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PubMed1986

Chlamydia trachomatis infection in women with ectopic pregnancy.

Fifty women with ectopic pregnancy and 49 control women with intrauterine pregnancy were interviewed and evaluated for evidence of Chlamydia trachomatis infection. Among women with ectopic pregnancy, 14 women were wearing an intrauterine contraceptive device or had a tubal ligation (group A), and 36 women had no readily identifiable risk factors (group B). Group B women had greater total numbers of sexual partners than did control women with intrauterine pregnancy (P less than .005). Group B women more often had C trachomatis antibody than group A (P = .03) and control women (P = .002). Of 27 C trachomatis cultures from fallopian tube tissue from women with ectopic pregnancy, none were positive. Fallopian tube tissue distant from the site of ectopic implantation was available for histopathology of 41 cases. Nine (22%) had extensive subepithelial plasma cell infiltration. All nine were among group B women (P = .06) and all seven with plasma cell salpingitis who were tested for C trachomatis antibody were seropositive (P = .004). It is concluded that a subset of women with ectopic pregnancy were at increased risk for acquiring a sexually transmitted disease by virtue of their sexual behavior and that women in this subset frequently have serologic evidence of C trachomatis infection and histologic evidence of plasma cell salpingitis. Because few of these women recall having had pelvic infection, the authors speculate that subclinical C trachomatis tubal infection producing plasma cell salpingitis may commonly underly ectopic pregnancy.

Adolescent↗
PubMedDate not supplied

Chlamydial serology among patients with tubal factor infertility and ectopic pregnancy in Alexandria, Egypt.

BACKGROUND AND OBJECTIVES: Little is known about the role of Chlamydia trachomatis in the etiology of tubal factor infertility and ectopic pregnancy in Egypt. GOAL OF THIS STUDY: To assess the association between past chlamydial infection, tubal factor infertility, and ectopic pregnancy in an Egyptian population. STUDY DESIGN: This report consists of two concurrent case-control studies. First, 51 patients with tubal factor infertility were compared with 48 healthy subjects who did not have tubal factor infertility and 53 pregnant subject subjects. Second, 66 patients with ectopic pregnancy were compared with 51 pregnant control subjects. RESULTS: Geometric mean titers for Chlamydia trachomatis were higher among patients with tubal factor infertility and ectopic pregnancy, and they were more likely to have high antichlamydial titers (> or = 1:128 immunoglobulin G). Serum titer was significantly correlated with histologic evidence of salpingitis among the patients with an ectopic pregnancy. CONCLUSION: Our findings, similar to those from Western societies, suggest that among Egyptian women, prior chlamydial infection is associated with an increased risk of tubal factor infertility and possibly ectopic pregnancy.

Adult↗
PubMed2000

Ectopic pregnancy--a diagnostic challenge in the emergency department.

The aim of this study was to elucidate the clinical presentation of ectopic pregnancy in the emergency department and highlight the atypical presentations and pitfalls in its diagnosis. This was a 4-year retrospective descriptive study carried out at a tertiary teaching hospital. Two hundred and seven cases of ectopic pregnancy treated in a tertiary teaching hospital were reviewed. Among the risk factors, 4.9% had a history of tubal ligation. Two patients developed ectopic pregnancy while breastfeeding. Of the patients, 43.7% did not have the triad symptoms of lower abdominal pain, vaginal bleeding and amenorrhoea. One patient presented with rectal bleeding while three patients presented with epigastric pain and central abdominal pain instead of lower abdominal pain. All who had tachycardia (10.4% of all cases) had ruptured ectopic pregnancy. Of the cases, 30% and 49% did not have abdominal pain and rebound tenderness respectively; 37.5% had negative cervical motion tenderness; 3.1% and 2.6% of cases had negative urine HCG and plasma beta HCG tests respectively. Ultrasound missed 1.6% of ectopic pregnancies. Missed pregnancy, normal ultrasound study and diagnosis of other gynaecological conditions were reasons for the delayed diagnosis of 5.8% of cases. There was one mortality. Any female in the reproductive age group with syncope, abdominal symptoms or any of the components of the classical triad must have ectopic pregnancy excluded. Patients with normal ultrasound studies should have their serum beta HCG levels and ultrasound scans repeated until the condition can be completely excluded. Transabdominal or transvaginal ultrasound studies done within the emergency department would enable earlier diagnosis and management.

Adolescent↗
PubMed2006

The nonsurgical management of ectopic pregnancy.

PURPOSE OF REVIEW: This review discusses the diagnosis and nonsurgical management of ectopic pregnancy. RECENT FINDINGS: In the majority of cases the diagnosis of ectopic pregnancy should be made on transvaginal ultrasonography. Those for which the diagnosis is not made on the first scan may initially be classified as pregnancies of unknown location. There are now a number of strategies and mathematical models to predict ectopic pregnancy in this pregnancy of unknown location population. Reported success rates for expectant and medical management of ectopic pregnancy vary due to different inclusion criteria. A number of predictors of success have been studied: maternal age, previous obstetric history, gestational age, ultrasound features, human chorionic gonadotrophin levels, progesterone levels and the change in human chorionic gonadotrophin over time. At present the initial human chorionic gonadotrophin level probably remains the single most important predictor of success. Nonsurgical management is also particularly important for nontubal ectopic pregnancies: interstitial, cervical and caesarean section scar pregnancies. SUMMARY: The majority of ectopic pregnancies can be visualized by ultrasound and so can be considered for conservative treatment. Nonsurgical management can be safe and effective. Appropriate selection criteria remain an issue, however, and a consensus needs to be reached on the predictors of success and failure to optimize management.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

Risk factors for ectopic pregnancy in Lagos, Nigeria.

BACKGROUND: Ectopic pregnancy is an important cause of maternal deaths in Nigeria and in other developing countries. In Lagos, Nigeria, it is responsible for 8.6% of maternal deaths, and has a case fatality rate of 3.7%. The purpose of this study was to determine the risk factors for ectopic pregnancy in Lagos. METHODS: A case-control study of 100 patients and 280 controls was performed in the three hospitals--Lagos University Teaching Hospital, Ayinke House Maternity Hospital, and Lagos Island Maternity Hospital--in Lagos from June 1999 to December 1999. Data were analyzed by using logistic regression. RESULTS: The incidence was 23.1/1000 (1 : 43) deliveries and was responsible for 48.5% of gynecologic emergencies. Age, marital status, socioeconomic status, and parity were not the significant risk factors for ectopic pregnancy. An early age of sexual debut increased the risk of ectopic pregnancy almost two-fold (adjusted OR = 1.93; 95% CI = 1.71-2.93), whereas a late age of sexual debut was protective (adjusted OR = 0.37; 95% CI = 0.19-0.59). History of multiple lifetime sexual partners, induced abortions, pelvic inflammatory disease, sexually transmitted disease (STD), miscarriage, and pelvic surgery independently and significantly increased the risk of ectopic pregnancy. Induced abortion and STD increased the risk 14-fold and nine-fold, respectively. Previous use of intrauterine contraceptive device increased the risk almost four-fold (adjusted OR = 3.76; 95% CI = 2.12-6.69), whereas the use of condoms was protective (adjusted OR = 0.35; 95% CI = 0.17-0.71). CONCLUSIONS: Proper sex education, prevention of unwanted pregnancy, and prevention and proper treatment of sexually transmitted infections will reduce the incidence of ectopic pregnancy.

Adolescent↗
PubMed1991

Conservative laparoscopic treatment of ectopic pregnancies using the CO2-laser.

OBJECTIVE: To assess the feasibility of CO2-laser-endoscopic surgical treatment for large and/or ruptured ectopic pregnancies, and to compare the results with those of microsurgical salpingotomy. DESIGN: A retrospective review of all women treated for an ectopic pregnancy during a 6-year period, 1984-1989. During 1988 and 1989 treatment was randomized by the day of admission, depending only upon the surgeon in charge, some performing a linear salpingotomy (n = 42) and some a CO2-laser laparoscopy (n = 34) in all women haemodynamically stable. SETTING: Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven. SUBJECTS: 135 women with ectopic pregnancies of whom 76 were included in the randomized series between 1988 and 1989. Overall 11 were treated by pelvic lavage, 78 by laparotomy and 46 by laparoscopic procedures. MAIN OUTCOME MEASURES: Postoperative complications, duration of hospital stay. Cumulative pregnancy rates after the procedures. RESULTS: The two groups of women analysed in the randomized series were comparable for duration of amenorrhoea, diameter of the ectopic pregnancy and prevalence of 'ruptured' ectopics, but the duration of stay in hospital was much shorter (mean 2.9, SD 1.8 days) for the 34 women treated by laparoscopy than for the 42 women treated by laparotomy (mean 6.8, SD 1.6 days). The postoperative cumulative pregnancy rate was higher in nulliparous women with a history of infertility or pelvic inflammatory disease (PID), when treated with CO2-laser-laparoscopy (P = 0.009). The recurrency rate was low (less than 5% in both groups). Overall in the women treated by laparotomy, postoperative cumulative pregnancy rates were lower following excision or adnexectomy than after a microsurgical linear salpingotomy (P = 0.01). Four women treated by laparoscopy required a second procedure. CONCLUSION: Endoscopic treatment of large and/or ruptured ectopic pregnancies is feasible and resulted in a shorter hospital stay and, in nulliparous women with a history of PID or infertility, in higher cumulative pregnancy rates, than after microsurgical salpingotomies.

Endoscopy↗
PubMed1985

Ectopic pregnancy--potentials for diagnosis using ultrasound and urine and serum pregnancy tests.

The ultrasound findings from 260 patients with a clinical suspicion of ectopic pregnancy have been analysed and correlated with the results of urine pregnancy tests and tests of serum LH and/or HCG levels. Most importantly in a practical clinical context, it was found that a negative serum test virtually excludes an ectopic pregnancy, and an empty uterus with an adnexal mass and/or the presence of free fluid together with a positive urine test gives a very high probability of an ectopic pregnancy. The absolute diagnosis of an ectopic pregnancy by the demonstration of a living fetus outside the uterus is an uncommon finding (8%). Conversely, an empty uterus alone on ultrasound examination in the absence of other ultrasound findings in those patients with a positive serum test is not a reliable guide to the presence of an ectopic pregnancy unless there is an irrefutable conception date at least 5 weeks previously. It is recommended that pathology laboratories and ultrasound departments establish absolute levels of HCG above which an intrauterine pregnancy should always be visible within the uterus. Given appropriate attention to the clinical condition of the patient, the combined use of diagnostic ultrasound, simple urine pregnancy tests and serum assays of beta HCG levels goes a long way to discriminating between those patients with and those without an ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1991

Nonlaser videolaparoscopic surgery for ectopic gestation.

The potential of nonlaser videolaparoscopic surgery for ectopic gestation in a metropolitan public hospital was assessed by the review of the last 16 consecutive women presenting to the author with either a ruptured or an unruptured ectopic pregnancy. Ten of the 16 were treated by the videolaparoscopic techniques of either salpingotomy or aquaexpression, removal of the ectopic pregnancy and pelvic lavage; there were no intra or postoperative complications. HCG levels were monitored to extinction in all but one woman who had a coexistent intrauterine pregnancy. Three of the 10 women have subsequently had intrauterine conceptions and none have had further ectopic gestations. Those women unsuitable for videolaparoscopic therapy had substantial haemorrhage (4), an ovarian ectopic pregnancy (1) and extensive adhesions precluding laparoscopy (1). The techniques of nonlaser videolaparoscopic treatment for tubal ectopic gestation are simple and appropriate in a majority of women presenting with this condition.

Chorionic Gonadotropin↗
PubMed1999

Locating ectopic foci.

INTRODUCTION: Successful radiofrequency ablation of an ectopic focus requires accurate localization of the region of enhanced automaticity. Present localization techniques require detailed electrical mapping that is time-consuming and involves much trial and error. Here, we propose two new localization techniques which were used to locate a pacemaker in a computer simulation. METHODS AND RESULTS: We suggest that an ectopic focus can be located by measuring the activation sequence of three or more intracardiac electrodes subsequent to an ectopic depolarization. Furthermore, the resetting response of an ectopic pacemaker can be used to estimate the distance from the stimulation electrode to the ectopic focus. We derive simple geometric localization strategies based on these ideas and examine the sensitivity of the strategies with respect to measurement uncertainties and electrode arrangements. Our localization strategies were tested using a numerical simulation of a pacemaker in a sheet of excitable media described by modified FitzHugh-Nagumo equations. The strategy based on electrode activation sequences located the pacemaker region in a homogeneous isotropic sheet after an average of 2.2 +/- 0.8 iterates in 10 out of 10 trials starting from random initial catheter positions. In the case of an inhomogeneous anisotropic sheet, the pacemaker was located after an average of 4 +/- 3 iterates in 9 out of 10 trials. The localization strategy based on resetting successfully found the pacemaker in a homogeneous isotropic sheet after an average of 1.2 +/- 0.4 iterates in 5 out of 5 trials and localized the pacemaker in an inhomogeneous anisotropic sheet after an average of 1.4 +/- 0.5 iterates in 5 out of 5 trials. CONCLUSIONS: Simple geometric strategies can be used to locate an ectopic focus. Although our basic localization strategies are sensitive to the electrode arrangement and measurement uncertainties, we show that iteration of our techniques quickly locates the pacemaker.

Cardiac Pacing, Artificial↗
PubMed1995

Ultrasonographic examination by emergency physicians of patients at risk for ectopic pregnancy.

OBJECTIVE: To evaluate a diagnostic protocol that includes the early use of endovaginal sonography (EVS) by emergency physicians of patients at risk for ectopic pregnancy. METHODS: During this prospective study, pregnant patients > or = 18 years old and at risk for ectopic pregnancy were assessed. Emergency physicians who had completed a training program performed EVS on a convenience sample of eligible women. Clinical disposition was based on predetermined clinical, laboratory, and ultrasonographic criteria. The EVS examinations were reviewed on video by a gynecologist whose interpretation was correlated with the emergency physician EVS readings and with the final clinical diagnoses. Quantitative serum beta-human chorionic gonadotropin (beta hCG) levels were determined for patients who had no definite intrauterine pregnancy (IUP) on EVS. RESULTS: Of 152 patients studied during a 12-month period, four were lost to follow-up. Emergency physician ultrasonographic diagnoses included: definite IUP, 87/148 (59%); probable abnormal IUP, 17/148 (11%); definite ectopic pregnancy, 3/148 (2%); and no definite IUP, 41/148 (28%). The gynecologist agreed with 93% of the initial interpretations. Twelve of 16 patients who had the final diagnosis of ectopic pregnancy were admitted from the ED with this diagnosis. The ultrasonographic diagnosis of the other four was no definite IUP, and no mass or free fluid. For the latter four patients, the presenting serum beta hCG level was < 2,000 mIU/mL (First International Reference Preparation). They were diagnosed as having ectopic pregnancy after serial outpatient EVS and beta hCG measurements. CONCLUSIONS: The application of EVS to emergency practice appears promising. Emergency physicians trained in its use and who apply this diagnostic tool in conjunction with a defined protocol can stratify the risk of patients who have the potential for ectopic pregnancy.

Adolescent↗
PubMed2001

Ectopic pregnancy from surgical emergency to medical management.

During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantially decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy. This therapeutic transition from surgical emergency to medical management has been attributed to early diagnosis through the use of sensitive assays for hCG and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to medical management versus those who are at high risk of rupture and require surgery. Besides being less invasive and associated with significantly lower risks, medical therapy with methotrexate results in significant cost savings, which have been calculated to be approximately $3,000 per treated patient. Our goal is to identify those patients with ectopic pregnancy who are most likely to respond to methotrexate therapy and least likely to develop significant side effects. Recent studies have helped us define the predictors of success with methotrexate treatment in women with ectopic pregnancy. The reported success rates of treating ectopic pregnancy with methotrexate vary from 71% to 100%. The highest success rates have been reported from institutions that have detailed diagnostic and therapeutic protocols, readily available assays for serum hCG levels, high-resolution vaginal probe ultrasound, and support staff that can closely monitor clinical response. The importance of developing specific protocols to create a clinical environment that supports the effective use of medical therapy for ectopic pregnancy is confirmed by the associated cost savings, decreased morbidity, and patient preference. Modern diagnostic advances and minimally invasive treatments coupled with improved success rates for assisted reproductive technologies should reduce the morbidity and mortality associated with ectopic pregnancy and offer the affected couple a much more optimistic outlook for subsequent reproductive potential.

Emergency Medical Services↗
PubMed1989

Ectopic pregnancy: duplex Doppler evaluation.

Of 398 patients in whom there was a clinical suspicion of ectopic pregnancy, 96 (24%) were found to have the condition. Of the 96, 70 underwent duplex Doppler imaging. A viable ectopic fetus was seen in 10 of 70 (14%), and an extrauterine sac without an identifiable fetus was seen in an additional 27, giving a sensitivity for imaging alone of 53%. Fetal heart activity was detected with Doppler in 13 (19%). High-velocity flow, which suggested the presence of an ectopic pregnancy, was detected in 38 of 70 (54%) patients (total preoperative sensitivity, 73%). In the 91 patients who did not have an ectopic pregnancy, duplex Doppler imaging of the intrauterine contents alone allowed an ectopic pregnancy to be excluded in 29 (32%) on the first examination and in a further 21 on the second scan (specificity, 55%). Nine vascular adnexal masses were falsely considered to be ectopic pregnancies (specificity, 90%). The positive predictive values were 47% for imaging alone and 85% for Doppler. The negative predictive values were 60% for imaging alone and 81% for Doppler.

Adult↗
PubMed2005

Ectopic pregnancy: an 11-year review in a tertiary centre in the Niger Delta.

Ectopic pregnancy still remains a leading cause of maternal mortality and morbidity in the first trimester of pregnancy and also a significant cause of reproductive failure in Nigeria. A descriptive review of 211 consecutive cases of ectopic gestation over an 11-year period was undertaken. Ectopic pregnancy constituted 9.5% of gynaecological admissions. In all, 86% were nulliparous and 62.6% were married. Abdominal pain and tenderness were the most consistent modes of presentation. Also, 95.3% presented as ruptured ectopic pregnancy. Induced abortion (72%) was the most common factor associated with ectopic pregnancy. Anaemia was the most common post-operative complication. In all, 21% had prior dilatation and curettage as a result of misdiagnoses. The case fatality rate was 2.5%. Ectopic pregnancy presents a major public health challenge among women of reproductive age in this region. Community-based comprehensive health education programme focusing on contraception, sex education, prevention and treatment of postabortal sepsis, pelvic inflammatory disease and puerperal sepsis are urgently needed.

Adult↗
PubMed2003

Human chorionic gonadotropin isoforms in the diagnosis of ectopic pregnancy.

BACKGROUND: Early diagnosis of ectopic pregnancy uses ultrasound with serial measurements of total human chorionic gonadotropin (hCG). The objective of this study was to explore the possibility that an isolated measurement of hCG isoforms/subunits rather than total hCG could be used as a single test for ectopic pregnancy. METHODS: Total and intact hCG, free hCG beta- and alpha-subunits (hCGbeta and -alpha), and hCG beta-core fragment were measured by RIA and IRMA in the serum and urine of 76 women presenting at outpatient emergency departments with a positive pregnancy test, lower abdominal pain, and/or vaginal bleeding. Final diagnoses were based on outcomes of pregnancies and tissue histology. RESULTS: Twenty-seven of the 76 women were subsequently diagnosed with viable pregnancies, 37 with spontaneous miscarriage, and 12 with ectopic pregnancy. Concentrations of all forms of hCG were lower in cases of ectopic pregnancy and spontaneous miscarriage than in viable pregnancies. Serum samples gave better results than urine samples. The free hCGbeta isoform (P <0.0001) had 100% sensitivity at a specificity of 79% at a 281 pmol/L (6.5 micro g/L) cutoff. Total hCG (P = 0.005) had comparable ROC characteristics with a 100% sensitivity and 68% specificity at a cutoff value of 1053 pmol/L (375 IU/L). Neither hCGbeta (P = 0.7) nor total hCG (P = 0.4) could distinguish ectopic pregnancies from spontaneous miscarriage. CONCLUSION: Measurement of serum free hCGbeta at the time of presentation can identify women with a high probability of ectopic pregnancy who may benefit from closer surveillance, reducing the risk of tubal rupture.

Biomarkers↗
PubMed1994

[Synthesis and release of CRF and ACTH in ectopic CRF/ACTH-producing tumors].

To differentiate between ectopic ACTH syndrome and Cushing's disease, we examined the gene expression of CRF, POMC and glucocorticoid receptor in pituitary adenomas and in ectopic ACTH-producing tumors. CRF increased plasma ACTH levels in all patients with Cushing's disease and in some patients with ectopic ACTH syndrome whose tumors contained CRF and CRF mRNA. In CRF non-responders, no CRF was detected in tumors that contained no CRF mRNA or contained only long-size CRF mRNA. Dexamethasone (Dex) decreased plasma ACTH levels in all patients with Cushing's disease and in the patients with ectopic ACTH-producing bronchial carcinoid. These tumors contained glucocorticoid receptor mRNA. CRF increased and Dex decreased ACTH release and POMC mRNA levels in pituitary adenoma and bronchial carcinoid cells. PMA increased POMC mRNA levels only in carcinoid cells. These results reveal characteristics of ectopic ACTH-producing tumors: long-size CRF mRNA, PMA-induced POMC gene expression, two ectopic ACTH syndrome subtypes (tumors containing ACTH with CRF and tumors without CRF), and Dex-induced decrease in ACTH release and POMC mRNA levels in some bronchial carcinoid.

ACTH Syndrome, Ectopic↗
PubMed2006

Ectopic pregnancy in animals and humans.

Ectopic pregnancy denotes a pregnancy occurring elsewhere than in the cavity of the uterus. This pathology has been recognised for years and it causes numerous maternal deaths during the first trimester of pregnancy. While this condition is well-known in humans, it is rarely diagnosed in animals. However, the causes and mechanisms leading to an ectopic implantation of the ovum are not always clearly defined in humans or animals. Two types of ectopic pregnancy are mainly recognized: (1) tubal pregnancy occurs when an oocyte is fertilized and then remains in the oviduct and (2) abdominal pregnancy occurs when the gestation develops in the peritoneal cavity. The latter may be subdivided into two subtypes: the primary form, when a fertilized oocyte enters the peritoneal cavity and becomes attached to the mesentery or abdominal viscera, and the secondary form, which follows the rupture of an oviduct or the uterus after the fetus has been implanted, and the fetus is expelled into the peritoneal cavity. Cornual, ovarian and cervical ectopic locations are less frequent. Several differences exist in ectopic pregnancies between human beings and animal species. While abdominal pregnancy has been described in both human and animal species, tubal ectopic pregnancies would appear to be restricted to primates. Other than anecdotal cases, this pathological condition does not occur in laboratory, domestic or farm animals. Several factors are described as being the cause of these differences.

Animals↗
PubMed2005

[Prevalence of ectopic pregnancy liable to surgical treatment in a public hospital from 1995 through 2000].

OBJECTIVES: To determine the prevalence of women with ectopic pregnancy submitted to surgical treatment at the HMCP from 1995 to 2000; as well as to evaluate some characteristics of these women and the treatment performed. METHODS: The study was retrospective. Data was obtained from medical register of women submitted to laparotomy with the diagnosis of ectopic pregnancy. Variables studied were: patient's age, place of birth and occupation, status of ectopic pregnancy (with or without rupture), type of surgery, complications and duration of hospital stay. Data was analyzed in a descriptive way, followed by logistic regression analysis. RESULTS: Ninety six cases were studied. Age of the majority of women (65%) ranged from 25 to 35 years; 6% were adolescents. Of all patients 30% were employed. Distribution according to status of pregnancy: the study showed that 66% presented rupture; 79% of the patients were submitted to salpingectomy with or without ooforectomy. COMPLICATIONS: The most frequent complication was acute anemia, including one death due to DIVC (disseminated intravascular coagulation), and 12% of the patients had to receive blood transfusion. The average time of hospital stay was of 3.63 days (SD+/-0.81). Prevalence of ectopic pregnancies did not change during the period of study and was responsible for 11.2% of the total number of laparotomies. CONCLUSIONS: For the period of this study, the number of women submitted to laparotomy due to ectopic pregnancy remained quite high and unchanged For control, this situation requires preventive measures at different levels. Ectopic pregnancy is a severe pathology and induces high rates of morbidity. It remains a challenge for gynecologists.

Adolescent↗
PubMed1982

Ectopic pregnancy in New York City, 1975-1980.

Seventy-three non-federal acute care New York City hospitals were asked to report the number of ectopic pregnancies. These reports were compared with legally required certificates of termination of pregnancy (fetal death certificates). The number of ectopic pregnancies reported via the questionnaire was six times the number reported on the certificates of termination of pregnancy. Based on the hospital survey, ectopic pregnancies increased from 1,457 in 1975 to 2,080 in 1980. The number of ectopic pregnancies per 1,000 conceptions per year increased 48.5 percent, from 6.48 in 1975 to 9.62 in 1980 (p less than .001). Of the 30 fatalities related to an ectopic pregnancy, 93.4 percent were Black or Hispanic and two-thirds were single. An unexplained finding was that 75 per cent of the fatal tubal pregnancies were right-sided (p less than .01). At least one-half of the deaths were attributable to physician error and one-fifth were attributable to patient neglect. Ectopic pregnancy continues to be overlooked and misdiagnosed. Increased physician suspicion of this complication in the susceptible population is needed to decrease fatalities.

Adult↗