Intrauterine Pregnancy Group Research Articles

Predictive value of endometrial receptivity evaluated by three-dimensional ultrasound in ectopic pregnancy after in vitro fertilization-embryo transfer.

The aim of this study was to use three-dimensional (3D) ultrasound to detect ultrasound parameters related to the uterine artery and endometrium, evaluate endometrial receptivity, and investigate the predictive value of each parameter for ectopic pregnancy (EP) after in vitro fertilization-embryo transfer (IVF-ET). Fifty-seven cases of pregnancy following IVF-ET in our institution were collected and split into EP and intrauterine pregnancy (IP) groups based on the location of pregnancy, with 27 cases in EP and 30 cases in IP. Endometrial thickness, type, volume, endometrial blood flow parameters, and uterine artery blood flow parameters were all measured one day before transplantation in both groups, and the differences between the two groups were examined. There were differences in endometrial blood flow typing between the two groups, with type III endometrium accounting for the highest proportion in both; the uterine spiral artery pulsatility index PI was significantly higher in the EP group than in the IP group; there were no statistical differences in uterine volume, uterine artery resistance index mRI, or uterine artery resistance index S/D between the two groups; there were no statistical differences in uterine volume, or uterine artery. Intracavitary 3D ultrasound can assess endometrial tolerance and may predict pregnancy outcome after IVF-ET.

Non-Lactobacillus-Dominated Vaginal Microbiota Is Associated With a Tubal Pregnancy in Symptomatic Chinese Women in the Early Stage of Pregnancy: A Nested Case-Control Study.

The features of the vaginal microbiota (VM) community can reflect health status, and they could become new biomarkers for disease diagnosis. During pregnancy, domination of bacteria of the genus Lactobacillus in the VM community is regarded as a keystone because they stabilize the VM by producing antimicrobial compounds and competing adhesion. An altered VM composition provides a marker for adverse pregnancy outcomes. This nested case–control study aimed to characterize the VM in women with a tubal pregnancy (TP) presenting with pain and/or uterine bleeding in early pregnancy. Chinese women with a symptomatic early pregnancy of unknown location were the study cohort. 16S rDNA gene-sequencing of V3–V4 variable regions was done to assess the diversity, structures, taxonomic biomarkers, and classification of the VM community. The primary outcome was the location of the early pregnancy. The VM community in women with a TP showed higher diversity (PD-whole-tree, median: 8.26 vs. 7.08, P = 0.047; Shannon Diversity Index, median: 1.43 vs 0.99, P = 0.03) and showed different structures to those in women with an intrauterine pregnancy (IUP) (R = 0.23, P < 0.01). Bacteria of the genus Lactobacillus were significantly enriched in the IUP group, whereas bacteria of the genera Gardnerella and Prevotella were significantly enriched in the TP group. Lactobacillus abundance could be used to classify the pregnancy location (AUC = 0.81). Non-Lactobacillus-dominated microbiota (≤ 0.85% Lactobacillus) was significantly associated with a TP (adjusted odds ratio: 4.42, 95% confidence interval: 1.33 to 14.71, P = 0.02). In conclusion, among women with a symptomatic early pregnancy, a higher diversity and lower abundance of Lactobacillus in the VM is associated with a TP.

Relationship Between Polycystic Ovarian Morphology and Ectopic Pregnancy.

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

Using dynein heavy chain 5 and creatine kinase levels in cervical fluid and blood for early diagnosing of ectopic pregnancy.

Ectopic pregnancy is a life-threatening problem in reproductive ages. Diagnosing ectopic pregnancy in the early period provides to reducing mortality and morbidity and gives an opportunity for medical treatment to preserve fallopian tubes. Evaluation of cervical fluid for determining ectopic pregnancy with new promising markers provided different aspects for diagnosing ectopic pregnancy in the present study. In this prospective clinical study, ectopic pregnant patients as ectopic pregnancy group (n = 46), intrauterine pregnant patients as intrauterine pregnancy group (n = 29) and not-pregnant patients as nonpregnancy group (n = 10) participated to study. Cervical fluid samples were collected with using merocel sponge. In addition, serum samples were obtained from patients. Dynein heavy chain 5 (DNAH5) and creatine kinase (CK) levels were determined by enzyme-linked immunosorbent assay kits in samples. Reduced cervical fluid DNAH5 levels was diagnosed in ectopic pregnancy group compared to intrauterine pregnancy group (median 3.42 ng/mL; 25-75% percentile 0-9.56 ng/mL vs median 6.14 ng/mL; 1.40-8.31 ng/mL; P < 0.001). On the other hand, DNAH5 protein was not detected in nonpregnant patients' samples. In addition, statistical significant increased cervical fluid CK levels were diagnosed in ectopic pregnancy group compared to intrauterine pregnancy group (median 4477.61 IU/L; 0-64 925.37 IU/L vs 0 IU/L; 0-6832.30 IU/L; P = 0.006). Measuring of CK and DNAH5 in cervical fluid could be promising markers for early diagnosing of ectopic pregnancy. Decreased DNAH5 levels in cervical fluid might be result from abnormal cilia function in ectopic pregnant patients. ClinicalTrials.gov ID. NCT02995356.

Contrast-Enhanced Ultrasound Evaluation of Mifepristone for Treatment of Low-Risk Cesarean Scar Pregnancy.

Purpose The effect of mifepristone for treatment of low-risk cesarean scar pregnancy (CSP) was monitored by contrast-enhanced ultrasound (CEUS). Methods Data were collected from 23 CSP patients with a 10-point risk score <5 (low-risk CSP) and from 23 intrauterine pregnancy (IUP) patients with a scar from a previous cesarean delivery. All patients were prescribed 75 mg mifepristone daily for 2 days and underwent transvaginal CEUS before and after administration of mifepristone. On the third day, uterine curettage was performed after transvaginal CEUS. Arrival time (AT), peak intensity (PI), and area under the curve (AUC) around the gestational sac were monitored by CEUS before and after application of mifepristone, and the rate of effective treatment was compared between the two patient groups. Results No patients experienced side effects from either the CEUS procedure or the mifepristone treatment. Changes in AT, PI, and AUC index from before vs. after mifepristone treatment did not differ significantly between the two groups (all p values >0.05). There was also no significant difference in the rate of effective treatment between the two groups (95.65% in the CSP group vs. 100% in the IUP group; p > 0.05). Conclusions Based on monitoring by CEUS, the effect of mifepristone in low-risk CSP was comparable to that in IUP.

Management strategies of heterotopic pregnancy following in vitro fertilization-embryo transfer

ObjectiveThe purpose of this study was to evaluate the efficiency and safety of different treatment modalities for heterotopic pregnancy (HP) in vitro fertilization-embryo transfer (IVF-ET) cycles to avoid influence on intrauterine pregnancy (IUP). Materials and methodsCases of HP (n = 90) were from the IVF/ICSI registry database at the Reproductive Hospital Affiliated to Shandong University. An additional 360 women were randomly selected as controls. The primary outcome to examine the risk factors, diagnostic modalities and the impact of different treatment modalities for HP. ResultsOur results showed that surgical treatment had a certain effect on improving the live-birth rate, although the effect was not statistically significant (87.9% vs. 70.8%, P = 0.055). The risk factors for HP included previous tubal surgery and hydrosalpinx. Fourteen days after embryo transfer, the serum levels of β-human chorionic gonadotropin (β-hCG) and estradiol (E2) were lower in the HP group than in the IUP group (P < 0.05). Furthermore, age and endometrial thickness showed a significant difference between the early abortion and the live-birth groups of HP. ConclusionsIn our retrospective study, we supported early surgical laparoscopic intervention to minimize the incidence of abortion of IUP, which resulted in a better live-birth rate. A history of ectopic pregnancy and previous tubal surgery may increase the risk of HP. Low levels of serum β-hCG and E2 on the 14th day after embryo transfer could indicate the incidence of HP.

The performances of serum activins and follistatin in the diagnosis of ectopic pregnancy: A prospective case-control study

BackgroundThe diagnosis of ectopic pregnancy (EP) is challenging and 40–50% of patients are initially misdiagnosed. MethodsThis prospective case-control study measured activin-A, activin-B, activin-AB and follistatin for the diagnosis of EP, spontaneous abortion (SAB) and normal intrauterine pregnancy (IUP). Sera were collected from 120 women with symptoms suggesting early pregnancy failure and who were clinically diagnosed as IUP, SAB or EP (n = 40/group). The markers were measured by ELISA and their area under the curve (AUC), cut-off value, sensitivity and specificity were determined by receiver-operating characteristic curve. The results were compared with serum β-human chorionic gonadotropin and progesterone. ResultsActivin-A and activin-B decreased significantly, while activin-AB and follistatin increased, in the EP and SAB groups than the IUP group. Activin-AB (AUC = 0.961) and progesterone (AUC = 0.973) were the best markers for EP and SAB, respectively. Activin-AB (≥61.5 pg/mL) showed 92.5% sensitivity, 85% specificity, 75.5% positive predictive value (PPV) and 95.8% negative predictive value (NPV) for EP. Progesterone (≤6.3 ng/mL) had 100% sensitivity, 86.2% specificity, 78.4% PPV and 100% NPV for SAB. ConclusionsSerum activins and follistatin were significantly altered with EP and activin-AB could be a promising marker for the diagnosis of EP.

Efficacy and safety of very early medical termination of pregnancy: a cohort study.

To assess the efficacy and safety of medical termination of pregnancy (MTOP) when no intrauterine pregnancy (IUP) is confirmed on ultrasound. Retrospective case-note review. Two gynaecological clinics in Vienna, Austria, and Gothenburg, Sweden. All women with gestations of ≤49days undergoing an MTOP during 2004-14 (Vienna) and 2012-15 (Gothenburg). Two study cohorts were created: women with and women without a confirmed IUP. An IUP was defined as the intrauterine location of a yolk sac or fetal structure visible by ultrasound. Women with an IUP were selected randomly and included in the IUP cohort. Efficacy of MTOP, defined as no continuing pregnancy and with no need of surgery for incomplete TOP. After excluding 11 women diagnosed with an extra-uterine or molar pregnancy, 2643 cases were included in the final analysis; 1120 (98.2%) had a successful TOP in the no-IUP group, compared with 1458 (97.1%) in the IUP group, with a risk difference of 1.09% (95% confidence interval, 95%CI, -0.14, 2.32%; P=0.077). Significantly more women with confirmed IUP were diagnosed with incomplete TOP, and were treated with either surgery or additional medical treatment of misoprostol [64 (4.3%) versus 21 (1.8%); risk difference -2.42%; 95%CI -3.9, -1.1%; P<0.001]. There was no difference between the groups in efficacy of MTOP, whereas early treatment resulted in significantly fewer interventions for incomplete TOP. The risk of ectopic pregnancy needs to be considered if treatment is initiated before an IUP is confirmed, but with structured clinical protocols the possibility of the early detection of an ectopic pregnancy in an asymptomatic phase may increase. MTOP before confirmed intrauterine pregnancy is as effective as at later gestation with less incomplete TOP.

Anxiety associated with diagnostic uncertainty in early pregnancy

To determine anxiety levels of women presenting to an early pregnancy assessment unit (EPAU) with abdominal pain and/or vaginal bleeding and to assess how these levels change over time and according to ultrasonographic diagnosis. We undertook a prospective cohort study in an EPAU in a large UK teaching hospital. Women with abdominal pain and/or vaginal bleeding in early pregnancy (< 12 weeks' gestation) presenting for the first time were eligible for inclusion in the study. State anxiety levels were assessed using the standardized short form of Spielberger's state-trait anxiety inventory (STAI) on three occasions (before, immediately after and 48-72 hours after an ultrasound scan). Scores were correlated with ultrasonographic diagnosis. The diagnosis was either certain or uncertain. Certain diagnoses were either positive, i.e. a viable intrauterine pregnancy (IUP), or negative, i.e. a non-viable IUP or ectopic pregnancy. Uncertain diagnoses included pregnancy of unknown location and pregnancy of uncertain viability. Statistical analysis involved mixed ANOVAs and the post-hoc Tukey-Kramer test. A total of 160 women were included in the study. Anxiety levels decreased over time for women with a certain diagnosis (n = 128), even when negative (n = 64), and increased over time for women with an uncertain diagnosis (n = 32). Before the ultrasound examination, anxiety levels were high (STAI value, 21.96 ± 1.11) and there was no significant difference between the five groups. Immediately after the ultrasound examination, anxiety levels were lower in the viable IUP group (n = 64; 7.75 ± 1.13) than in any other group. The difference between the five groups was significant (P < 0.005). After 48-72 hours, women with a certain diagnosis had significantly lower anxiety levels than had those with an uncertain diagnosis (10.77 ± 4.30 vs 22.94 ± 1.65; P < 0.005). The experience of abdominal pain and/or vaginal bleeding in early pregnancy is highly anxiogenic. Following an ultrasound examination, the certainty of the diagnosis affects anxiety levels more than does the positive or negative connotations associated with the diagnosis per se. Healthcare providers should be aware of this when communicating uncertain diagnoses. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Evaluation of sonographic endometrial patterns and endometrial thickness as predictors of ectopic pregnancy.

To evaluate whether endometrial patterns and thickness could be used for the prediction of ectopic pregnancy (EP). A prospective study was conducted in a center in India between October 2007 and December 2008. It included 100 women with an early pregnancy confirmed by urine pregnancy testing but for whom an intrauterine gestational sac was not visualized on transvaginal ultrasonography (TVS). The women were divided into an EP group and an intrauterine pregnancy (IUP) group depending on the final diagnosis. The endometrial pattern and endometrial thickness were determined by TVS. Sensitivity and receiver operating characteristic curve analyses were performed to determine the predictive value. A heterogenous hyperechoic or trilaminar endometrial pattern was noted in 53 (77%) of 69 women in the EP group and 12 (39%) of 31 in the IUP group, and a homogenous hyperechoic pattern in 3 (4%) women in the EP group and 13 (42%) in the IUP group. An endometrial thickness of less than 9.8mm was predictive of EP (P<0.001), and an endometrial pattern other than homogenous hyperechoic had a sensitivity and a negative predictive value of 81.3% for the diagnosis of EP. Evaluation of endometrial thickness and pattern by TVS helps to identify women with a pregnancy of unknown location for close supervision.

Evaluation of mean platelet volume in unruptured ectopic pregnancy: A retrospective analysis

We aimed to investigate and compare the mean platelet volume (MPV) levels in ectopic and viable intrauterine pregnancy (IUP). The medical records of 78 unruptured tubal ectopic pregnancy patients (TEP, Group 1) and 150 patients with viable IUP (Group 2) served as control group between May 2014 and February 2015 in our clinic were retrospectively analysed. The demographic characteristics including age, parity, gravida, abortus, haemoglobin levels and leucocyte counts showed no statistically difference between two groups. The mean MPV level was significantly lower in TEP group compared to IUP group (8.69 ± 1.14 and 10.06 ± 1.46, p < 0.001). The platelet (PLT) distribution width was higher in TEP group, however, there was no statistical difference between the two groups (p = 0.078). The early diagnosis of TEP is crucial in order to prevent maternal morbidity and mortality. Our results showed that MPV is lower in TEP than IUP and it seems to be related with the possible inflammation at implantation site of tuba uterina. However, there is need for further studies for employing PLT indices in the diagnosis of TEP.

Association between knowledge about levonorgestrel emergency contraception and the risk of ectopic pregnancy following levonorgestrel emergency contraception failure: a comparative survey.

ObjectiveTo study the association between knowledge about levonorgestrel emergency contraception (LNG‐EC) and the risk of ectopic pregnancy (EP) following LNG‐EC failure.MethodsThis study included 600 women who had visited the hospital with LNG‐EC failure. Of these, 300 with EP and 300 with intrauterine pregnancy (IUP) were recruited to the EP group and IUP group respectively. The participants were interviewed face‐to‐face using a standardized questionnaire.Main Outcome MeasuresPearson's chi‐square tests and t‐test were used to compare the sociodemographic characteristics, reproductive and gynecological history, surgical history, previous contraceptive experience, and answers to 10 questions concerning the knowledge about LNG‐EC.ResultsThose who gave incorrect answers to the question regarding the basic mechanism and specific method of levonorgestrel emergency contraceptive pills (LNG‐ECPs) were at a higher risk of EP after LNG‐EC failure. Women who did not strictly follow instructions or advice from healthcare professionals were more likely to subsequently experience EP (p < 10−4). Women with LNG‐EC failure reported friends/peers, TV, and Internet as the main sources of information. No difference was observed with regard to the sources of knowledge on LNG‐EC (p = 0.07).ConclusionsThe results illustrate the importance of strictly following the doctor's guidance or drug instructions when using LNG‐ECPs. The media should be used to disseminate information about responsible EC, and pharmacy staff should receive regular educational training sessions in this regard. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

Serum progesterone levels in early pregnant women and its relation to luteal maintenance therapy for pregnancy protection

Objective To investigate serum levels of β-human chorionic gonadotrophin (β-HCG) and progesterone (P) in early pregnant women, and their relation to luteal maintenance therapy for early pregnancy protection. Methods One hundred and thirty five infertility women treated in Department of Gynecology and Obstetrics of Beijing Chaoyang Hospital from January 2007 to December 2011. Total 150 pregnancy cycles, including 84 with intrauterine insemination (IUI) and 66 with natural conception, were divided into two groups: normal intrauterine pregnancy group (group A, n=80) and early pregnancy loss group (group B, n=70). Medical history, ultrasonic findings, serum female hormone, P and β-HCG levels at early pregnancy stage were analyzed. Results The age of group A and group B was (30.0±3.9) years and (30.7±4.9) years, respectively (P>0.05). The follicle-stimulating hormone/luteinizing hormone in group A and group B was 1.57±0.96 and 1.56±1.08; the estradiol levels in two groups were (152±66) pmol/L and (147±69) pmol/L, respectively (both P>0.05). There were no differences in dominant follicles and endometrial thickness between groups A and B (P>0.05). Ovulation promotion and luteal support treatments were adopted in both groups: 50%(40/80) of cycles in group A received ovulation promotion, 73%(58/80) of cycles received luteal support, while 44%(31/70) and 76%(53/70) received in groups B, respectively. The levels of serum progesterone in group A during 14-21 d, 22-27 d and ≥28 d after ovulation were higher than those in group B at each time points (P 0.05). Conclusion Dynamic monitoring of serum progesterone level in early pregnancy may be used as an auxiliary index for prediction of pregnancy outcome, but it may not be an indicator for luteal maintenance therapy. Key words: Pregnancy trimester, first; Intrinsic factor; Abortion, spontaneous; Progesterone; Corpus luteum maintenance

Aberrant Sphingolipid Metabolism in the Human Fallopian Tube with Ectopic Pregnancy

Sphingosine 1-phosphate (S1P), a product of sphingomyelin metabolism, is generated via phosphorylation of sphingosine by sphingosine kinases (SphK). It acts via a family of G protein-coupled receptors or as an intracellular second messenger for agonists acting through the S1P receptors (S1P1-5). In our study, the expression of SphK1 and S1P1 was identified by immunohistochemistry and immunoblot. The concentration of S1P was measured using ELISA. The spontaneous contraction of isolated fallopian tube strips was determined by tension recording. Our results showed that SphK1 and S1P1 were localized in the fallopian tube epithelial cells. In addition, smooth muscle cells also contained S1P1. Compared with the intrauterine pregnancy group, SPHK1 and S1P1 were overexpressed in ectopic pregnancy. However, the S1P concentration within the human oviduct from ectopic pregnancy subjects was largely reduced than that from normal pregnancy subject. The results from tension recording indicated that exogenous and intracellularly generated S1P can regulate the spontaneous contraction of oviduct isolated from rats and human. In conclusion, the sphingolipid metabolism signal pathway functionally existed in the human fallopian tube. Aberrant sphingolipid metabolism in the human fallopian tube may be involved in ectopic pregnancy.

Hyperglycosylated hCG in early pregnancy and its use as a diagnostic marker for ectopic pregnancy

OBJECTIVE: Diagnosis of ectopic pregnancy (EP) is hampered by a lack of rapid, reliable tests. Hyperglycosylated hCG (HhCG) is the predominant hCG isoform early in gestation and plays a role in cytotrophoblast invasion. We theorized that decreased HhCG production may be a consequence of ectopic implantation, and that serum measurement of HhCG may be a useful biomarker in discriminating between EP and intrauterine pregnancy (IUP). DESIGN: Multicenter prospective cohort. MATERIALS AND METHODS: As part of the Predictors of Ectopic Pregnancy (PEP) study we collected serum samples from pregnant women in the first trimester presenting with pain and/or vaginal bleeding. For this study, we included 50 samples from subjects with definitive diagnoses, 25 with EP and 25 with IUP. HhCG was measured by an electrochemiluminescence assay. Multivariable logistic regression was used for analysis. RESULTS: The median estimated gestational age at time of serum collection was 5 0/7 weeks (3 1/7-9 3/7) in the IUP group, compared with 5 4/7 weeks (3 3/7-9 3/7) for EP. The median HhCG level was 99.5 mg/L (1.30-1131) in IUP and 52.1 mg/L (2.0-1354) in EP. The median HhCG/total hCG ratio was 0.075 (0.003-0.673) for IUP and 0.030 (0.004-0.816) for EP. HhCG concentration and HhCG/total hCG ratio were lower for EP compared to IUP, trending toward significance when controlling for gestational age (p=0.07 and 0.065, respectively). A HhCG cut-off value of 13 mg/L conferred 72% sensitivity and 27% specificity for detection of EP, while use of a cut-point of 0.286 for HhCG/total hCG ratio yielded 88% specificity and 24% sensitivity for detection of EP. CONCLUSION: Serum HhCG levels and HhCG/total hCG ratio are lower in EP compared with IUP. The previously reported cut-off HhCG value of 13 mg/L used to discriminate viable from non-viable IUPs confers poor specificity for detection of EP. However, the ratio of HhCG/total hCG appears to be a better predictor of outcome, with ratios below 0.286 yielding 88% specificity for EP diagnosis.

A local GABAergic system is functionally expressed in human fallopian tube

γ-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the mammalian central nervous system and exerts its actions via ionotropic (GABAA and GABAC) and metabotropic (GABAB) receptors. The GABAB receptor is a dimer composed of R1 and R2 components. In addition to their location on neurons, GABA and functional GABAB receptors also have been detected in some peripheral tissues. In the present study, we combined immunohistochemistry, immunoblot and tension recording to determine if the human fallopian tube express glutamic acid decarboxylase (GAD65/67), two isoforms for synthesis of GABA and functional GABAB receptors. Immunoblots showed that the human fallopian tube tissue contained GABABR1 protein which was localized in the epithelial cells and smooth muscle cells by immunohistochemistry. In addition, epithelial cells also expressed GAD65/67. Tension recording found that both GABA and baclofen, a GABAB receptor agonist increased the spontaneous activity of human fallopian tube. The expressions of GABABR and GAD65/67 were significantly upregulated in the ectopic pregnancy group than in the intrauterine pregnancy group. We conclude that the human fallopian tube is capable of synthesizing GABA and expresses functionally active GABAB receptors. An upregulation of GABA synthesis and corresponding GABAB receptors may involve in ectopic pregnancy.

Endometrial stripe thickness in tubal and intrauterine pregnancies

Objective: To evaluate endometrial stripe thickness (EST) among patients with tubal pregnancy (TP) and intrauterine pregnancy (IUP). Design: Historical cohort. Setting: City hospital. Patient(s): Ninety-four women suspected to have TP. Intervention(s): Serum βHCG and sonographic EST measurements. Main Outcome Measure(s): Comparison of age, gestational age (GA), EST, and log βHCG. Result(s): The two groups of women, 65 with TP and 29 with IUP, had similar mean ages (±SD) of 28.6 ± 5.7 and 28.6 ± 6.1, respectively. The median values of GA in the 2 groups were similar, 46.6 and 44.6 d, respectively. The mean values for EST (±SD), adjusted for GA, were significantly different: 9.9 ± 5.9 mm in the TP group and 12.6 ± 5.3 mm in the IUP group. The mean values (±SD) of log βHCG in the 2 groups also differed significantly: 6.90 ± 1.29 and 7.52 ± 0.97, respectively. No correlation was found between EST and GA or log βHCG within either group. Conclusion(s): The mean EST in women with TP was significantly smaller than in women with IUP. The wide range of EST values and their overlap precludes the utilization of EST as a single feature in the diagnosis of a tubal pregnancy.