Occurrence Of Ectopic Pregnancy Research Articles

The relationship between serum levels of epidermal growth factor and β-human chorionic gonadotropin and the type and prognosis of ectopic pregnancy.

This work aimed to explore the relationship between epidermal growth factor (EGF) and β-human chorionic gonadotropin (β-HCG) and ectopic pregnancy types and impact on prognosis. Twenty women with normal pregnancies (NPs) were recruited as control group, and twenty women each with tubal pregnancy (TP) and cervical pregnancy (CP) were recruited. Blood samples were collected to detect EGF and β-HCG. Data on length of hospital stay and incidence of complications were collected. The differences in serum EGF and β-HCG levels were compared among groups and within various types of ectopic pregnancy using analysis of variance and Pearson correlation analysis. Serum EGF and β-HCG were notably lower in TP and CP group vs. controls (P < 0.05). In subgroup analysis within the types of ectopic pregnancy, serum EGF levels were drastically higher in TP group vs. CP group (P < 0.05). Serum EGF levels were negatively correlated with pregnancy outcomes and incidence of complications (P < 0.05). In patients with TP and CP, serum EGF and β-HCG recovery time and hospital stay differed drastically (P < 0.05). Serum EGF and β-HCG levels showed optimal cutoff values identified at 2.65μg/L and 11,745.35IU/L, respectively. The corresponding area under the curve (AUC) values were 0.885 and 0.841. Elevated levels of EGF may be associated with the occurrence of ectopic pregnancy and may impact the type of ectopic pregnancy, pregnancy outcomes, and the incidence of complications. Further clinical research is warranted to investigate these findings.

Surgical Outcomes and Trends in Incidence of Ectopic Pregnancy.

We aimed to evaluate the surgical results for ectopic pregnancy (EP) treated at Fukushima Red Cross Hospital for over a 20-year period from 2002 to 2021. We evaluated the incidence, surgical procedures, site of implantation, amount of hemoperitoneum, and the proportion of cases with risk factors of EP. Two hundred and fifty-nine cases of EP were treated surgically. The incidence of EP seemed to be gradually decreasing in recent years. By pregnancy site, 235 (90.7%) of EPs were tubal pregnancies (TPs), 13 in interstitial pregnancies (IPs), 7 in ovarian pregnancies, and 4 in peritoneal pregnancies. For IPs, human chorionic gonadotropin (hCG) levels were statistically higher than with TP and intraperitoneal bleeding was less than with other EP sites. Thirty-nine patients (15.0%) were with massive hemoperitoneum (>500 mL), and laparoscopic surgery was performed in all patients with massive hemoperitoneum except in two patients. The proportion of cases with risk factors for EP such as Chlamydia trachomatis infection or history of smoking was 5.4% and 40.6%, respectively. Epidemiological research shows that the number of patients with chlamydia infection, rates of smokers, or the occurrence of EP with assisted reproductive technology has been decreasing in recent years in Japan. Appropriate surgical intervention should be selected while considering such as facility capabilities, context, and surgeon skill, especially in critical cases, such as cases involving massive hemoperitoneum and hemorrhagic shock. The recent presumed decrease in the occurrence of EP may partly be associated with the decrease in the occurrence of risk factors.

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.

Body mass index impacts ectopic pregnancy during in vitro fertilization: an analysis of 42,362 clinical pregnancy cycles

PurposeThis large, single-center, retrospective cohort study was aimed to explore the effect of female body mass index (BMI) on ectopic pregnancy (EP) following fresh and frozen-thawed embryo transfers (ET).MethodsA total of 27,600 pregnancies after fresh ET and 14,762 pregnancies after frozen-thawed ET were included between January 2010 to June 2022. Women were divided into three groups based on BMI according to the Working Group on Obesity in China (WGOC), International Life Sciences Institute (ILSI): underweight (BMI < 18.5 kg/m2), normal weight (BMI, 18.5–23.9 kg/m2), and overweight or obesity (≥ 24 kg/m2). Compare EP rates among BMI categories in fresh and frozen-thawed ET cycles respectively. Multivariate logistic regression analyses were used to investigate the association between female BMI and EP.ResultsThe overall EP rates in fresh, and frozen thawed transfer cycles were 2.43% (672/27,600) and 2.82% (417/14,762), respectively. In fresh ET cycles, underweight women yielded a significantly higher EP rate than those with normal and excess weight (3.29% vs. 2.29% vs. 2.54%, P = 0.029). But EP rates did not differ among the three BMI groups (2.72% vs. 2.76% vs. 2.96%, P = 0.782) in frozen-thawed ET cycles. In fresh ET cycles, after adjusting for potential confounding factors, no significant association was found between female BMI and EP occurrence (adjusted OR: 0.98, 95% CI 0.70–1.37, P = 0.894, for BMI 18.5–23.9 kg/m2; adjusted OR: 0.89, 95% CI 0.75–1.06, P = 0.205, for BMI ≥ 24 kg/m2. Reference = BMI < 18.5 kg/m2).Conclusion(s)Female BMI did not affect the occurrence of ectopic pregnancy in either fresh or frozen-thawed embryo transfer cycles.

P-282 The role of activin A in the development of embryo: a preliminary insight using a mouse in vitro model

Abstract Study question Is activin A involved in the preimplantation development of mouse embryo? Do maternal-derived and zygotic protein have a different impact on embryogenesis? Summary answer Deletion of zygotic activin A does not impair the preimplantation development of mouse embryos. However, reduced level of maternal activin A affects female fertility. What is known already Activin A is a protein secreted by the reproductive system of females, both in mouse and human. Disruption of its signalling pathway is correlated with the occurrence of ectopic pregnancies and miscarriages. Activin A is also a known regulator of the hormone FSH, affecting the growth of ovarian follicles and, consequently, the formation of functional gametes. Furthermore, expression of this protein is detected in embryos themselves and is imperative during postimplantation development. Although activin has been reported to be present from the preimplantation stages, due to the multiple sources of secretion, its role during this period of embryogenesis remains elusive. Study design, size, duration In the first part of our project, we compared the phenotype of zygotic knockout mouse embryos (Inhba−/−, n = 43) with stage-matched heterozygotes (Inhba+/−, n = 113) and wild-type (Inhba+/+, n = 42) embryos. In addition, the blastocyst outgrowth assay has been used as an in vitro implantation model. The second part of our studies focuses on the protein provided by the mother. Using hypomorphic mutants, we investigated the impact of reduced level of activin A on mouse female fertility. Participants/materials, setting, methods We analysed the morphokinetic parameters of Inhba−/−, Inhba+/− and Inhba+/+ embryos by recording their development using time-lapse microscopy. Then blastocysts were immunostained and the percentage of each cell lineage was quantified using Imaris software. To assess the fertility of hypomorphic mice, we mated them with wild-type individuals. We evaluated the time needed to receive the offspring and the size of the litter. Furthermore, we examined the functionality of oocytes of hypomorphs by in vitro fertilisation. Main results and the role of chance We revealed that the deletion of zygotic activin A does not affect the rate and course of development of embryos from the zygote to the blastocyst stage. Inhba−/− embryos have similar timing of cleavage divisions, compaction, cavitation and synchrony of the cleavage rounds to the stage-matched Inhba+/− and Inhba+/+ embryos. Moreover, Inhba−/− embryos do not significantly differ in the number and percentage of cells contributing to the cell lineages of a blastocyst. Despite the reports on the possible involvement of activin A in the embryo implantation process, the obtained Inhba−/− outgrowths have normal morphology and a similar surface area to the corresponding control embryos. Therefore, our results indicate that zygotic activin A is indispensable for preimplantation development and embryo implantation. To study the effect of activin A secreted by the maternal reproductive system on embryogenesis, we used mice with a hypomorphic mutation of the activin A gene. We revealed that homozygotic mice have a characteristic phenotype and significantly reduced fertility. Crossing hypomorphic homozygous females with wild-type males resulted in the pregnancy of only one of the seven females. These results, combined with successful oocyte in vitro fertilisation experiments, point to the role of maternal-derived activin A in mouse reproduction. Limitations, reasons for caution Literature data indicate that oocytes have a pool of protein that is a product of the maternal genome. This maternal activin A can partially compensate for the lack of zygotic protein. Therefore, our further research will address the consequences of maternal and maternal-zygotic activin A knockout on embryo development. Wider implications of the findings Separate examination of zygotic and maternal-derived activin A allowed a comprehensive investigation of the contribution of this protein to mouse reproduction and preimplantation embryo development. Despite using a mouse as a model organism, the obtained results may become an argument for discussion of the impact of activin on human pregnancy. Trial registration number not applicable

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.

Ectopic pregnancy risk factors in infertile patients: a 10-year single center experience

The present retrospective study included both intrauterine insemination and in vitro assisted reproductive technologies (ART) procedures performed from January 2009 to December 2018 at a tertiary-care Fertility Centre. The purpose was to assess the incidence of ectopic pregnancy (EP) in infertile population who undergoes ART and to identify any risk factor impacting the occurrence of EP after ART. Among 27,376 cycles, 7352 pregnancies were achieved, of which 132 were EPs, the 1.80% (95% CI 1.5–2.1) of all pregnancies. In fresh embryo transfer cycles, a history of prior pelvic adhesions showed the greatest impact on the incidence of EP (aOR 2.49 95% CI 1.53–4.07 p < 0.001). Other factors associated with EP incidence were also identified, such as female age, basal FSH, the transfer of blastocyst embryos and difficulties during the embryo transfer procedure. In frozen embryo transfer cycles, the only factor influencing the incidence of EP was anti Müllerian hormone (AMH) serum concentration (aOR 0.81 95% CI 0.65–1.00, p = 0.048). To conclude, the incidence of EP observed was comparable to that reported after natural conception. On the other hand, pre-existing risk factors, traditionally more common in infertile population, appeared to influence the incidence of EP and should thus be modified if possible.

The role of endometrial thickness in predicting ectopic pregnancy after in vitro fertilization and the establishment of a prediction model.

ObjectiveTo explore the risk factors of ectopic pregnancy after in vitro fertilization.MethodsThis retrospective cohort study was conducted at the Reproductive Medical Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to April 2020. Univariate and multivariate analysis were used to analyze the related factors affecting the occurrence of ectopic pregnancy (EP) and to construct a nomographic prediction model for the incidence of ectopic pregnancy.ResultsA total of 12,766 cycles of 10109 patients were included, comprising 214 cases of EP and 12,552 cases of intrauterine pregnancy (IUP). Multivariate logistic regression analysis showed that the tubal factor was associated with a 2-fold increased risk for EP (aOR = 2.72, 95% CI: 1.69-4.39, P < 0.0001). A stratified analysis showed that women with an endometrial thickness (EMT) between 7.6 to 12.1mm (aOR = 0.57, 95%CI: 0.36-0.90, P = 0.0153) and >12.1mm (aOR = 0.42, 95%CI: 0.24-0.74, P = 0.0026) had a significant reduction of the risk of EP compared to women with an EMT of <7.6mm. Compared to cleavage stage transfer, blastocyst transfer can reduce the risk of ectopic pregnancy (aOR = 0.36, 95%CI: 0.26-0.50, P < 0.0001). The saturation model (full mode) establishes a nomographic prediction model with an AUC = 0.68 and a sensitivity and specificity of 0.67and 0.64, respectively. The nomination model was internally verified by self-sampling method (bootstrap sampling resampling times = 500). The resulting AUC = 0.68 (sensitivity: 0.65; specificity: 0.65) showed that the model was relatively stable.ConclusionsOur findings indicate that EMT is inversely proportional to the risk of EP. Embryo stage, number of embryos transferred were also significantly associated with EP rate. A simple nomogram for the predicting the risk of EP was established in order to reduce the occurrence of EP.

Factors associated with frequency of ectopic pregnancy

Background/Aim: Ectopic pregnancy is defined as a pregnancy outside the uterine cavity, most often in the fallopian tube. It is a life-threatening condition and requires early diagnosis and adequate care. Aim of this study was to examine the frequency of ectopic pregnancy, as well as the influence of parity, age of patients and previous in vitro fertilisation (IVF) procedure on the occurrence of ectopic pregnancy. Methods: A retrospective research was conducted in the Clinic for Gynaecology and Obstetrics of the University Clinical Centre of the Republic of Srpska from 1st of January 2016 up to 31 of December 2018, which included 125 hospitalised patients with a confirmed diagnosis of ectopic pregnancy. Data on the age of patients , parity and previous IVF, as well as the method of treatment of patients with ectopic pregnancy were analysed and compared. Results: In the observed period, there were a total of 9781 births and in the same period, 125 patients with a diagnosis of ectopic pregnancy were hospital-ised, which is 1.27 %. Pregnancy did not occur after IVF. Laparoscopy and drug therapy are represented almost equally, depending on the clinical picture and the wishes of the patients and open access was represented only sporadically. Conclusion: According to this research, the onset of ectopic pregnancy is not affected by age, parity and previous IVF, which does not fit into the results of world research. The most common form of treatment in our country is both lap-aroscopy and medical approach and open access occurs only sporadically, which fits into the recommendations of the relevant guides.

Tubal abortion masquerading as an acute appendicitis with a negative urine pregnancy test: A case report.

Introduction and importanceSpontaneous expulsion of product of conception through the fimbrial end to the peritoneal cavity is a rare mode of progression of tubal pregnancy. Thus, ectopic pregnancy can present with right-sided iliac fossa pain which can be preoperatively misdiagnosed as acute appendicitis.Case historyA 30-year regularly menstruating woman presented with right iliac fossa pain which was diagnosed as acute appendicitis preoperatively with an ultrasound. However, intraoperatively, a product of conception-like material measuring 3 ∗ 3 cm was seen hanging from the right fimbrial end of the fallopian tube with a normal appendix. With an intraoperative diagnosis of spontaneous tubal abortion, histopathology of the resected mass showed chorionic villi lined by trophoblastic cells along with decidualized tissue, fibrinoid material, and blood clot.DiscussionEctopic pregnancy presenting as a right iliac fossa pain can mimic acute appendicitis. An abnormal β-hCG pattern/level which doesn't correspond to the gestational age suggests the likely diagnosis of ectopic gestation. Transvaginal ultrasound is the preferred imaging modality for the evaluation of patients with suspected ectopic gestation. A urine pregnancy kit cannot always exclude an underlying ectopic pregnancy because of the associated false-negative results.ConclusionUrgent laparotomy to prevent detrimental complications associated with ectopic gestation should be done. Surgeons should be aware of this suspicion as a false negative UPT can happen and misguide clinicians about the possible occurrence of ectopic pregnancy.

FACTORS RELATED TO ECTOPIC PREGNANCY IN RSUD R.A KARTINI JEPARA

Background: Ectopic Pregnancy (EP) is a pregnancy outside the womb that ends with a rupture. Bleeding is one of the causes of the increase in Maternal Mortality Rate (MMR) by 24.5% in Central Java Province in 2017. Research to determine the factors associated with the occurrence of EP needs to be known so that the incidence of EP and MMR in Indonesia can be controlled.Purpose: This study aimed to see the incidence of EP and analyzing the relationship between age and parity with the incidence of EP in RSUD R.A Kartini Jepara.Methods: This study used an analytic observational method with a case-control research design. Sampling was done by consecutive sampling method. A total of 83 samples met the inclusion criteria, which were divided into 51 pregnant women with EP and 32 pregnant women without EP. Data were analyzed using descriptive test and Chi-square test. The factors assessed were age and parity. Other variables contained in medical records are included in the form of descriptive data.Results: The incidence of EP in RSUD R.A Kartini Jepara was 0.4% in 2017, 0.5% in 2018, and 0.3% in 2019. In EP patients, it was found that 54.9% of patients had an education level of junior high school, 58.8% of patients had a salpingectomy procedure, 92.1% of patients whose EP location was in the tube and 60.7% of patients needed inpatient services for &gt;4 days. The results of the bivariate analysis using the Chi-square test showed a significant relationship between parity (p = 0.029) and the incidence of EP (p &lt;0.05). Meanwhile, age (p = 0.897) did not show a significant relationship with the incidence of EP (p&gt; 0.05).Conclusion: The incidence of EP in RSUD R.A Kartini Jepara in was 0.4% in 2017, 0.5% in 2018, and 0.3% in 2019. There is a relationship between parity and the incidence of EP. Meanwhile, age is not related to the incidence of EP in RSUD R.A Kartini Jepara. Keywords: Ectopic Pregnancy, Age, Parity

The role of microRNAs in ectopic pregnancy: A concise review.

Ectopic pregnancy (EP) is reported in about 1%–2% of pregnant females and is associated with mortality and morbidity. Several genetic and environmental factors might modulate occurrence of EP. Prediction of EP and patients' follow-up is an important task in management of pregnancy. MicroRNAs (miRNAs) as non-coding RNAs with sizes between 21 and 24 nucleotides have been shown to regulate several aspects of implantation and early fetal life. They have potential role in early detection of EP especially considering their presence in body fluids such as serum. Assessment of their expression in serum might provide a noninvasive method for diagnosis and patients' follow-up. However, data regarding their role in EP is not sufficient due to small sample sizes of the studies. Future studies are required to find miRNAs that regulate expression of EP-associated genes such as VEGFA, EGFR, ESR1 and immune response-related genes to provide new diagnostic biomarkers for EP.

Relation of Chlamydia trachomatis infections to ectopic pregnancy: A meta-analysis and systematic review.

Background:In a multitude of previous studies, Chlamydia trachomatis (CT) plays an important role in the occurrence of ectopic pregnancy (EP). However, the predictive value of CT infections in the occurrence of EP has not been estimated worldwide. We thus evaluated, by means of a meta-analysis, the current status of the association between CT infections with EP and the potential predictive value of CT infections in EP.Methods:We evaluated studies performed between the database construction time and August 2018 published in PubMed, the Cochrane Library, EMBASE, and the Web of Science (SCI). The relationship between CT and EP was calculated based upon the predetermined entry criteria for control group selection and the original data. The related articles were analyzed using a random-effects model, and the heterogeneity of the studies was assessed using the I2 index. Data were analyzed with the STATA 12.0 software.Results:Twenty-five studies that recruited 11960 patients were included in the present meta-analysis, and the relation of CT infections with EP were assessed. The association between CT infections and EP risk showed an odds ratio (OR) of 3.03, with a 95% confidence interval (CI) of 2.37 to 3.89. Our results showed that there was a statistically significant difference between the intervention and control groups. The prevalence of CT infections in EP was then calculated by a subgroup analysis: African (OR, 2.22; 95% CI, 1.14–4.31), European (OR, 3.16; 95% CI, 2.10–4.47), North American (OR, 3.07; 95% CI, 1.78–5.31), and Asian (OR, 3.39; 95% CI, 1.95–5.90).Conclusions:From the results of numerous studies conducted on different continents, this meta-analysis showed a clear association between EP and prior CT infections, that is, CT infections increase the risk of EP occurrence.

Blood Cadmium Concentrations in Women with Ectopic Pregnancy.

The purpose of this study is to investigate the relationship between the blood level of cadmium and the occurrence of ectopic pregnancy. Forty-one (41) case patients with ectopic pregnancy and 41 uncomplicated intrauterine pregnant patients as controls were recruited. The concentrations of cadmium (Cd) were measured from blood samples using atomic absorption spectrometry. The cases and controls were similar in age, body mass index, and smoking habits. The median blood level of Cd was 0.32μg/l (interquartile range [IQR] 0.00-0.71) in the women with ectopic pregnancies and 0.34μg/l (IQR 0.09-0.59) in the controls. There was no significant association between blood cadmium levels and ectopic pregnancy.

Ectopic Pregnancy of the Tubal Stump in ART Patients, Two Case Reports and a Review of the Literature

Background: An ectopic pregnancy (EP) is the development of an embryo outside of the uterus. A heterotopic pregnancy (HP) is a multiple pregnancy with different sites of implantation, where one is intrauterine. These conditions have arisen also by the use of assisted reproduction techniques (ART), in addition to other causes. Case presentation: We consider two cases of interstitial gestation in patients with previous omolateral salpingectomy for ectopic pregnancies, and a review of the literature. The correct diagnosis was achieved for both patients by the use of ultrasound transvaginal examination. The first patient received a treatment of methotrexate (MTX) before performing a successful removal of the tubal stump, while the second one was managed directly with surgery.No postoperative complications occurred and they were discharged on the second day, postoperatively. Conclusion: In women with first trimester pregnancy and a reported surgical history of a previous salpingectomy, transvaginal ultrasound examination should be performed in order to correctly and promptly identify the implantation site. When a salpingectomy becomes necessary, its complete resection should be performed, in order to prevent or significantly lower an EP occurrence in the tubal stump.

A Study of Ectopic pregnancy in a Tertiary Care Teaching Hospital

Aims and Objectives: To study the incidence, risk factors, clinical presentations and sites of Ectopic pregnancy among the patients attending to department of Obstetrics and Gynecology, Government General Hospital, Anantapuramu. Material and Methods: The current prospective study was conducted over a period of 2 years from October 2013 to September 2015 in the department of Obstetrics & Gynecology at Government general hospital, Anantapuramu, Andhra Pradesh, India. Various parameters studied were age, parity, risk factors, symptomatology and sites of ectopic pregnancy, laterality of ectopic pregnancy, admission to surgery interval, and requirement of blood transfusions. Results: A total of 25 patients were admitted with ectopic pregnancy during the study period amounting to an incidence of 1.6 per 1000 deliveries. Most of the patients were multiparous belonging to the age group 21 to 30 years. Risk factors were present in 64% of cases, the commonest being previous abortion (32%) followed by tubal surgery (24%). The classic triad symptoms observed were history of amenorrhea, pain abdomen and bleeding per vagina. Ampullary part of the fallopian tube was the most frequent site as observed in 48% of cases. Right fallopian tube was observed to be the most common site of occurrence of ectopic pregnancy. On an average of three units of blood transfusion was administered for each surgery. All patients were managed by surgical intervention within three hours of admission. Conclusion: Ectopic pregnancy is a challenge for every obstetrician due to its bizarre clinical presentation. Early diagnosis and early intervention would reduce the morbidity and mortality in ectopic pregnancy. Hence ectopic pregnancy should be highly anticipated on an emergency basis in a woman in reproductive age group irrespective of tubal ligation as the condition is compared to black cat in dark room. Key words: Clinical picture, Ectopic pregnancy, risk factors, surgical intervention

Misdiagnosis and delayed diagnosis for ectopic and heterotopic pregnancies after in vitro fertilization and embryo transfer

This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy (EP) and heterotopic pregnancy (HP) after in vitro fertilization and embryo transfer (IVF-ET) in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP: early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8% (125/3286) and 0.8% (27/3286) respectively for IVF/ICSI-ET cycle, and 3.8% (55/1431) and 0.7% (10/1431) respectively for frozen- thawed embryo transfer (FET) cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories: (1) clinician factors: misunderstanding of patients' medical history, insufficient training in ultrasonography and unawareness of EP and HP; (2) patient factors: noncompliance with medical orders and lack of communication with clinicians; (3) complicated conditions of EP: atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.

Ectopic pregnancy: a review

Ectopic pregnancy (EP) presents a major health problem for women of child-bearing age. EP refers to the pregnancy occurring outside the uterine cavity that constitutes 1.2-1.4% of all reported pregnancies. All identified risk factors are maternal: pelvic inflammatory disease, Chlamydia trachomatis infection, smoking, tubal surgery, induced conception cycle, and endometriosis. These developments have provided the atmosphere for trials using methotrexate as a non-surgical treatment for EP. The diagnosis measure of EP is serum human chorionic gonadotropin, urinary hCGRP/i-hCG, progesterone measurement, transvaginal ultrasound scan, computed tomography, vascular endothelial growth factor, CK, disintegrin and metalloprotease-12 and hysterosalpingography. The treatment option of EP involves surgical treatment by laparotomy or laparoscopy, medical treatment is usually systemic or through local route, or by expectant treatment. It was concluded that review data reflect a decrease in surgical treatment and not an actual decline in EP occurrence so that further new avenues are needed to explore early detection of the EP.

Study on the incidence and influences on ectopic pregnancy from embryo transfer of fresh cycles and frozen-thawed cycles

To investigate ectopic pregnancy from embryo transfer (ET)of in-vitro fertilization (IVF) cycle and intracytoplasmic sperm injection (ICSI) cycle and frozen-thawed (FET) cycle. From Jan.2005 to Dec. 2010, a total of 9037 IVF-ET or ICSI-ET cycles and 4034 FET cycles were performed in our reproductive medicine center, Affiliated First Hospital of Zhengzhou University. The incidence of ectopic pregnancy rate was studied in fresh cycles IVF-ET (5998) and ICSI-ET (3039) cycles, and natural FET (2198) and hormone replacement (E-P) FET (1836) cycles. Of 4034 FET cycles, 1090 clinical pregnancies and 26 ectopic pregnancies were observed, the incidence of ectopic pregnancy was 2.38% (26/1090). Of 9037 fresh cycles, 3602 cycles were clinical pregnancy, and 133 cycles were ectopic pregnancy, and the incidence of ectopic pregnancy was 3.69% (133/3602). The ectopic pregnancy rate in FET cycles was lower than in fresh cycles significantly (P < 0.05). Of 3039 fresh ICSI-ET cycles, the incidence of ectopic pregnancy was 2.62% (34/1298) in 1298 clinical pregnancies. Of 5998 IVF-ET cycles, 2304 clinical pregnancies were observed, the incidence of ectopic pregnancy was 4.30% (99/2304). Ectopic pregnancy rate in the fresh ICSI-ET cycles was lower than that of IVF-ET group significantly (P < 0.01). The ectopic pregnancy rate in the natural FET cycles was 1.46% (8/547), which was significantly lower than 3.31% (18/543) in E-P group (P < 0.05). The incidence of ectopic pregnancy of FET cycles was significantly lower than that of fresh embryo transfer cycles. The application of exogenous sex hormones in assisted reproductive cycles might increase occurrence of ectopic pregnancy.

Influence of EmbryoGlue on the implantation of embryo and pregnancy outcome in vitro fertilization-embryo transfer

To study the influence of EmbryoGlue on the implantation of embryo and pregnancy outcome in vitro fertilization (IVF)-embryo transfer (ET). From August 2010 to January 2011, 243 infertile patients in Reproductive Medical Center of Tianjin Medical University General Hospital who underwent IVF or intracytoplasmic sperm injection (ICSI) were divided into two groups, including 129 cases used EmbryoGlue as the embryo transfer medium in experimental group and 114 cases used G-2 as embryo transfer medium in control group. Pregnancy outcome were compared between two groups. (1) The female age, IVF/ICSI constituent ratio, previous failure cycles and infertile factors of patients did not show statistical difference between experimental group and control group (P > 0.05). (2) The implantation rate of women in experimental group increased significantly compared with the control group [30.4% (85/280) vs. 18.8% (48/255), P < 0.05]; Clinical pregnancy rate increased significantly compared with the control group [48.8% (63/129) vs.34.2%(39/114), P < 0.05]; Multiple pregnancy rate increased significantly compared with the control group [34.9% (22/63) vs. 20.5% (8/39), P < 0.05]; Ectopic pregnancy rate decreased significantly compared with the control group [4.8% (3/63) vs. 17.9% (7/39), P < 0.05]. EmbryoGlue can facilitate embryo implantation in IVF-ET and reduce the occurrence of ectopic pregnancy.