Risk Factors For Ectopic Pregnancy Research Articles

Surgical Outcomes and Trends in Incidence of Ectopic Pregnancy

Objectives: 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. Materials and Methods: We evaluated the incidence, surgical procedures, site of implantation, amount of hemoperitoneum, and the proportion of cases with risk factors of EP. Results: 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. Conclusion: 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.

Risk factors of ectopic pregnancy after in vitro fertilization-embryo transfer in Chinese population: A meta-analysis.

The prevalence of ectopic pregnancy after assisted reproduction is notably high, posing a significant threat to the life safety of pregnant women. Discrepancies in published results and the lack of a comprehensive description of all risk factors have led to ongoing uncertainties concerning ectopic pregnancy after assisted reproduction. This study aimed to understand the risk factors for ectopic pregnancy after in vitro fertilization-embryo transfer in the Chinese population and provide a reference for targeted prevention and treatment. A comprehensive search of the China National Knowledge Infrastructure, Wang fang Database, China Science Technology Journal Database, Chinese Biomedical Literature Database, PubMed, Web of Science, and Embase was conducted to identify relevant literature on the risk factors for ectopic pregnancy in Chinese women after assisted reproductive technology in Chinese women. A meta-analysis of the included studies was performed using Stata17. Overall, 34 articles were included in the analysis. The risk factors for ectopic pregnancy after in vitro fertilization-embryo transfer in the Chinese population included a thin endometrium on the day of HCG administration and embryo transplantation, a history of ectopic pregnancy, secondary infertility, a history of induced abortion, polycystic ovary syndrome, decreased ovarian reserve, tubal factor infertility, cleavage stage embryo transfer, fresh embryo transfer, artificial cycle protocols, elevated estradiol levels on the day of human chorionic gonadotropin administration, a history of tubal surgery, two or more number of embryo transfers, previous pregnancy history, and a history of pelvic surgery. This study clarified the factors influencing ectopic pregnancy after in vitro fertilization and embryo transfer in the Chinese population, focusing on high-risk groups. Targeted and personalized intervention measures should be adopted to prevent and detect the disease early to reduce its incidence and harm. The protocol for this view was registered in PROSPERO (CRD42023414710).

Effect of endometrial thickness on the risk of ectopic pregnancy for frozen embryo transfer

Objective: Few studies have explored the suitability of endometrial thickness (EMT) as a predictor of ectopic pregnancy (EP) in frozen embryo transfer (FET) cycles. Our study aimed to investigate the association between EMT and EP and explore the cutoff value of EMT to predict EP. Methods: This retrospective cohort study included women aged 20 - 45 years undergoing FET between March 2015 and September 2021. The primary outcomes and measured variables were ectopic pregnancy and endometrial thickness, respectively. The threshold effect of EMT on EP was calculated based on a constructed smooth curve fitting. The patients were divided into two groups based on the threshold for comparison. A subgroup analysis was conducted to examine whether the relationship between EMT and EP remained consistent across the different subgroups. Additionally, a generalized linear model was used to analyze the interactions between the treatment factors and EMT in EP. Results: In total, 27,549 FET cycles were included, with 27,086 intrauterine and 463 ectopic pregnancies. The risk of EP in the EMT ≤ 8.7 mm group was 3.36 times higher than that in the EMT >8.7 mm group (OR: 3.36, 95% CI 2.57-4.05). Subgroup analysis further indicated that a thin EMT was a risk factor for EP, independent of other risks. We also noted that diminished ovarian reserve, tubal factor infertility, transfer of two embryos, or transfer of cleavage-stage embryos may further enhance the risk of EP in patients with thin endometrium. Conclusions: Thin endometrium was associated with an increased risk of EP. Patients with EMT less than 8.7 mm need close medical observation and management after embryo transfer. In addition, diminished ovarian reserve, tubal factor infertility, transfer of two embryos, or transfer of cleavage-stage embryos may significantly enhance the effect of a thin endometrium on the risk of EP.

An endometrium of type C along with an endometrial thickness of < 8 mm are risk factors for ectopic pregnancy after stimulated cycles with fresh embryo transfer

BackgroundThe study investigated whether specific ultrasonographically observed endometrial features (including endometrium type and thickness) were linked to ectopic pregnancy after stimulated cycles with fresh embryo transfer.MethodOf 6246 pregnancy cycles after fresh embryo transfer, 6076 resulted in intrauterine pregnancy and 170 in ectopic pregnancy. The primary outcome of the study was ectopic pregnancy, with the main variables being endometrium type and endometrial thickness. Univariate and subsequent multiple-stepwise logistic regression analyses were used to identify the risk factors of ectopic pregnancy.Results1. Compared with patients with an endometrial thickness ≥ 8 mm, the adjusted odds ratio for those with an endometrial thickness < 8 mm was 3.368 (P < 0.001). The adjusted odds ratio for women with a type-C endometrium was 1.897 (P = 0.019) compared with non-type C. 2. A larger dose of gonadotropin used during controlled ovarian hyperstimulation was a protective factor against ectopic pregnancy (P = 0.008). 3. The GnRH antagonist protocol (P = 0.007) was a risk factor for ectopic pregnancy, compared with the use of GnRH agonists.Conclusion(1) An endometrial thickness < 8 mm coupled with a type C endometrium significantly increased the risk of ectopic pregnancy after fresh embryo transfer. (2) A thin endometrial thickness and a type C endometrium could be further related to an abnormal endometrial receptivity/peristaltic wave. (3) Patients at a high risk of ectopic pregnancy should therefore be given special attention, with early diagnosis during the peri-transplantation period may assist in the prevention of ectopic pregnancy.

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.

Clinical Predictive Factors Affecting Laparoscopic Approach in the Management of Ectopic Pregnancy: A Retrospective Cross-Sectional Study

Introduction: Ectopic pregnancy accounts for approximately 2% of all pregnancies and is the most common cause of pregnancy-related mortality in the first trimester. Our aim was to study the preoperative clinical factors affecting the choice of laparoscopic approach to tubal ectopic pregnancy. &#x0D; Materials and methods: This was a retrospective cross-sectional study of tubal ectopic pregnancy cases that were managed by laparoscopy at an academic university hospital in the period January 2010 to December 2018. Cases that were managed medically or conservatively and laparoscopic cases that were converted to laparotomy were excluded. Cases where the surgical approach of laparoscopy or laparotomy were determined by the patients’ choice were also excluded.&#x0D; Results: The laparoscopy rate was 49.4%. The mean age was 32.04 years. Compared with laparotomy, laparoscopy was significantly associated with low parity (less than 3) (p=0.008), a low level of initial beta-human chorionic gonadotrophin (p=0.032), fewer cases of adnexal mass (p=0.000451), hemoperitoneum (p=0.000072), ruptured ectopic (p=0.000261), and more cases of bowel adhesions (p=0.0095). There was no significant difference between laparoscopy and laparotomy regarding the risk factors of ectopic pregnancy. Salpingectomy and salpingostomy were not significantly different between the two surgical approaches (p=0.643). Twenty-eight laparoscopic cases were converted to laparotomy.&#x0D; Conclusion: The laparoscopic approach to ectopic pregnancy was affected by parity, presenting symptoms of pain and vomiting, mean initial beta-human chorionic gonadotrophin, the presence of adnexal mass, the presence of hemoperitoneum, and the rupture of the ectopic. Bowel adhesions were seen more frequently in laparoscopy than laparotomy. Salpingectomy and salpingostomy were no different between laparoscopy and laparotomy.

P-469 Body mass index impacts ectopic pregnancy during in vitro fertilization: are we jumping the gun? An analysis of 42,362 clinical pregnancy cycles

Abstract Study question Does female body mass index (BMI) have impact on ectopic pregnancy (EP) in women undergoing in vitro fertilization (IVF) and embryo transfer (ET) treatment? Summary answer EP rate is higher in underweight patients in fresh cycles. However, BMI is not a risk factor for EP after controlling confounders. What is known already It has been shown that tubal factor infertility, stage of embryos transferred (cleavage stage or blastocyst stage), high estrogen levels during ovarian stimulation, and endometrial thickness, have impact on EP rate in IVF cycles. In addition, other potential factors including ovarian stimulation protocols, number of embryos transferred, and type of embryos (fresh or frozen thawed) are also seemed to be associated with EP rate. However, BMI has interactions with these confounding factors mentioned above. Study design, size, duration This was a retrospective cohort study. From January 2010 to June 2022, patients between the ages of 20 and 45 years who had their first fresh/frozen thawed ET cycles, and reported as clinical pregnant were included. BMI was categorized into three groups: underweight (&amp;lt; 18.5 Kg/m2), normal weight (18.5–23.9 Kg/m2), overweight and obesity (≥ 24 Kg/m2). Participants/materials, setting, methods A total of 42,362 cycles were included in the final analysis. The overall ectopic pregnancy rate was 2.57% (1,089/42,362). Firstly, possible factors affecting ectopic pregnancy were screened in both fresh and frozen thawed ET cycles. Then, multivariate logistic regression analysis was used to adjust confounding risk factors. Main results and the role of chance 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, the ectopic pregnancy rate was significantly higher in underweight patients when compared with that in normal and overweight/obesity patients (3.29% vs. 2.29% vs. 2.54%; P = 0.029). However, the ectopic pregnancy rate was not differ among patients with different BMI (2.72% vs 2.76% vs 2.96%; P = 0.782) in frozen thawed cycles. In fresh ET cycles, secondary infertility, tubal infertility, elevated estrogen level, thin endometrial thickness, and cleavage stage embryo transfer were risk factors with ectopic pregnancy. However, female BMI was not associated with ectopic pregnancy (adjusted OR: 0.98, P = 0.894, for BMI 18.5-23.9 Kg/m2; adjusted OR: 0.89, P = 0.205, for BMI ≥ 24 Kg/m2. Reference = BMI &amp;lt; 18.5 Kg/m2). In frozen thawed embryo transfer cycles, only thin endometrial thickness, and cleavage stage embryo transfer were risk factors with ectopic pregnancy. Female BMI was not predictable for ectopic pregnancy, either (adjusted OR: 1.15, P = 0.513, for BMI 18.5-23.9 Kg/m2; adjusted OR: 1.24, P = 0.367, for BMI ≥ 24 Kg/m2. Reference = BMI &amp;lt; 18.5 Kg/m2). Limitations, reasons for caution This is a retrospective study with 12 years period. New embryo culture methods and embryo transfer strategy emerged. It is possible that not all confounders have been controlled. Meanwhile, the definition of tubal infertility and pelvic disease need more caution as the lack of laparoscopic examination in some cases. Wider implications of the findings Understanding the impact of BMI on EP during IVF treatment may be useful for predicting results. At the first glance, underweight patients are more likely to encounter with EP during fresh ET. However, it is the high estrogen level, but not low BMI, that contributes to this phenomenon. Trial registration number N/A

Association between Progesterone-Only Emergency Contraceptive Pill and Ectopic Pregnancy

Context: Ectopic pregnancy remains a significant cause of morbidity and mortality in the developing countries, where mortality rates are 10 times higher than in the developed countries. In Kenya, there is however no recent data on ectopic pregnancy. Objective: We sought to identify if using an emergency contraceptive pill predisposes to ectopic pregnancy and assess other risk factors for ectopic pregnancy at the Kenyatta National Hospital. Methods: We conducted a case-control study of 120 consecutively sampled women matched for age diagnosed with ectopic pregnancy. Data were analyzed using a statistical package for the social sciences (SPSS software) [version 18.0]. Multivariate logistic regression analysis was performed to calculate the odds ratios (OR) and the corresponding 95% confidence intervals (CI). Results: Of the 120 cases and 120 controls recruited, 27.5% of the cases and 2.5% of the controls had taken Levonogesterol emergency contraceptive (LNG-EC) pill during the menstrual cycle leading to the current pregnancy. Of the cases, 72.7% took the LNG-EC within 24hrs after coitus, while all the controls took the pill within 24-48 hrs. The risk of ectopic pregnancy (EP) increased 12-fold in women who had used LNG-EC (OR=12.44, 95% CI 3.1-49.84) after adjusting for other confounders. EP was associated with an early sexual debut (p= 0.039), and a history of subfertility/infertility (OR=6.87, 95% CI 2.14-22.03). Conclusions: Progesterone only emergency contraceptive pill is as a risk factor for ectopic pregnancy and should be included in the client information leaflet in the drug package insert.

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.

Laparoscopic treatment of advanced interstitial pregnancy: key steps for a successful management

To describe a conservative laparoscopic treatment of an advanced case of interstitial pregnancy diagnosed in a woman at 14 weeks of gestational age. Video case report with demonstration of diagnostic work-up and laparoscopic management of rare subtypes of ectopic pregnancy SETTING: University tertiary care hospital. A 32-year-old nulliparous woman at 14 weeks of gestational age, presented with moderate abdominal pain. She reported an history of irregular periods however, no risk factor for ectopic pregnancy were identified. HCG levels was 7345 mIU/mL. Transvaginal ultrasound revealed an empty uterine cavity and a complex heterogeneous mass of 6 cm on the left cornual region. Myometrial thickness surrounding the gestational sac was 4 mm. There were several critical strategies for this laparoscopic approach. To reduce intraoperative bleeding, the peritoneum was opened, the ureters were identified, and bulldog clamps were used to temporarily reduce uterine vascularization. An intramyometrial injection of vasopressin was performed. After a first cornuostomy attempt, we had to get on a cornual resection to achieve a complete removal of the ectopic mass. Multilayer uterine suture and anatomical restoration to prevent adhesion was then accomplished. Institutional review board approval was not required for this case report as per our institution's policy; patient consent was obtained for publication of the case. Description of a laparoscopic management of huge interstitial pregnancy RESULTS: The overall operation time was 55 minutes, and the estimated blood loss was 55cl. A successfully conservative treatment was achieved with no short-term complications. Postoperative ultrasound showed a normal uterus and complete regression of hCG was obtained two weeks after surgery. Interstitial ectopic pregnancy presents a high risk of maternal mortality considering that the interstitial part of the tube, because of its thickness, has a great capacity to expand before rupture.

Management of ectopic pregnancy in a tertiary hospital: a retrospective cohort study.

The goal of this study was to manage the treatment modalities of ectopic pregnancy. This retrospective study included 1,103 women diagnosed and treated for ectopic pregnancy at Kanuni Sultan Suleyman Training and Research Hospital between January 1, 2017, and December 31, 2020. Serial beta-human chorionic gonadotropin (β-Hcg) measurements and transvaginal ultrasound (TV USG) findings were used to establish the diagnosis of an ectopic pregnancy. They were divided into four groups: expectant treatment, single-dose methotrexate, multidose methotrexate, and surgical treatment. All data analyses were performed using SPSS version 24.0. A receiver operating characteristic (ROC) analysis was used to determine the cut-off for change in beta-human chorionic gonadotropin (β-hCG) levels between the first and fourth day. There were significant differences between groups in terms of gestational age and β-hCG changes (p < 0.001). In patients receiving expectant treatment, the decrease in β-hCG values on the fourth day was 35.19%, while patients receiving single-dose methotrexate treatment showed a decrease of 24%. The most common risk factor for ectopic pregnancy was the absence of risk factors. Comparison of the surgical treatment group with the other groups revealed significant differences in terms of the presence of free fluid in the abdomen, the average diameter of the ectopic pregnancy mass, and the presence of fetal cardiac activity. A single dose of methotrexate was effective in patients with β-hCG levels lower than 1,227.5 mIU/ml, with a 68.5% sensitivity and 69.1% specificity. An increase in gestational age also leads to an increase in β-hCG values and the diameter of the ectopic focus. As the diagnosis period progresses, the need for surgical intervention increases.

Risk factors for ectopic pregnancy in a sub-Saharan African country.

Our case-control study aimed at identifying the risk factors (RFs) for ectopic pregnancy (EP), and was carried out between 1st February and 31st May, 2019. Women who had EP were compared to those without EP. Out of 3421 pregnancies, 93 (2.7%) had EP. Independent RFs were previous EP, past history of infertility, first sexual encounter <15 years, past history of chlamydia infection, ≥ 3 sexual partners, use of levonorgestrel based emergency contraceptive pill, and unemployment. Girls should be counselled concerning these RFs and specifically against early sexual intercourse and multiple sexual partnership.

Clinical study of ectopic pregnancy in a tertiary care centre in Andhra Pradesh

Background: If not detected early, ectopic pregnancy can result in a gynaecological emergency with significant abdominal bleeding, hypovolemic shock, and maternal death. The main objectives of this study are to find out the incidence of ectopic pregnancy, demographic profile of the women, risk factors and to study the clinical presentation, treatment modalities and outcome in our hospital. Methods: This prospective observational study was conducted in the department of obstetrics and Gynaecology, at a tertiary care centre, Andhra Pradesh from January 2021 to December 2022. A total of 62 cases of ectopic pregnancy were analysed for parameters like demographic characteristics, gravidity, risk factors, clinical presentation, treatment modalities and outcome. Results: The incidence of ectopic pregnancy in present study was 9.7 per thousand deliveries. Majority of cases belonged to age group of 21-25 years (67.7%) and were gravida 3 and above (49.1%). Commonest risk factors identified were tubal ligation (29%) and history of previous abortions (19.3%). The frequent presenting symptoms were abdominal pain (87%) and amenorrhea (38.7%). Most of the patients required surgical management (91.9%), medical management was done in 4 cases and expectant management was done in 1 case. Tubal ectopic pregnancy (87%) is more common. Anaemia was seen in 64.5% of cases that required multiple blood transfusions (72.5%) for resuscitation. There was no maternal mortality in the current study.Conclusions: Ectopic pregnancy is an emergency in which timely intervention will reduce the maternal morbidity and mortality. Clinical presentation varies from case to case and still there is a chance of missing the diagnosis in a small proportion of patients even with the availability of advanced imaging techniques. For early diagnosis a clinician should be aware about the various presentations and associated risk factors of ectopic pregnancy.

Evaluation of Risk Factors Associated with Ectopic Pregnancy in Our Sociodemographic Setup: A Prospective Observational Study

Background: Women in this region may have a different risk factor profile for ectopic pregnancy compared to women from other countries because they have specific characteristics (such as cultural, religious, and traditional values), socio-demographic determinants, sexual behavior and beliefs, and a preference for contraception. The present study has been objectively conducted to assess the various risk factors of ectopic pregnancy among women of Jammu region. Methods: This was a one year prospective observational study conducted in the department of obstetrics and gynaecology, SMGS Hospital, GMC Jammu with effect from February 2022 to November 2022. The patient provided written, fully informed consent. A total of 120 patients were included in the study in which 60 patients were cases and 60 were controls. Results: The risk of ectopic pregnancy was also found to increase with a number of risk factors, such as patients with lower socioeconomic status (56% vs 13.3%; p-value0.001), patients with history of abortions (23.3% vs. 8.3%;p-value=0.024*), patients with tuberculosis (13.3% vs. 1.7%; p-value&lt; 0.001*), patients with endometriosis (11.7% vs. 1.7%; p-value=0.028), patients with infertility (18.3% vs. 3.3%; p-value=0.008*), patients with IUCD (13.3% vs1.7% ; p-value=0.015) and patients with previous ectopic pregnancy (11.7% vs. 1.7%;p=0.028). Conclusion: The current study showed that the primary risk factors for the incidence of ectopic pregnancies among women of Jammu region include advanced maternal age, low socioeconomic position, prior ectopic pregnancies, usage of IUCDs, history of abortions, and infertility Keywords: Ectopic pregnancy, risk factor for ectopic pregnancy, contraception, women of Jammu region

Assessment risk factors for women with ectopic pregnancy in Al-Zashraa teaching hospital at Al-Najaf city

Ectopic pregnancy (EP) is the leading cause of maternal death during the first trimester of pregnancy, accounting for approximately 10% of all pregnancy-related deaths. It remains to be a condition presenting as a serious health problem for women of childbearing age. It has been shown to reduce subsequent fertility and increase the chances of subsequent EP. Over recent decades, there has been a rise in the incidence of EP. There is extensive literature regarding the potential risk factors for EP. The identified risk factors for EP include age, previous EP, previous pelvic surgery, use of intrauterine devices (IUDs), female sterilization, history of pelvic inflammatory disease, history of infertility and smoking at the time of conception. Methodology: A descriptive cross sectional study was adopted in order to achieve the stated objectives. The study began from 2 November 2021 to 24 April 2022. A non-probability sampling technique (purposive sample) based on the criteria of patient with only women with ectopic pregnancy sample of (48) woman who admitted who were selected from Al Zahra Teaching Hospital. Results: The study show the previous abortion was risk factors of ectopic pregnancy which there was high significant association. Recommends: The study recommends Educational health programs for women regarding risk factors of ectopic pregnancy.

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.

Predictors of Successful Medical Management With Methotrexate in Unruptured Tubal Ectopic Pregnancy.

Introduction Medical treatment with methotrexate (MTX) is a safe and effective alternative to surgery in carefully selected cases of ectopic pregnancies diagnosed early prior to rupture. Aim To determine the optimal pre-treatment levels of beta human chorionic gonadotropin (𝛽-hCG) and its changing trends most likely to have a successful outcome with medical management. Material and methods A prospective observational study was conducted in a tertiary teaching hospital from December 2018 to May 2021. "Single-dose" MTX regime was used for medical management of ectopic pregnancy in patients fulfilling the selection criteria. The 𝛽-hCG levels were recorded at baseline and on day 4 and day 7 of MTX injection. Thereafter, at weekly intervals till complete resolution or surgical intervention due to failure of medical management. In addition, receiver operating characteristic (ROC) curve analysis for a pre-treatment 𝛽-hCG cut-off value and changing trends in post-treatment 𝛽- hCG levels most likely to have a successful outcome with MTX treatment were determined. Results Fifty patients fulfilling the inclusion criteria were included in the study, with successful medical management in 33 (66%). The mean pre-treatment 𝛽-hCGlevels in women with successful medical management were 3270.97 (+/- 901) compared to 5249.17 (+/-808.02) for those with treatment failure (p=0.00001). The mean 𝛽-hCG level in the failed treatment group was significantly higher on day 4 than the pre-treatment levels (6742.56 +/- 572 vs. 5249.17+/- 808.02; p<0.05). Inadequate reduction of 𝛽-hCG level on day 7 (<15% of day 4 levels) requiring repeat dosage of MTX was more likely to have an unsuccessful outcome (p=0.00001). The area under curve (AUC) value of 0.905 (95% CI: 0.814-0.996) depicted that pre-treatment 𝛽-hCG level of 4000 mIU/ml taken as the cut-off value was able to predict levels ≤4000 mIU/ml had a greater likelihood of successful outcome with MTX, having a sensitivity of 84.5%, specificity of 83.3%, positive predictive value (PPV) of 90.3%, and negative predictive value (NPV) of 75% (p< 0.05). Demographic variables or previous clinical history, considered risk factors for ectopic pregnancy, did not affect the outcome of medical management in this study. Conclusion Medical management of ectopic pregnancy is a viable first-line treatment option in carefully selected patients. In this study, the most important predictors for the successful outcome of medical management were the pre-treatment β-hCG levels and their fall on day 4 and day 7 after MTX therapy.

Very early medical abortion: treatment with mifepristone and misoprostol before ultrasonographic visualisation of an intrauterine pregnancy

IntroductionAbortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was...

Ectopic pregnancy following intracytoplasmic sperm injection-embryo transfer (ICSI-ET)

Ectopic pregnancy (EP) is defined as a pregnancy implanted outside of the endometrial cavity and one of the leading causes of maternal morbidity and mortality during the first trimester. There are several risk factors of ectopic pregnancy have been described especially following ART. However, prevalence of ectopic pregnancy is varied and slightly higher in pregnancies following ART. Several mechanisms have been described of EP following ART. Serial serum beta hCG and pelvic sonographic screening facilitates early diagnosis and avoid the delay to initiate treatment for EP in ART patients. No particular treatment modality is shown to be superior in EP. In this case, we reported two cases of ectopic tubal pregnancy following Intracytoplasmic Sperm Injection (ICSI)-Embryo Transfer (ET) which were successfully managed without complications by laparoscopic salpingectomy our own practice we present a management approach for future pregnancies with particular focus on fetal surveillance.

RISK OF ECTOPIC PREGNANCY IN PATIENTS WITH A TRANSIENT DIAGNOSIS OF PREGNANCY OF UNKNOWN LOCATION

Pregnancy of unknown location (PUL) is a transient diagnosis for a patient who has a positive pregnancy test and no evidence of an intrauterine or extrauterine pregnancy on transvaginal ultrasound. The concern is that the patient may have an undiagnosed ectopic pregnancy. The objective of this study was to determine whether a transient diagnosis of a PUL is an additional risk factor for ectopic pregnancy, which has a 6-9% mortality due to rupture causing severe abdominal hemorrhage.