Risk Of Ectopic Pregnancy Research Articles

ACTIVE TREATMENT OR NO TREATMENT (ACTORNOT) FOR PERSISTING PREGNANCY OF UNKNOWN LOCATION; A RANDOMIZED CLINICAL TRIAL

Women in early gestation without a pregnancy visualized on ultrasound (pregnancy of unknown location, (PUL)) and serial hCG values consistent with a nonviable gestation are at high risk for ectopic pregnancy. There is no consensus regarding optimal management of PUL among the possibilities of expectant management, uterine evacuation, or administration of methotrexate. The goal of this trial was to determine if active management options are superior to expectant management, and to determine if the two active management strategies are non-inferior.

Antioxidants for female subfertility.

Antioxidants for female subfertility.

Female underweight and risk of ectopic pregnancy.

Female underweight and risk of ectopic pregnancy.

Embryo retention significantly decreases clinical pregnancy rate and live birth rate: a matched retrospective cohort study

To investigate the embryo retention (ER) rate in embryo transfer (ET) cycles and its effects on reproductive outcomes. Matched retrospective cohort study. A tertiary hospital-based reproductive medicine center. A total of 6,089 ET cycles were performed from January 2013 to December 2018 in our unit. Each woman was matched with two separate control subjects of the same age (±1 year), embryo condition, main causes of infertility, type of protocol used for fresh or frozen ET cycles. ER rate, implantation, clinical pregnancy, ectopic pregnancy, and live birth rate. The overall incidence of ER was 1.59% (97/6,089). A significantly increased ER rate was observed in fresh ET cycles compared with frozen transfer cycles (2.71% vs. 1.08%). In fresh transfer cycles, the rate of mucus in or on the catheter after ET in ER group was significantly higher than in the non-ER group (48.09% vs. 13.65%). A total of 194 non-ER cycles were matched to the ER group. Compared with the matched group, the ER group was associated with a significantly lower clinical pregnancy rate (32.98% vs. 48.96%), implantation rate (20.88% vs. 35.97%), and live birth rate (22.68% vs. 37.63%, P<.01), and a higher ectopic pregnancy rate (12.50% vs. 3.16%). Our results suggest that ER rate is correlated with mucus on or in the transfer catheter in fresh transfer cycles. Retained embryos are associated with lower implantation, clinical pregnancy, live birth, and increases risk of ectopic pregnancy.

Low body mass index is associated with ectopic pregnancy following assisted reproductive techniques: a retrospective study

To investigate the association between body mass index (BMI) and ectopic pregnancy (EP) following embryo transfer (ET). Retrospective cohort study. University-affiliated hospital. A total of 16378 pregnancies derived from either fresh ET or frozen-thawed ET between January 2008 and December 2017. We used the generalised estimating equation (GEE) to analyse the association between BMI categories and EP, as one woman may contribute to more than one pregnancy. Generalised additive models were also used to demonstrate the non-linear association. Models were adjusted for age, parity, gravidity, previous history of ectopic pregnancy, duration of infertility, polycystic ovary syndrome, endometriosis, diagnosis of tubal problems, ovarian reserve markers, ovarian stimulation parameters, insemination protocol, endometrial thickness and embryo transfer policies. Ectopic pregnancy. According to the WHO criteria, the number of cycles with low (<18.5kg/m2 ), normal (18.5-24.9kg/m2 ) and high (≥25kg/m2 ) BMI were 2155, 13447 and 776, respectively. In comparison with the normal BMI group, the rate of EP was significantly increased in the low BMI group (2.92% versus 2.02%, relative risk 1.45, 95% CI 1.11-1.90), but not in the high BMI group (2.84%, relative risk 1.41, 95% CI 0.92-2.20). Adjusted for confounding factors, the odds ratio for EP comparing low BMI versus normal BMI was 1.61 (95% CI 1.19-2.16) and that comparing high BMI versus normal BMI was 1.12 (95% CI 0.72-1.76). Low BMI is associated with an increased risk of EP. The ectopic pregnancy rate after embryo transfer for lean women is higher than that for women of normal weight.

Ectopic Pregnancy Risk with Assisted Reproductive Technology

To investigate the optimal methods for the reduction of ectopic pregnancy incidence due to assisted reproductive technology (ART). Day five or six blastocyst transfer may decrease ectopic pregnancy rates when compared with day three transfer, similarly, frozen-thawed embryo transfer may lessen the risk of ectopic pregnancy relative to fresh embryo transfer. Single embryo transfers decrease ectopic pregnancy risk and have similar clinical pregnancy outcomes as double embryo transfers. Ectopic pregnancy remains a major cause of maternal morbidity and mortality in the first trimester of pregnancy. Compared with spontaneously conceived pregnancies, pregnancies resulting from in vitro fertilization (IVF) treatments are initially associated with an increased risk of an ectopic implantation. Many risk factors related to ART have been linked to increased ectopic pregnancy risk, though the exact mechanism underlying the link between ectopic pregnancy and ART remains unclear. Tubal factor infertility is the major risk factor for ectopic pregnancy following IVF. Day of transfer, fresh or frozen-thawed cycle single or double transfer are the main controversial factors regarding ectopic pregnancy risk. According to recent data, day 5 blastocyst transfer has decreased ectopic pregnancy risk than day 3, also frozen-thawed cycle has lower risk of ectopic implantation than fresh cycles. Single frozen-thawed blastocyst transfer may thus be the best choice for reducing ectopic pregnancy incidence among IVF patients. Further studies should be done to compare the ectopic pregnancy rates between the single frozen-thawed blastocyst transfer and spontaneous pregnancies.

Benzodiazepine use before conception and risk of ectopic pregnancy

Are women who fill a benzodiazepine prescription before conception at increased risk of ectopic pregnancy? Risk of ectopic pregnancy is 50% higher among women who fill a benzodiazepine prescription before conception. Benzodiazepine use in pregnancy increases the risk of miscarriage, adverse birth outcomes and adverse child development outcomes. Using data from US commercial insurance claims, we performed a cohort study of 1 691 366 pregnancies between 1 November 2008 and 30 September 2015. We identified ectopic pregnancies using diagnosis and procedure codes and used unadjusted and inverse probability of treatment (IPT)-weighted log-binomial models to calculate relative risks (RR) of ectopic pregnancy for pregnant women who did and did not fill any prescriptions for benzodiazepines in the 90days before conception. Two sub-groups of women with specific indications for benzodiazepine use were also examined-women who had a least one diagnosis for anxiety disorder and women who had at least one diagnosis of insomnia in the year before conception. Of the 1 691 366 pregnancies, 1.06% filled at least two benzodiazepine prescriptions totaling at least 10days supply in the 90days before conception. Among women with a benzodiazepine prescription, there was an excess of 80 ectopic pregnancies per 10 000 pregnancies, and their IPT-weighted risk of ectopic pregnancies was 1.47 (95% CI 1.32 to 1.63) times greater relative to women without benzodiazepine prescriptions before conception. The IPT-weighted RR between ectopic pregnancy and benzodiazepine use was 1.34 (95% CI 1.18 to 1.53) among women with anxiety disorder diagnoses and 1.28 (95% CI 0.99 to 1.68) among women with an insomnia diagnosis. We relied on outpatient prescription data to identify benzodiazepine use before conception, which could result in over- or under-estimation of actual benzodiazepine consumption. We relied on medical claim codes to identify pregnancies and conception date, which may result in misclassification of pregnancy outcomes and gestational length. This study found that women who have a benzodiazepine prescription before conception are at an increased risk of ectopic pregnancy. This information can help women, and their healthcare providers make more fully informed decisions about benzodiazepine use in their reproductive years. Funding for this project was provided by a Banting Postdoctoral Fellowship and a Stanford Maternal and Child Health Research Institute Postdoctoral Award. Data access for this project was provided by the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and internal Stanford funding. The authors have no competing interest. N/A.

Benzodiazepine use increases risk of ectopic pregnancy

Benzodiazepine use increases risk of ectopic pregnancy

Antidepressant Use around Conception, Prepregnancy Depression, and Risk of Ectopic Pregnancy.

To compare the risk of ectopic pregnancy among women with and women without antidepressant prescriptions around conception and examine whether this risk differs by prepregnancy depression status. We conducted a cohort study of all pregnancies between November 1, 2008, and September 30, 2015, identified in the nationwide (American) IBM® MarketScan® Databases. At least one day's supply of antidepressants in the 3 weeks after a woman's last menstrual period defined active antidepressant use around conception. At least one depression diagnosis in the year before the last menstrual period defined prepregnancy depression. Relative risk (RR) of ectopic pregnancy was estimated using unadjusted and inverse probability of treatment (IPT)-weighted log-binomial models. Of the 1,703,245 pregnancies, 106,788 (6.3%) women had a prepregnancy depression diagnosis. Among women with a depression diagnosis, 40,287 (37.7%) had an active antidepressant prescription around conception; the IPT-weighted risk of ectopic pregnancy was similar among women who did and did not fill an antidepressant prescription around conception (IPT-weighted RR = 1.01; 95% CI, 0.93 to 1.10). Overall, the risk of ectopic pregnancy was higher among women who had a prepregnancy depression diagnosis than women who did not have a prepregnancy depression diagnosis (IPT-weighted RR = 1.09; 95% CI, 1.04 to 1.15). This study's findings suggest that women who have a prepregnancy depression diagnosis are at a slightly increased risk of ectopic pregnancy, and among women who have a prepregnancy depression diagnosis, the use of antidepressants around conception does not increase the risk of ectopic pregnancy.

Suboptimal endometrial-embryonal synchronization is a risk factor for ectopic pregnancy in assisted reproduction techniques.

What are the main risk factors associated with ectopic pregnancy and what is the true incidence of ectopic pregnancies in an IVF programme? Retrospective single-centre study of 12,429 blastocyst transfers (8182 fresh and 4247 frozen embryo transfers) conducted between January 2010 and December 2017. IVF outcome was analysed, and ectopic pregnancy risk evaluated according to patient's characteristics and assisted reproductive technology treatment factors. Of 5061 patients reporting a positive pregnancy test, 43 were diagnosed with ectopic pregnancy (0.85%). Neither female age (36.7 versus 35.8 years), body mass index, quality of transfer nor stimulation protocol affected the ectopic pregnancy rate, but history of previous ectopic pregnancy (OR 3.26; P = 0.0080), tubal surgery, or both (OR 6.20; P < 0.0001) did. The incidence of ectopic pregnancy was increased in women with uterine malformations (OR 3.85; P = 0.0052), uterine pathologies (OR 5.35; P = 0.0001), uterine surgeries (OR 2.29; P = 0.0154) or sub-optimal endometrial build-up (OR 4.46 to 5.31; P < 0.0001). Transfer of slow-developing blastocysts (expressed by expansion) significantly increased the risk of ectopic pregnancy (OR 2.59; P = 0.0102). Unfavourable uterine environment, including uterine pathologies, uterine or tubal surgery and suboptimal endometrial build-up were related to ectopic pregnancy. Low expansion grade of blastocysts was identified as an additional putative risk factor for ectopic pregnancy, indicating the importance of proper embryonal-maternal synchronization. The overall ectopic pregnancy rate after blastocyst transfer was low, comparable with reported ectopic pregnancy rates in spontaneous conceptions. Proper evaluation of tubal and uterine pathologies, optimizing endometrial preparation and the transfer of expanded blastocysts in a frozen embryo transfer cycle, might be beneficial.

Low-dose human menopausal gonadotrophin versus natural cycles in intrauterine insemination for subfertile couples with regular menstruation

BackgroundWomen with irregular menstruation should be considered to benefit from the ovarian stimulation. However, most literature did not separate ovulatory disorders from normal menstrual cycles. Our purpose was to assess the superiority of ovarian mild stimulation compared with the natural cycle in IUI for subfertile couples when the women with regular menstruation.MethodsA retrospective study in a single medical center in which 2413 couples with 3573 IUI cycles were studied from 2013 to 2018. The results of IUI in natural cycles versus low-dose HMG induced cycles were analyzed.ResultsFor young women (age < 35 years) with normal menstrual cycle, HMG induced ovulation combined with IUI can improve clinical pregnancy outcome (13.55% in two follicular induced cycles vs. 7.23% in natural cycles, p < 0.01); even if only one follicle was induced, the clinical pregnancy rate was increased to 10.32% (p < 0.01). When two growth follicles were induced in HMG cycles, a remarkable improvement of the live birthrate (10.28% vs. 5.91% in natural cycles, p < 0.05) was noted. Simultaneously, twin pregnancy rates were increased to 20.69% (p < 0.01). Twin pregnancies showed significantly increased risk of both ectopic pregnancy and preterm birth (p = 0.00 for both). For advanced women (age ≥ 35 years) with regular menstrual cycle, ovulation induction didn’t improve clinical pregnancy and live birthrates, while age was the only relevant factor.ConclusionsCombining HMG induced ovulation and IUI can improve pregnancy outcome in young women with normal menstrual cycles. 1–2 follicles with diameter ≥ 14 mm served as the purpose of ovulation induction. Further, both twin and ectopic pregnancy rate in HMG cycles with two growth follicles were significantly higher than those in natural cycles were. Therefore, doctors must evaluate the risk before making choices and inform the patients to achieve the best results. For advanced women with normal menstrual cycles, natural IUI cycles were optional.

OVULATION INDUCTION AND INTRAUTERINE INSEMINATION FOR TUBAL FACTOR INFERTILITY: TO DO OR NOT TO DO?

Ovulation induction (OI)/intrauterine insemination (IUI) is an option available to patients with tubal factor infertility (TFI) and one patent fallopian tube. However, patients with a unilateral blocked fallopian tube likely have inherent risk factors for non-viable pregnancies such as ectopic pregnancy1,2. If a patient has an inherent risk factor such as TFI, is IUI a worthwhile treatment, or is it putting the patient at increased risk of ectopic pregnancy? Objective To evaluate the success of OI/IUI (with either oral agents or gonadotropins) in patients with TFI and at least one patent fallopian tube. Design: Retrospective chart review Setting: Large academic fertility center Patients: Women with TFI undergoing OI/IUI from 12/2003 to 09/2019. Interventions: Data from 3555 cycles were retrospectively reviewed. Women with TFI (n=244) were compared to those with idiopathic infertility (IdI) (n =3311). A sub-analysis restricted only to cycles utilizing injectable gonadotropins was also performed, Outcome Measures: Primary: Clinical pregnancy rate (CPR)/cycle, defined as at least one gestational sac identified on transvaginal ultrasound and including viable pregnancies and spontaneous abortions. Secondary: Non-viable pregnancy rate (NVPR), defined as ectopic, biochemical, and pregnancies of unknown location. Statistics: T-tests and x2 were used, as appropriate. Odds ratios were calculated utilizing logistic regression analysis and adjusting for age and BMI. Women with TFI did not differ from those with IdI in regards to age, day-3 FSH, or AMH. TFI/IUI when compared to IdI/IUI cycles, resulted in significantly lower CPR/cycle (8.6% vs. 13.4%, p<0.01, respectively). The unadjusted odds for achieving clinical pregnancy were 40% lower in TFI/IUI compared to IdI/IUI cycles (OR (95%CI): 0.61 [0.38-0.96], p<0.05, for TFI/IUI vs. IdI/IUI). Results did not change when adjusting for maternal age and BMI (adjOR (95%CI): 0.61 [0.38-0.96], p<0.05). NVPRs were comparable between the two groups (16% vs 10.8%, respectfully, adjOR (95%CI): 1.08 [0.87-1.35]). However, as expected, when TFI/IUI cycles were compared to IdI ones, the odds for an ectopic pregnancy were 62% higher (12.0% vs 1.2%, respectfully, aOR [95%CI]:1.62 [1.20-2.19], p<0.01). When analysis was restricted to gonadotropin/IUI cycles (79.5% of TFI/IUI and 62.7% of IdI/IUI cycles) results were similar but differences in CPR were attenuated (10.3% vs 14.7%, p=0.08). No significant difference was found regarding CPR, NVPR or ectopic rate between the TFI/IUI and IdI/IUI groups (Table 1). TFI/IUI cycles that used oral pills for OI had limited cases for statistical comparison with IdI/IUI cyclesTable 1Comparison of TFI/IUI to IdI/IUI Pregnancy OutcomesTubal Factor Infertility/IUI (TFI/IUI)Idiopathic Infertility/IUI (IdI/IUI)Adjusted Odds Ratio OR (CI)All IUIsAll cycles (TFI/IUI n=244, IdI/IUI n=3311)CPR N (%)*21 (8.6)444 (13.4)0.61 (0.38-0.96)*465 (13.1)NVPR N (%)4 (16.0)54 (10.8)1.08 (0.866-1.351)58 (11.1)Ectopic**3 (12.0)6 (1.2)1.62 (1.20-2.19)**9 (1.7)Gonadotropin OI Cycles Only (TFI/IUI n=194, IdI/IUI n=2077)CPR20 (10.3)306 (14.7)0.67 (0.41-1.09)326 (14.4)NVPR1 (4.3)31 (9.1)0.86 (0.57-1.28)32 (8.8)Ectopic1 (4.3)3 (0.9)1.44(0.89-2.34)4 (1.1)*P<0.05, **P<0.01 Open table in a new tab *P<0.05, **P<0.01 Overall, IUI as management for a patient with a unilateral tubal disease leads to a lower chance of clinical pregnancy and higher chance of ectopic pregnancy when compared to patients with idiopathic infertility. The differences in clinical pregnancy rate are attenuated when utilizing gonadotropins for ovulation induction. These patients might benefit from immediate access to ART, instead.

Adverse Pregnancy Outcomes in Endometriosis - Myths and Realities.

There is increasing interest in the long-term health and comorbid conditions associated with endometriosis for both women and neonates. The purpose of this review was to synthesize and discuss the current state of the literature investigating endometriosis and risk of adverse pregnancy outcomes. Methodologic considerations for studying endometriosis and adverse pregnancy outcomes include complexities regarding the comparison population, endometriosis definition, sample size, residual confounding, and interactions. The current research on endometriosis and adverse pregnancy outcomes should be interpreted cautiously. To date, evidence suggests that endometriosis may be associated with higher risk of ectopic pregnancy, placenta previa, preterm birth, and cesarean section. While an association with miscarriage and stillbirth has been consistently observed, the relative risk was small. Pregnant women with endometriosis may be at higher risk for certain adverse pregnancy outcomes and may therefore benefit from additional monitoring. However, additional research is needed to confirm these associations and should focus on ensuring studies have internal and external validity, as well as, investigate the potential for differences in endometriosis phenotypes. Moreover, future research should focus on understanding potential mechanisms of association and better understanding how early interventions, through increased monitoring or screening during pregnancy, may improve outcomes.

Triaging women with pregnancy of unknown location using two-step protocol including M6 model: clinical implementation study.

The M6 risk-prediction model was published as part of a two-step protocol using an initial progesterone level of ≤ 2 nmol/L to identify probable failing pregnancies (Step 1) followed by the M6 model (Step2). The M6 model has been shown to have good triage performance for stratifying women with a pregnancy of unknown location (PUL) as being at low or high risk of harboring an ectopic pregnancy (EP). This study validated the triage performance of the two-step protocol in clinical practice by evaluating the number of protocol-related adverse events and how effectively patients were triaged. This was a prospective multicenter interventional study of 3272 women with a PUL, carried out between January 2015 and January 2017 in four district general hospitals and four university teaching hospitals in the UK. The final pregnancy outcome was defined as: a failed PUL (FPUL), an intrauterine pregnancy (IUP) or an EP (including persistent PUL (PPUL)). FPUL and IUP were grouped as low-risk and EP/PPUL as high-risk PUL. Serum progesterone and human chorionic gonadotropin (hCG) levels were measured at presentation in all patients. If the initial progesterone level was ≤ 2 nmol/L, patients were discharged and were asked to have a follow-up urine pregnancy test in 2 weeks to confirm a negative result. If the progesterone level was > 2 nmol/L or a measurement had not been taken, hCG level was measured again at 48 h and results were entered into the M6 model. Patients were managed according to the outcome predicted by the protocol. Those classified as 'low risk, probable FPUL' were advised to perform a urine pregnancy test in 2 weeks and those classified as 'low risk, probable IUP' were invited for a scan a week later. When a woman with a PUL was classified as high risk (i.e. risk of EP ≥ 5%) she was reviewed clinically within 48 h. One center used a progesterone cut-off of ≤ 10 nmol/L and its data were analyzed separately. If the recommended management protocol was not adhered to, this was recorded as a protocol deviation and classified as: unscheduled visit for clinician reason, unscheduled visit for patient reason or incorrect timing of blood test or ultrasound scan. The classifications outlined in the UK Good Clinical Practice (GCP) guidelines were used to evaluate the incidence of adverse events. Data were analyzed using descriptive statistics. Of the 3272 women with a PUL, 2625 were included in the final analysis (317 met the exclusion criteria or were lost to follow-up, while 330 were evaluated using a progesterone cut-off of ≤ 10 nmol/L). Initial progesterone results were available for 2392 (91.1%) patients. In Step 1, 407 (15.5%) patients were classified as low risk (progesterone ≤ 2 nmol/L), of whom seven (1.7%) were ultimately diagnosed with an EP. In 279 of the remaining 2218 women with a PUL, the M6 model was not applied owing to protocol deviation or because the outcome was already known (usually on the basis of an ultrasound scan) before a second hCG reading was taken; of these patients, 30 were diagnosed with an EP. In Step 2, 1038 women with a PUL were classified as low risk, of whom eight (0.8%) had a final outcome of EP. Of 901 women classified as high risk at Step 2, 275 (30.5%) had an EP. Therefore, 275/320 (85.9%) EPs were correctly classified as high risk. Overall, 1445/2625 PUL (55.0%) were classified as low risk, of which 15(1.0%) were EP. None of these cases resulted in a ruptured EP or significant clinical harm. Sixty-two women participating in the study had an adverse event, but no woman had a serious adverse event as defined in the UK GCP guidelines. This study has shown that the two-step protocol incorporating the M6 model effectively triaged the majority of women with a PUL as being at low risk of an EP, minimizing the follow-up required for these patients after just two visits. There were few misclassified EPs and none of these women came to significant clinical harm or suffered a serious adverse clinical event. The two-step protocol incorporating the M6 model is an effective and clinically safe way of rationalizing the management of women with a PUL. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

The Outcome of 40 Patients Becoming Pregnancy after Conservative Treatment of Cesarean Scar Pregnancy

Background: The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and more attention. Objectives: To assess pregnancy course and outcome after conservative treatment of cesarean scar pregnancy. Methods: A retrospective case series of 40 patients become pregnancy after conservative treatment of cesarean scar pregnancy by Foley or Methotrexate and aspiration. Patients in present study were treated at Hung Vuong and Tu Du Hospital between 2015 and 2017. A telephone follow-up was conducted after cesarean scar pregnancy (CSP) treatment. The outcomes of these subsequent pregnancies and mode of delivery were all recorded. Results: In 40 pregnancies, there are 22 cases of intrauterine pregnancy with childbirth (55%); all babies were born healthy, with no complications recorded in pregnancy. 12 Women had recurrent scar ectopic (30%). There were 2 abortion cases, 2 cases of ectopic pregnancy, and 2 cases of early miscarriage. Conclusions: Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of recurrent caesarean scar ectopic pregnancy is a concern.

Active Treatment or No Treatment (ACT or NOT) for Persisting Pregnancy of Unknown Location;&amp;nbsp; A Randomized Clinical Trial

Background: Women in early gestation without a pregnancy visualized on ultrasound and serial hCG values consistent with a nonviable gestation are at high risk for ectopic pregnancy. The goal of this trial was to determine if active management is superior to expectant management, and if two active management strategies are non-inferior. Methods: This multi-center study, 255 women with a persistent pregnancy of unknown location were randomized to expectant management or active management in a 1:2 ratio, and 1:1 within active management to a) uterine evacuation followed by methotrexate if needed or b) empiric methotrexate. The primary outcome was successful resolution of the pregnancy without change from initial strategy. Findings: Women treated with active management had a significantly higher percentage of successful resolution, Rate ratio 1·43 (1·04–1·96) intention to treat (ITT) and 1·64 (1·39–1·94) as treated (AT) and a lower rate of unscheduled surgery RR 0·43 (0·25-0·74) ITT and 0·24 (0·11-0·55) AT. Methotrexate was non-inferior to uterine evacuation (difference=6·6% (-8.4% to 21.6%) ITT. As treated, time to resolution was 8·1 days shorter after uterine evacuation compared to methotrexate. All strategies were safe and were rated with high acceptability and satisfaction. Women expressed a preference for expectant management with differential cross-over within this trial. Interpretation: A greater percentage of women achieved uneventful resolution with active management compared to expectant management with at least a 50% reduction in unscheduled interventions. Uterine evacuation resulted in a shorter time to resolution. Acceptability and safety of treatment were high for all strategies, but subjects expressed a preference for expectant management. Trial Registration: The trial was performed under IND #56407 and clinical trial registration number NCT02152696. Funding Statement: This work was supported by the National Institutes of Health (NIH)/ Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Declaration of Interests: Dr. Barnhart reports consulting fees to Swiss Precision Diagnostics and Bayer. Dr. Hansen reports research grants from Roche Diagnostics and Ferring outside of the submitted work. Dr. Diamond reports institutional grants/contracts from Bayer, ObsEva, and AbbVie; serving as a member of the Board of Directors and a stockholder of Advanced Reproductive Care; and serving as a Consultant for Seikagaku, Actamax, AEGEA, Temple Therapeutics, and ARC Medical Devices. Dr. Steiner reports consulting fees from Seikagaku and Prima-Temp. Dr. Cedars reports research funding from Ferring Pharmaceuticals outside of the submitted work. Dr. Wild reports Ablacare PCOS, Amgen Repatha in Pg and Partners Mass General Menopause Reviews, outside of the submitted work. Dr Hoeger reports consultation to Bayer and Ablacare and research funding from Abbvie. Dr. Krawetz reports a research grant from Merck outside of the submitted work. Dr. Santoro reports consulting for Ansh Lab, and is a Scientific Advisor to Astellas and Menogenix, Inc. Ethics Approval Statement: The protocol was approved by a National Institutes of Health appointed advisory board and a data and safety monitoring board. The University of Pennsylvania served as single IRB (IRB # 815013).

Incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon

INTRODUCTION: Ectopic pregnancy (EP) is the leading cause of maternal mortality in the first trimester of pregnancy in our environment. This study aimed at evaluating the incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon. METHODS: This was a retrospective nested case control study carried out from December 2006 to December 2016. A ratio for control vs cases of 3:1 was obtained. Any pregnancy implanted outside the normal uterine cavity was considered as an ectopic pregnancy. Student´s t-test was used to compare continuous variables and Pearson´s Chi-square test for categorical variables. The association between EP and the demographical and clinical variables was estimated using logistic regression. Statistical significance was set at p-values

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.

Endometrial thickness as a predictor of ectopic pregnancy in 1125 in vitro fertilization-embryo transfer cycles: a matched case-control study.

The ectopic pregnancy (EP) rate after in vitro fertilization-embryo transfer (IVF-ET) is higher than after spontaneous conception. The reason for the increased risk of EP is not clear. We aimed to determine the risk factors associated with EP in patients undergoing IVF-ET. This was a 1:4 matched case-control study that enrolled 225 EP patients and 900 matched intrauterine pregnancy patients from the ART center of Northwest Women's and Children's Hospital from January 2014 to April 2018. Conditional logistic regression was used to analyze the association between risk factors and EP, and a receiver-operating characteristic (ROC) curve was generated for the predictors of EP. Our findings showed that tubal factor (OR 1.61; 95% CI 1.12-2.31) and pelvic surgery other than cesarean section (OR 2.04; 95% CI 1.26-3.29) were associated with a higher risk of EP (p = 0.001). An endometrial thickness > 12mm prior to embryo transfer (OR 0.27; 95% CI 0.13-0.56) and the number of transferable embryos (OR 0.71; 95% CI 0.65-0.78) were protective factors against EP (p < 0.001). The other factors did not have a significant effect on the probability of developing ectopic pregnancy. The area under the curve of the endometrial thickness and the number of transferable embryos for EP prediction were higher than those for tubal factor and pelvic surgery other than cesarean section. An endometrial thickness > 12mm is a strong protective factor against ectopic pregnancy. Attention should be paid to women with specific characteristics who have undergone IVF-ET.

Effect of endometrial thickness on ectopic pregnancy in frozen embryo transfer cycles: an analysis including 17,244 pregnancy cycles

To investigate whether endometrial thickness (EMT) influences the incidence of ectopic pregnancy (EP) in frozen embryo transfer (FET) cycles. Retrospective cohort study. Academic tertiary-care medical center. A total of 16,556 patients were enrolled between January 2010 and December 2017, comprising 16,701 intrauterine, 488 ectopic, and 45 heterotopic pregnancy cycles after FET. None. EP was the primary outcome. EMT was the main measured variable. Data were analyzed with the binary logistic general estimating equations model to calculate the adjusted odds ratio (aOR) for EP. After adjusting for confounders, EMT remained statistically significant as an independent risk factor for EP. Compared with women with an EMT of ≥14 mm, the aORs for women with EMT in the ranges 7-7.9, 8-9.9, and 10-11.9 mm were 2.70 (95% confidence interval [CI], 1.65-4.40), 2.06 (95% CI, 1.33-3.20), and 1.66 (95% CI, 1.07-2.58), respectively. Hormone replacement treatment for endometrial preparation during FET increased the risk of EP after adjustment for confounding variables. EMT is inversely proportional to EP rate in FET cycles and is therefore a potential quantitative marker of endometrial receptivity and uterine contractibility in an FET cycle. The predictive validity of EMT value must be evaluated in further studies.