share this case to alert medical practitioners of the potential for ectopic pregnancy after hysterectomy to ensure it is considered when women of childbearing age present with abdominal pain.

Outcome with Methotrexate versus Expectant Management for Ectopic Pregnancy

Background: Patients with ectopic pregnancy and low serum β-HCG concentrations are commonly treated with systemic methotrexate. Aim: To compare the outcome of methotrexate versus expectant management for females presenting with ectopic pregnancy. Study design: Randomized controlled trial. Methodology: Females with ectopic pregnancy (n=140) were enrolled in study. Blood sample was taken and beta-HCG was noted. Then females were randomly divided in two groups by using lottery method. In group A, females were given methotrexate. In group B, females were given expectant management and not received any specific treatment. Then females were followed-up for 24 hours for assessment of decline in HCG was labeled. If HCG was not declined or even increase, then females underwent surgical intervention. Data was evaluated by using SPSS v.24. Results: The mean age of patients randomized to methotrexate group was 31.24±8.85years while in expectant management group was 29.94±8.02 years. In methotrexate group, 67(95.7%) females had decline in beta-HCG while 3(4.3%) had no decline in beta-HCG. In expectant management group, 37(52.9%) females had decline in beta-HCG while 33(47.1%) had no decline in beta-HCG. Practical Implication: As there is a high incidence of ectopic pregnancies among our pregnant females and there is lack of local data that specifically addresses this health issue thus current study was planned. Conclusion: It was concluded that methotrexate is an effective way to treat ectopic pregnancy with less chances of complications. Keywords: Ectopic Pregnancy, Methotrexate, Beta-Human Chorionic Gonadotropin and Surgical Intervention.

Overview of Risk Factors for Ectopic Pregnancy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction: Ectopic pregnancy is an emergency condition that is the cause of maternal death during the first trimester of pregnancy. Most extrauterine implantations occur in the fallopian tubes. This study aimed to find an overview factor risk of ectopic pregnancy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.&#x0D; Methods: This study was a descriptive observational study and used secondary data from medical record data at the medical record installation of Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. A total of 100 research subjects participated in this study, and the research subjects met the inclusion criteria. The inclusion criteria in this study were patients with ectopic pregnancy disorders who were treated at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia, over 18 years of age and had complete medical record data. Data analysis was carried out using SPSS software version 25. Univariate analysis was performed to present the distribution frequency data for each variable test.&#x0D; Results: The majority of research subjects had an age range of 26-35 years (55%). The most common risk factors in this study were a history of abortion in a previous pregnancy (47%), parity 0 (46%), and abortion occurring in the first pregnancy (35%).&#x0D; Conclusion: Maternal age, history of abortion, parity, and gravidity are risk factors that play a role in the incidence of ectopic pregnancy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

Reproductive outcomes of ectopic pregnancy with conservative and surgical treatment: A systematic review and meta-analysis.

Ectopic pregnancy (EP), one of the most common gynecological emergencies, is the major cause of maternal death in the first trimester and increases the incidence of infertility and repeat ectopic pregnancy (REP). The aim of this study was to compare the effects of different treatment methods for tubal EP on natural pregnancy outcomes. We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials for observational studies on EP (published until October 30,2022 in English) comparing methotrexate (MTX) versus surgery, MTX versus salpingostomy, MTX versus salpingectomy, salpingostomy versus salpingectomy, and MTX versus expectant treatment. Our main endpoints included subsequent natural intrauterine pregnancy (IUP) and REP. We assessed the pooled data using Review Manager software (version 5.3) with a random effects model. Of 1274 identified articles, 20 were eligible and 3530 participants were included in our analysis. There was a significant difference in the odds of subsequent IUP in tubal EP patients who underwent MTX compared with those who were treated with surgery [odds ratios (OR) = 1.52, 95% confidence interval (CI):1.20-1.92]. No significant difference was found in the odds of REP between the 2 groups (OR = 1.12, 95% confidence interval [CI]: 0.84-1.51). There was no significant difference in the odds of subsequent IUP and REP in patients after MTX compared to those after salpingostomy (OR = 1.04,95% CI: 0.79-1.38; OR = 1.10, 95% CI: 0.64-1.90). There was a significant difference in the odds of subsequent IUP in patients after MTX compared with those after salpingectomy (OR = 2.11, 95% CI: 1.52-2.93). No significant difference was found in the odds of REP between the 2 groups (OR = 0.98, 95% CI: 0.57-1.71). There was a significant difference in the odds of subsequent IUP between patients who underwent salpingostomy and those who underwent salpingectomy (OR = 1.61, 95% CI: 1.29-2.01). No significant difference was found in the odds of REP between the 2 groups (OR = 1.21, 95% CI: 0.62-2.37). There was no significant difference in the odds of subsequent IUP and REP in patients after MTX compared with those after expectant treatment (OR = 1.25, 95% CI: 0.64-2.45; OR = 0.69, 95% CI: 0.09-5.55). For hemodynamically stable tubal EP patients, MTX has advantages over surgery, particularly salpingectomy, in improving natural pregnancy outcomes. However, MTX is not inferior to salpingostomy and expectant treatment.

To determine the burden of ectopic pregnancy in the tertiary care centre (TRIHMS) of Arunachal Pradesh and its implication on the type of surgical and anaesthetic management

The incidence of Ectopic Pregnancy (EP) is 1 – 2% in India, with mortality rate of none to 3.5%. It is considered to be emerging as one of the leading problem for woman’s fertility with major mortalities in reproductive age group.In this study we had intended to find out the incidence of EP in tertiary care centre of Arunachal Pradesh along with clinical presentation and mode of surgical and anaesthetic management. After clearance from Institutional ethics committee, patients’ with diagnosis of ectopic pregnancy, whether elective or emergency were included in this study. This study aimed to determine the incidence of EP, type of surgical intervention and mode of anaesthesia. 81 diagnosed cases of EP admitted in obstetrics ward were enrolled for this study. The incidence of EP was 22.9 per 1000 deliveries in tertiary care centre of state of Arunachal Pradesh. Emergency contraceptive pill intake was single most leading risk factor in this study, with history of intake in 28.4% of the cases. 85.2% cases had salphingectomy and 90.1% surgeries were conducted under spinal anaesthesia EP may be rising in recent trends due emerging use of contraceptive and other reproductive techniques. We conclude that the ectopic pregnancy is major cause of morbidity in reproductive female age group; however, with timely diagnosis and collaborative obstetrical and anaesthetic management, its mortality can be reduced significantly.