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PubMed1991

Risk factors in ectopic pregnancy. Results of a population-based case-control study.

In a population-based case-control study, possible risk factors for ectopic pregnancy were compared in 119 patients with ectopic pregnancy and in 119 age-matched controls with intra-uterine pregnancy from each of the following categories: deliveries, spontaneous abortions and induced abortions. The following factors were found significantly more often in cases of ectopic pregnancy: a history of earlier ectopic pregnancy, a history of salpingitis, a history of earlier operation on the Fallopian tubes, a history of infertility, and a pregnancy that had occurred in spite of an intra-uterine contraceptive device. A history of appendectomy was also found significantly more often among the cases. There was no significant correlation between ectopic pregnancy and a history of no earlier pregnancy, earlier deliveries, earlier spontaneous or induced abortions or a history of other gynecological operations and increased risk of ectopic pregnancy. One or more of the risk factors were found in 76.5% of cases and 23% of controls.

Adolescent↗
PubMed1996

DNA ploidy of ectopic pregnancy and first trimester spontaneous abortion investigated by flow cytometry.

BACKGROUND: To compare the success rate of DNA flow cytometry in determining the DNA ploidy status in ectopic pregnancy and first trimester spontaneous abortion. METHODS: Thirteen women with ectopic pregnancy (Group I) and 17 women with first trimester spontaneous abortion (Group II) were included into this study. DNA flow cytometric analysis was performed on all specimens. Aneuploidy was classified according to DNA index. The first trimester spontaneous abortions were also karyotyped after long-term culture of chronic villi. Student-t test and Fisher's exact test were used in statistical comparisons. RESULTS: DNA aneuploidy was found in five women with ectopic pregnancy (38.5%) versus in 12 women with first trimester spontaneous abortion (70.6%), and it was comparable. A triploidy and a tetraploidy were detected in group I. Six tubal ectopic pregnancies were unruptured at laparatomy and four of them had aneuploid DNA content. CONCLUSIONS: We believed that DNA flow cytometry was successful in determining the ploidy status of ectopic pregnancy and first trimester spontaneous abortion. In addition, it was interesting that ectopic pregnancies with aneuploid DNA content tended to be unruptured. However, this suggestion needs to be confirmed by further studies with larger numbers of cases.

Abortion, Spontaneous↗
PubMed1997

Multiple induced abortions as risk factor for ectopic pregnancy. A prospective study.

OBJECTIVE: To assess the risk of ectopic pregnancy by the number of previous induced abortions. DESIGN: Prospective cohort study. METHODS: Three thousand seven hundred and fifty-four women, 39 years old or younger, living permanently in one Norwegian county, who had had at least one induced abortion between January 1, 1987 and December 31, 1992, at the University Hospital of Trondheim, Norway were followed prospectively for histologically verified ectopic pregnancies until December 31, 1993. Exposure time was measured from the most recent induced abortion (index abortion) until the ectopic pregnancy, closure date, or the subject's 40th birthday. Statistical analyses were done in SAS applying survival analyses and poisson regression. RESULTS: During the follow-up period of 164,167 women-months, we observed 24 ectopic pregnancies in 3,754 women. The adjusted incidence density ratio (aIDR) for women who had had two or more induced abortions was 1.2 (95% CI: 0.5-3.1) in comparison with the reference group of women who had had one induced abortion. Measuring exposure as increasing number of consecutive induced abortions, no dose-response to ectopic pregnancy was found between two consecutive (aIDR 0.9) and three or more consecutive abortions (aIDR 1.1) in comparison with the reference group. CONCLUSION: In our setting, no excess risk of ectopic pregnancy was associated with multiple previous induced abortions compared with one previous induced abortion.

Abortion, Induced↗
PubMed2005

Clinical effectiveness of urinary human chorionic gonadotropin related protein (hCGRP) quantification for diagnosis of ectopic pregnancy.

We detected pregnancy related new molecule, human chorionic gonadotropin related protein (hCGRP) in the urine of a pregnant women by using a monoclonal antibody against the human chorionic gonadotropin (hCG). This study examined the effectiveness of urinary hCGRP quantification in diagnosing ectopic pregnancy. This study included 40 normal pregnant women and 25 patients with ectopic pregnancy. Patients' serum and urinary intact whole hCG (i-hCG) and hCGRP concentrations were measured using sandwich ELISA and the ratio of hCGRP to i-hCG was calculated. Statistical analysis was performed using statistical package for social sciences (SPSS) 10.0. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the cut-off value to discriminate ectopic pregnancies from normal intrauterine pregnancies. Urinary hCGRP and hCGRP/i-hCG ratio in ectopic pregnancy group (14 +/- 6.6 ng/mL, 4.6 +/- 1.9%, respectively) were significantly lower than those of normal pregnancy group (149 +/- 10.2 ng/mL, 29.7 +/- 1.9%, respectively; p<0.001). Based on ROC curve analysis, a cut-off point of urinary hCGRP/i-hCG ratio <16.2% discriminated between ectopic pregnancy and normal pregnancy with a sensitivity, specificity, positive predictive value and negative predictive value of 92.0%, 90.0%, 32.6%, and 99.5%, respectively. Urinary hCGRP/i-hCG ratio measurement may be effective in diagnosing ectopic pregnancy.

Adult↗
PubMed1995

Cytogenetic study employing chorionic villi in ectopic pregnancy.

Maternal factors such as salpingitis and peritubal adhesion are known to be associated with ectopic pregnancy; however, a few studies have considered the chromosomal complements of ectopic conceptuses. We studied 16 ectopic conceptuses obtained by surgical resection. The karyotyping of chorionic villi was performed using direct and culture technique. Among 16 studied cases, 14 cases showed normal karyotype (nine with 46, XY; five with 46, XX). One case showed trisomy 16(47, XY, + 16) and another showed variation from normal chromosomal complement (46, XY, 14s+), resulting in 6.3% incidence of the structural abnormalities of the chromosome. On the basis of our study, we determined the possibility of chorionic villi karyotyping in ectopic pregnancy. This ectopic conceptuses are no more likely to show chromosomal abnormalities than in utero conceptuses of comparable gestational age. Therefore, maternal factors such as salpingitis and peritubal adhesion are the most likely explanations for ectopic pregnancy.

Adult↗
PubMed1991

Ectopic pregnancy: transvaginal color Doppler of trophoblastic flow in questionable adnexa.

The purpose of this study was to see if color flow Doppler measurements could aid in the positive diagnosis of ectopic pregnancy when no gestational sac can be seen in the adnexa. We examined 148 women with abdominal pain and suspected ectopic pregnancy by abdominal ultrasonography, followed by vaginal ultrasonography and color Doppler when the diagnosis was still uncertain. Seventy-three patients proved to have ectopic pregnancies. Color flow with low resistance and high velocity vascular signals were observed in complex adnexal masses and in some of the corpora lutea. The resistance index for ectopic trophoblast was 0.36 +/- 0.02 SD. Color Doppler had both positive and negative discrimination of adnexal masses (P = 10(-15). The resistance index for the corpora lutea was 0.48 +/- 0.04. A cutoff value of 0.40 or less is proposed as a diagnostic index for suspected trophoblast in the adnexa. In nine cases of ectopic pregnancy, no color flow was noted. In these women, the beta-human chorionic gonadotropin level was less than 1000 mIU/ml. The clinical operative suspicion in these cases was tubal abortion. Sensitivity and specificity were 88% and 97%, respectively, in this highly selective series. Positive and negative predictive values were 97% and 89%. Color Doppler appears to be useful for the positive diagnosis of ectopic pregnancy with ultrasonography when no adnexal gestational sac is observed. Prospective randomized trials will determine the ultimate clinical value of these findings.

Adnexa Uteri↗
PubMed1993

Pitfalls in the transvaginal sonographic diagnosis of ectopic pregnancy.

Transvaginal sonograms (TVS) of 40 adequately documented ectopic pregnancies were reviewed retrospectively. Difficulties that interfered with the accurate demonstration of the adnexal mass of the ectopic pregnancy were identified in 21 of these studies (52.5%). In three cases (7.5%) the ectopic pregnancy was visualized in an erroneous location. In 11 cases (27.5%), the ectopic pregnancy was overshadowed by coexisting pathologic findings, misinterpreted as a bowel segment or poorly demarcated from the adjoining ovary. In seven cases (17.5%), the adnexal mass of an ectopic gestation was completely over-looked on initial TVS. TVS in the women suspected of having an ectopic pregnancy must be performed meticulously and with due consideration to the pitfalls described.

Adolescent↗
PubMed2001

Low-resistance endometrial arterial flow in the exclusion of ectopic pregnancy revisited.

The objective of this study was to evaluate the efficacy of endometrial arterial flow in the exclusion of ectopic pregnancy. From October 1997 to June 1999, 66 women with elevated beta-human chorionic gonadotropin titers and clinical indications of ectopic pregnancy were evaluated by endovaginal sonography. Women with a gestational sac containing an embryo, a yolk sac, or both were excluded from the study. Doppler ultrasonography was performed in the remaining cases when a definite intrauterine pregnancy could not be visualized. In all cases the thermal index was kept to less than 1.0, consistent with as-low-as-reasonably-achievable principles. Trophoblastic flow was defined as a resistive index of less than 0.6 within the endometrium. Statistical analysis was performed using a 2-tailed t test. Twenty women had ectopic pregnancies; 33 had spontaneous pregnancy losses; and 13 had normal intrauterine pregnancies. A total of 29 women had endometrial trophoblastic flow: 11 of 13 with intrauterine pregnancies, 1 of 20 with ectopic pregnancies, and 17 of 33 with spontaneous pregnancy losses. The negative predictive value for the presence of endometrial low-resistance flow for excluding ectopic pregnancy was 97%. The presence of low-resistance arterial endometrial flow can be a useful sign in diagnosing an early intrauterine pregnancy and decreasing the probability that an ectopic pregnancy is present, particularly in patients with otherwise normal ultrasonographic findings.

Adult↗
PubMed2005

Reliability of adnexal mass mobility in distinguishing possible ectopic pregnancy from corpus luteum cysts.

OBJECTIVE: The purpose of this study was to evaluate the utility of paraovarian pelvic mass mobility as an indicator of mass identity, corpus luteum versus other, in ruling out ectopic pregnancy. METHODS: This was a retrospective study of all pelvic sonographic examinations on patients with first-trimester complications seen over an 18-month period at a large urban emergency department. All pregnant patients with signs or symptoms of concern for ectopic pregnancy were scanned to evaluate for intrauterine pregnancy. Masses suggestive of either a corpus luteum or an ectopic pregnancy were separated from the ovary with abdominal palpation and endovaginal transducer movement. The ultrasound director and assistant director reviewed videos of all scans. Results of mass separation and outcome were recorded. Independent movement of a mass and ovary was defined as movement of the mass away from the ovary, sliding past the ovary or rotation past the ovary. Statistical analysis included descriptive statistics, inter-rater reliability, the Fisher exact test, and sensitivity, specificity, and negative and positive predictive values. RESULTS: A total of 78 patient scans fit the criteria, and in 27 of them, the mass separated from the ovary. Twenty-three patients had ectopic pregnancy as the final diagnosis, and in 2 of these, no independent mass movement occurred. Lack of independent movement of the mass and ovary was significantly more common in patients without a final diagnosis of ectopic pregnancy (P < .0001). The negative predictive value was 96.1%. CONCLUSIONS: Lack of independent movement of an adjacent mass and ovary was strongly associated with absence of ectopic pregnancy.

Adnexa Uteri↗
PubMed1999

Reproductive potential after methotrexate treatment of ectopic gestation in a community hospital.

OBJECTIVE: To compare the rates of ipsilateral tubal patency after methotrexate treatment versus conservative surgical treatment in a small community hospital lacking personnel dedicated to methotrexate management. STUDY DESIGN: From hospital and clinic records, cases of ectopic gestation within a six-year interval were identified. Method of treatment and location of the ectopic gestation were documented by review of records and confirmed by patient interviews. Women desiring fertility were offered hysterosalpingography (HSG) to evaluate tubal patency. HSG was performed under fluoroscopy with water-soluble contrast medium. RESULTS: HSG was completed in 11 cases of linear salpingostomy and 11 cases of ectopic gestations treated by methotrexate. Ipsilateral patency was documented in 8 of 11 (72%) tubes treated by linear salpingostomy and 9 of 11 (81%) methotrexate-treated tubes. One methotrexate case had a prior ipsilateral ectopic treated by salpingostomy, and two additional cases had a prior contralateral ectopic removed by salpingectomy. Each of these three cases had ipsilateral tubal patency after methotrexate for the most recent ectopic gestation. CONCLUSION: Data from this study suggest comparable tubal patency rates after methotrexate and conservative surgery. Comparable tubal patency outcomes were obtained in our community hospital despite a less-rigorous-than normal follow-up protocol.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

[Ectopic pregnancy. I. Diagnostic-therapeutic algorithm used in clinics at the Gynecology Department of the Polish Mother's Memorial Institute].

In prospective study from 1988 to 1992 I analysed possibility of early non-invasive detection and treatment of ectopic pregnancy. In this purpose I used a gynecological examination, estimation of concentration of beta-hCG and progesterone in serum, transvaginal ultrasound and in certain patients, curettage. The fusion of all these methods permits to gain right diagnosis of ectopic pregnancy. In this work I described diagnostic and therapeutic algorithm of ectopic pregnancy allows in using conservative treatment in this pathology. Empty uterus (without gestational sac) in transvaginal ultrasound examination, in cases with beta-hCG concentration is higher than 3000 mIU/ml, allows recognise ectopic pregnancy. I introduced predictive scale for possibilities of conservative treatment and therapeutic algorithm allows to chose way of treatment (laparatomy, laparoscopy, Methotexate i.m. expectant management). The estimation of clinical value of diagnostic algorithm for ectopic pregnancy will present in part II and efficacy of conservative treatment methods in patients with ectopic pregnancy in part III.

Adult↗
PubMed2002

[Smoking is associated with increased risk of ectopic pregnancy--a population based study].

BACKGROUND: There has been a world-wide increase in the incidence of ectopic pregnancies over the last decades. In Norway about 1,500 women are hospitalized every year because of this potentially lethal condition. Several studies have shown that smoking is one of several risk factors for ectopic pregnancies. We wanted to examine whether such an association could be established in a large Norwegian material. MATERIAL AND METHODS: We analysed data from a cross-sectional questionnaire-based study of 9,237 Norwegian women aged 35-49 years. 61.6% responded. RESULTS: 67.4% of the women were present or previous smokers. 301 (3.3%) had experienced an ectopic pregnancy. We found that smokers had a relative risk of 1.5 (95% CI 1.1-1.9) for ectopic pregnancy compared to non-smokers. INTERPRETATION: Our results support other studies. Identification of risk factors is important in the prevention of ectopic pregnancies. Smoking is a risk factor for ectopic pregnancy that can be reduced through counselling.

Adult↗
PubMed2002

[The treatment of postoperative junctional ectopic tachycardia].

OBJECTIVE: To evaluate treatment of junctional ectopic tachycardia after cardiac surgery. MATERIAL AND METHODS: Twenty-seven patients (5.5 % of 488 patients who underwent surgery) were treated for junctional ectopic tachycardia between 1994 and 1998. There were 14 boys and 13 girls with a mean age of 11 11 months. Seven suffered from tetralogy of Fallot, seven from ventricular septal defect, six from atrioventricular septal defect, three from transposition of the great vessels and the remaining four had other complex heart diseases. The mean initial frequency was 186 27 beats/min. Crystalloid cardioplegia was applied in 274 patients (1994-1996) and 20 patients (7.4 %) showed junctional ectopic tachycardia. Hematic cardioplegia was performed in 214 patients (1997-1998) and seven patients (3.2 %) developed junctional ectopic tachycardia. Of the 33 patients who were treated during the surgical procedure with high mean doses of sympathomimetic catecholamine agents, 27 (81 %) developed tachycardia. Tachycardia developed 8.24 7 hours after surgery (range: 1-24 hours) in 25 patients and after 4 and 5 days in the remaining two patients. The mean duration of tachycardia was 4 days. RESULTS: In all patients rectal temperature was reduced to 32-34 C. Nineteen patients (70 %) showed a quick response (1-2 hours), although the technique was effective as an isolated procedure in only one patient. Sympathomimetic catecholamine level was reduced to 2-5 g/kg/min in 20 patients but this was effective in 14 (70 %). In 15 patients intravenous amiodarone was also administered and was effective in 11 patients (73 %). Finally, intravenous propafenone was administered to 5 patients. The most effective treatments were hypothermia with reduction of sympathomimetic catecholamine levels in 7 patients (100 %) or intravenous amiodarone in 4 (80 %). Tachycardia led to low cardiac output in 10 patients and only four recovered normal sinus rhythm. Eight patients died. Of these, hemorrhage in the junction area was confirmed in six patients. CONCLUSIONS: Junctional ectopic tachycardia is favored by high levels of sympathomimetic catecholamines after surgery. On the other hand, myocardial protection with hematic cardioplegia reduces tachycardia. Moderate hypothermia with reduction of sympathomimetic agents or intravenous amiodarone reverses ectopic tachycardia.

Amiodarone↗
PubMed1992

Surgical strategy in the management of non-small cell ectopic adrenocorticotropic hormone syndrome.

BACKGROUND: Non-small cell ectopic adrenocorticotropic hormone (ACTH) syndrome is a rare cause of hypercortisolism that may require surgery for either curative resection or palliative adrenalectomy. METHODS: We report our surgical experience with 41 patients with ectopic ACTH syndrome and no evidence of small cell lung cancer at initial evaluation. RESULTS: All 41 patients had documented hypercortisolism secondary to ectopic production of ACTH. Based on imaging study results, we determined that 21 patients had localized/resectable disease; eight patients had metastatic disease, and 12 patients had occult disease at examination. Of the 21 patients with localized disease, 16 (76%) were cured of ectopic ACTH by surgery (15 bronchial carcinoid, one pheochromocytoma). Patients with bronchial carcinoid had the greatest probability for cure of ectopic ACTH syndrome, and patients with thoracic primary tumor were more likely to be cured than patients with abdominal primaries. Of the eight patients who had metastatic disease, none were cured of the disease; five patients underwent bilateral adrenalectomy, and three patients were given medical therapy. Only one patient was alive after 5 years. Of the 12 patients who had occult disease, four patients were eventually cured of the disease (three bronchial carcinoid, one thymic carcinoid); one patient died of disease (small cell lung cancer), and seven patients still have occult disease. Nine of 12 patients with occult disease underwent bilateral adrenalectomy for surgical management of hypercortisolism. CONCLUSIONS: This study suggests that the most common primary focus of ectopic ACTH production is within the thorax with 25 of 34 (74%) identifiable tumors originating within either the thymus or bronchus. Adrenalectomy offers excellent palliation of hypercortisolism secondary to either occult or metastatic disease. Patients who initially have localized disease usually have bronchial carcinoids and have a high probability of cure with surgical resection (81%).

ACTH Syndrome, Ectopic↗
PubMed1992

Expectant management of ectopic pregnancy.

OBJECTIVE: To evaluate expectant management in selected cases of ectopic pregnancy. METHODS: Transvaginal sonography and estimation of serum hCG concentrations were used in the evaluation and follow-up of ectopic pregnancy. Entry criteria for expectant management were: decreasing level of serum hCG, diameter of the ectopic pregnancy less than 4 cm, and no signs of rupture or acute bleeding by vaginal sonography. RESULTS: Expectant management was studied in 83 patients, representing 26% of all ectopic pregnancies during a 2-year period. In 57 patients (69%), spontaneous resolution occurred, corresponding to 18% of all ectopic pregnancies. Laparoscopy was performed in 26 because of clinical symptoms or a rise in hCG level after expectant management for 1-18 days. One patient had a tubal rupture requiring tubal resection by laparoscopy. No serious complications occurred. With increasing experience, the rate of expectant management and spontaneous resolution increased during study period. CONCLUSION: Expectant management with repeated vaginal sonography and estimations of serum hCG concentrations is a useful form of treatment for ectopic pregnancy in selected cases.

Chorionic Gonadotropin↗
PubMed2003

[Analysis of the relative factors of the onset of repeated ectopic pregnancy].

OBJECTIVE: To determine the relative factors of the onset of repeated ectopic pregnancy. METHODS: The clinical data of the first time ectopic pregnancy of 28 cases with repeated ectopic pregnancy were analysed, and compared with those of 56 cases of non-repeated ectopic pregnancy onsetting at the same period. The factors measured included: age at onset of disease, age at first coitus, gravidity, parity, methods of contraception, duration of amenorrhea, duration of vaginal bleeding, serum beta-human chorionic gonadotropin level, volume of intraperitoneal bleeding, types of ectopic pregnancy, methods of therapy and inflammation evidence of fallopian tube. Logistic regression analysis was performed to determine the relative factors for onset of repeated pregnancy. RESULTS: The risk factors and its odds ratio (OR) from the multivariate analysis were as follow: anastomosis of the tube (62.74, P = 0.043), positive evidence of inflammation of the tube (54.85, P = 0.000), no contraception (11.29, P = 0.002), contraception by condom occasionally (4.75, P = 0.046); the protective factors and its OR were as follow: therapy being salpingectomy and sterilization of the opposite tube (0.06, P = 0.049), oral contraception (0.10, P = 0.050) and pharmacotherapy (0.33, P = 0.002). CONCLUSIONS: The risk factors of onset of repeated ectopic pregnancy include: anastomosis of the tube, positive evidence of inflammation of the tube, no contraception and contraception by condom occasionally; the protective factors include: therapy being salpingectomy and sterilization of the opposite tube, oral contraception and pharmacotherapy.

Female↗
PubMed2004

[Predictive models for the early diagnosis of ectopic pregnancy].

In the past patients with acute abdominal pain and presumably suffering from an ectopic pregnancy often required an immediate surgical intervention. The diagnosis of ectopic pregnancy has become more frequent during the last decades but the incidence of ectopic pregnancy rupture has declined. This decline is due to quantitative hCG measurements, minimally invasive surgery and transvaginal ultrasonography. Gynaecologists presently are increasingly confronted with pregnancies of unknown location (PUL). This is due to the fact that women consult earlier in pregnancy for ultrasonographic assessment. The usual biochemical procedures for diagnosing ectopic pregnancy have been developed for pregnancies associated with abdominal pain and abnormal bleeding and not for asymptomatic pregnant women with a much lower pre-test probability of ectopic pregnancy. For this reason new diagnostic procedures and criteria had to be developed and tested to detect ectopic pregnancies in women with PUL, without exerting any deleterious effect on early intra-uterine pregnancies. In our experience the hCG-ratio and our new mathematical model seem to be the best method to satisfy these criteria.

Abdominal Pain↗
PubMed2005

[Fertility after treatment for ectopic pregnancy: evaluation of the switch from laparotomy to laparascopy].

OBJECTIVE: Evaluation of the switch in surgical treatment for ectopic pregnancy from laparotomy to laparoscopy at the Sophia Hospital, Zwolle, the Netherlands. DESIGN: Retrospective. METHOD: Initially an ectopic pregnancy was treated by means of laparotomy at the Sophia Hospital, Zwolle, the Netherlands. At the end of 1996 laparoscopic treatment became the method of first choice. In 2003, all patients who received surgical treatment for ectopic pregnancy in the period 1995-2001 were evaluated. As well as examining their medical records, all patients were questioned about the fertility outcome since the ectopic pregnancy. All of the patients could be traced and the response was 100%. RESULTS: In the study period 97 patients were operated on due to an ectopic pregnancy. The admission period was significantly shorter after laparoscopy compared to laparotomy. The complication rate in both groups was low. In total 78 (80%) of the patients still wanted to conceive. During the observation period, 94 pregnancies occurred in 61 patients. The pregnancy rates following laparotomy and laparoscopy were the same. After salpingostomy, the future fertility was significantly higher (p < 0.05) compared to salpingectomy. CONCLUSIONS: A laparoscopic treatment of ectopic pregnancy is more advantageous for the patient compared to laparotomy: in our results this did not compromise future fertility. Salpingostomy was associated with an increased chance of later pregnancy compared to salpingectomy.

Adult↗