Presence Of Ectopic Pregnancy Research Articles

A rare case of heterotopic pregnancy managed by laparoscopic salpingectomy

Heterotopic pregnancy is the existence of 2 or more simultaneous pregnancies with separate implantation sites, one of which is tubes or ovaries or other ectopic site. The estimated incidence in the general population is estimated at 1:35,000 (for a naturally conceived pregnancy). With increasing trend in assisted reproductive technique, the frequency of heterotopic pregnancies was increased to be between 1:100 to 1:7,000. A 36 yrs third gravida (P1, L1, A1) presented with 2 month amenorrhoea In Doppler usg there was evidence of irregular solid component at periphery with echogenic tissue around showing ring vascularity and burning ring fire sign present. There is evidence of mild free fluid collection in the pouch of Doughlas pre operative and post operative injection 17 –oh progesterone acetate (proleutone) used and post operative tidilan injection. Left sided laparoscopic salpingectomy was done. The material was collect in endobag and afterward sent it for histopathological examination which confirms trophoblastic tissue and presence of ectopic pregnancy. There is no proven role of medical management in this because of high Bhcg titer which helps to continue it afterwards. Like other cases if there was no facility for laparoscopy, laparotomy for salpingectomy is another option. Diagnosis of heterotopic rare and challenging but proper ultrasonography skills and broad mind set helps in diagnosis.

Peritoneal relative to venous serum biomarker concentrations for diagnosis of ectopic pregnancy

To retrospectively analyze the relationships of peritoneal serum relative to venous serum (R (p/v)) ratios for human chorionic gonadotropin, CA-125, and creatine kinase to the ectopic pregnancy (EP). Intra-abdominal fluid and venous blood samples of 118 subjects with suspected EP were obtained for biomarker measurements. R (p/v-hCG) >1 was considered indicative of EP, and final diagnosis was based on surgical finding of an ectopic chorionic villous or gynecological ultrasound finding of an intrauterine gestational sac. R (p/v-hCG) and R (p/v-CA-125) were both significantly greater for abortive as compared to ruptured EP and for the absence as compared to presence of active bleeding. However, neither ratio differed significantly between ampullary and isthmic EP. R (p/v-hCG) and R (p/v-CA-125) correlated negatively with hemoperitoneum volume. R (p/v-hCG) exhibited only modest predictive value for rupture. However, with R (p/v-CA-125) as the diagnostic criterion for rupture, sensitivity and specificity were 66.7 and 100%, respectively; in patients initially diagnosed with EP, R (p/v-CA-125) values <22.43 effectively predicted rupture. R (p/v-CK) did not exhibit significant diagnostic value. R (p/v-hCG) values >1 combined with positive culdocentesis test findings reliably indicate the presence of EP. In patients initially diagnosed with EP, R (p/v-CA-125) values <22.43 predict tubal rupture.

Serum activin A levels are lower in tubal than intrauterine spontaneously conceived pregnancies

Objective. To measure serum activin A levels together with progesterone and hCG, in women with overt clinical signs and symptoms of ectopic pregnancy (EP) and, in gestational age-matched intrauterine pregnancy (IUP).Design. Retrospective case–control study.Setting. Department of Pediatrics, Obstetrics and Reproductive Medicine, Section of Obstetrics and Gynecology, University of Siena, Siena, Italy.Population. The study group was composed by 30 women with an EP; the control group was composed by 30 women with a sonographic evidence of a single spontaneous IUP.Methods. Clinical examination; transvaginal ultrasound scan; hCG, progesterone and activin-A measurements; laparoscopy; uterine curettage; histological examination.Main Outcome Measure. Pregnancy outcome; sensitivity and specificity of hCG, progesterone, and activin A for EP.Results. Serum hCG levels did not differ significantly between tubal EP and IUP, while P concentrations were significantly (P < 0.001) lower in tubal EP than IUP. Serum levels of activin A were significantly (P < 0.0001) lower in tubal EP than in IUP and, at the cutoff 0.43 ng/mL achieved a sensitivity of 96.7% and a specificity of 100% for EP.Conclusion. Activin A secretion in EP is reduced and measurement of its serume levels may have the potential clinical advantage to signal the presence of EP.

Ultrasound Diagnosis of Ectopic Pregnancy

The diagnosis of tubal ectopic pregnancy should be based upon the positive visualization of an adnexal mass using transvaginal ultrasound rather than the absence of an intrauterine gestational sac. Ultrasound diagnosis earlier in the natural history of the condition has meant that more conservative treatment options can be considered and implemented in clinically stable women. Although laparoscopy traditionally is accepted as the gold standard in the diagnosis of tubal ectopic pregnancy, there is substantial evidence that transvaginal ultrasound is the diagnostic tool of choice in modern practice. In expert hands, this single noninvasive and reproducible diagnostic test correlates well with the presence of ectopic pregnancy at the time of surgery. This article discusses the use of ultrasound as a single stand-alone test in the diagnosis of tubal ectopic pregnancy.

Risk Factors for Ectopic Pregnancy in Women With Symptomatic First-Trimester Pregnancies

Approximately one in 50 pregnancies in the United States is ectopic, and the incidence of ectopic pregnancy (EP) reportedly has increased 6-fold over the past 25 years. Early diagnosis and appropriate outpatient care clearly limit morbidity and mortality from EP as well as helping to preserve future fertility. This study is the first to associate both historical variables and symptoms with the presence of EP in women who present in the first trimester with pain and/or bleeding but in whom the diagnosis is not readily apparent. A total of 2026 such women, seen at a single center in the years 1990 through 1999, were evaluated. EP was diagnosed in 367 patients, ongoing intrauterine pregnancy in 467, and spontaneous abortion (SAB) in 1192. Case patients were slightly older than controls in this largely black study cohort. A large number of possible confounding factors were adjusted for, including age, voluntary interruption of pregnancy in the past, the number of ectopic gestations, a history of pelvic inflammatory disease (PID), parity, moderate to severe bleeding at presentation, pain as the presenting symptom, and the initial level of human chorionic gonadotropin (hCG). A history of EP was positively associated with current EP as were an initial hCG level exceeding 500 mIU/mL, parity of one, past hospitalization for PID, and presentation with either pain or moderate to severe bleeding. Age less than 25 and a history of voluntarily interrupting pregnancy both were negatively associated with EP. Putative risk factors for EP that were not significant factors in the present study included gravidity, previous SAB, previous live births, the past use of an intrauterine device, previous pelvic surgery or cesarean section, and either a history of or current cervical infection with chlamydia and/or gonorrhea. If the risk factors for EP identified in this study do have high predictive value, they may aid the timely diagnosis of this condition, permit medical treatment, lower morbidity and mortality, preserve fertility, and lessen healthcare costs.

Ectopic pregnancy: Value of transabdominal sonography without deliberate bladder distention

We reviewed 19 consecutive patients with ectopic pregnancy in whom pelvic sonography demonstrated findings highly predictive of the diagnosis. The correct diagnosis was established by transabdominal sonography without attempting bladder distention in 12 patients (63%); the bladder was full in only one patient. Transabdominal sonography performed without waiting for the bladder to fill and thus with no delay or patient discomfort can establish the presence of ectopic pregnancy and obviate the need for transvaginal sonography in a substantial proportion of patients in whom the diagnosis can be made sonographically. In patients at risk for ectopic pregnancy, we recommend that transabdominal sonography without waiting for bladder distention be attempted before transvaginal sonography is performed.

Rapid one step urine test for human chorionic gonadotrophin in evaluating suspected complications of early pregnancy.

To determine the ability of a sensitive one step urine test to detect human chorionic gonadotrophin in women with suspected complications of early pregnancy. Test on women presenting to accident and emergency department with gynaecological problems over six months. Results were validated using a quantitative assay for human chorionic gonadotrophin in serum and urine. Accident and emergency department and gynaecology wards of a university teaching hospital. 130 unselected women. Detection of human chorionic gonadotrophin by one step test, presence of ectopic pregnancy, and results of quantitative analysis of chorionic gonadotrophin in serum and urine. 79 women had a positive urine test result and 51 a negative result. All 12 women with ectopic pregnancy had a positive test result, although urinary concentration varied from 191 IU/l to 47,800 IU/l. Only one woman, who had a faintly positive result, was found not to be pregnant on subsequent examination. The sensitivity and negative predictive values of the urine test were 100% respectively. 33 women were sent home from the accident and emergency department with normal clinical findings after a negative urine test result. All these women had undetectable concentrations of chorionic gonadotrophin in matched samples of urine and serum. A simple, rapid one step test for chorionic gonadotrophin should be available for the initial evaluation of emergency gynaecological problems. The additional cost of the test is offset by not admitting those patients whose clinical findings are normal and who have a negative urine test result and by reducing the number of women requiring quantitative assays of chorionic gonadotrophin.

Ectopic pregnancy in a patient with three fallopian tubes.

THE presence of ectopic pregnancy in a supernumerary fallopian tube is sufficiently unusual to warrant the report of a case. Novak1 states that duplication in the form of a third tube is very rare...