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At least 559 records · Page 31Linked to original sources
PubMed1987

Luteal function in ectopic pregnancy.

Human chorionic gonadotropin, estradiol, progesterone, and 17-hydroxyprogesterone have been measured in the serum of 46 patients with ectopic pregnancy. All these hormones were significantly lower than in normal pregnancy. Unruptured ectopic pregnancy differed from the ruptured state by a lower serum human chorionic gonadotropin concentration, a slower human chorionic gonadotropin increment, a higher incidence of metrorrhagia, and an earlier diagnosis. The concentration of estradiol, progesterone, and 17-hydroxyprogesterone in the serum of patients with ectopic pregnancy was lower than could be expected from the decrease of human chorionic gonadotropin, often lower than in a normal luteal phase. It is suggested that, as long as ultrasonography fails to show an intrauterine pregnancy, the simultaneous determination of serum human chorionic gonadotropin and progesterone could aid in the early diagnosis of ectopic pregnancy and in the improvement of subsequent fertility; to that regard any progesterone level below 15 ng/ml in the presence of detectable amounts of human chorionic gonadotropin is highly suggestive of either a threatened abortion or an ectopic pregnancy, whatever the gestational age.

17-alpha-Hydroxyprogesterone↗
PubMed1988

Rapid measurement of urinary pregnanediol glucuronide to diagnose ectopic pregnancy.

We investigated the ability of a single, random, urinary pregnanediol-3 alpha-glucuronide level to differentiate early intrauterine from ectopic pregnancy. Thirty-four patients with intrauterine gestations were compared with 60 patients with ectopic pregnancies. Urinary pregnanediol-3 alpha-glucuronide was measured by radioimmunoassay and enzyme immunoassay. Compared with intrauterine gestations, results demonstrate that urinary pregnanediol-3 alpha-glucuronide is significantly depressed in ectopic pregnancies: 24.5 +/- 2.2 versus 4.8 +/- 0.7 micrograms/ml (p = 0.0001). Urinary pregnanediol-3 alpha-glucuronide levels obtained by conventional radioimmunoassay correlated closely with values measured in minutes with enzyme immunoassay (r = 0.95, p = 0.0001), and with serum progesterone (r = 0.74, p = 0.0001). Urinary pregnanediol-3 alpha-glucuronide measured by enzyme immunoassay exhibited predictive values for detecting ectopic gestations comparable with random serum progesterone or serum beta-human chorionic gonadotropin values. We conclude that ectopic gestations demonstrate a reduced level of urinary pregnanediol-3 alpha-glucuronide (55/60 cases) detectable with a rapid enzyme immunoassay, which makes this assay a practical screening test in early pregnancy.

Chorionic Gonadotropin↗
PubMed1989

Ectopic pregnancy subsequent to laparoscopic sterilization.

Ectopic pregnancy after laparoscopic sterilization is analyzed and compared with the occurrence of ectopic pregnancy in a fertile female population of Denmark. The incidence of ectopic pregnancy in laparoscopic-sterilized women is significantly decreased compared with the nonsterilized fertile female population. When a poststerilization pregnancy occurred, ectopic pregnancy occurred 76% of the time, and the incidence of ruptured ectopic pregnancy is significantly increased after previous laparoscopic sterilization.

Adult↗
PubMed1989

Fertility after ectopic pregnancy.

In the period July 1983 to March 1985, 264 women had surgery for ectopic pregnancy at Grady Memorial Hospital; 76 had postoperative hysterosalpingograms. Of these, 55 (76.4%) women were followed up for 3 to 41 months (mean, 23.8) to determine subsequent fertility. During the follow-up period, 30 pregnancies occurred among the 55 patients; 24 were intrauterine and 6 were repeat ectopic pregnancies. In the surgical group of 39 patients with salpingectomy, 60.8% of those desiring pregnancy achieved an intrauterine pregnancy. Of the 12 patients with salpingostomy, the three who desired pregnancy achieved it (100%). In the tubal abortion group, the two women desiring pregnancy conceived (100%). There were six repeat ectopic pregnancies (10.9%). Of the ectopic pregnancies, one occurred in the salpingectomy group (2.6%), four in the salpingostomy group (33.3%), and one in the tubal abortion group (25%). Five of the six ectopic gestations were found in the contralateral fallopian tube. Hysterosalpingographic evidence of contralateral tubal patency was a good prognostic indicator for subsequent intrauterine pregnancy. By contrast, one half of study patients with findings suggesting tubal occlusion still achieved an intrauterine pregnancy.

Adult↗
PubMed1989

Transvaginal ultrasonography in patients at risk for ectopic pregnancy.

Transvaginal ultrasonography was performed in 139 patients at risk for ectopic pregnancy. Among these patients, 22 ectopic pregnancies and 117 intrauterine pregnancies were eventually confirmed. Transvaginal ultrasonography definitively identified 18 of 22 (82%) ectopic pregnancies at initial evaluation by either direct visualization of an ectopically placed gestational sac (N = 14) or failure to visualize an intrauterine gestational sac combined with a level of the beta-subunit of human chorionic gonadotropin greater than 1300 mIU/ml (First International Reference Preparation) (N = 4). Transvaginal ultrasonography definitively diagnosed 103 of 117 (88%) intrauterine pregnancies at initial evaluation. Eighteen patients could not be definitively diagnosed by transvaginal ultrasonography at initial evaluation because nonvisualization of a gestational sac and a beta-subunit of human chorionic gonadotropin value less than 1300 mIU/ml. Evaluation of this group with serial measurements of beta-subunit of human chorionic gonadotropin, repeat ultrasonography, or both, revealed ectopic gestation (N = 4), early intrauterine pregnancy (N = 4), and complete abortion (N = 10).

Chorionic Gonadotropin↗
PubMed1990

Contraception and ectopic pregnancy risk.

Studies of the association of ectopic pregnancy with contraception have generated a conflicting array of results because of methodologic differences between studies. We estimated the absolute incidence rates of ectopic pregnancy for various contraceptives by multiplying the pregnancy rate by the proportion of pregnancies with ectopic implantation for each method. Our results indicated a more than 500-fold difference in ectopic pregnancy incidence, from a low of 0.005 ectopic pregnancies per 1000 women years of oral contraception or vasectomy to a high of 2.6 per 1000 women years of no contraception. These estimated incidence rates should be useful for clinicians and patients seeking to better understand the risks and benefits of contraceptives.

Adult↗
PubMed1984

The role of laparoscopy in the diagnosis of ectopic pregnancy: a plea for conservative management.

This report evaluates the role of laparoscopy in patients admitted with the diagnosis of "Rule Out Ectopic". There were 186 patients admitted to the Brookdale Hospital Medical Center in the 6-year period 1974-1979 inclusive with a diagnosis of "Rule Out Ectopic" or "Possible Unruptured Ectopic". These patients were all laparoscoped. There were 157 satisfactory and 27 unsatisfactory laparoscopies. There were 71 ectopic pregnancies: 42 ruptured, 25 unruptured. Thirty-six cysts were diagnosed. The value of early laparoscopy is clearly established. Particular emphasis is placed on the diagnosis of the unruptured ectopic so that appropriate conservative management of the tube can be instituted in order to preserve potential reproductive capacity.

Female↗
PubMed1992

Pelvic surgery, reproductive factors and risk of ectopic pregnancy: a case controlled study.

A case controlled study among 361 women with surgically treated ectopic pregnancy and 420 women delivered at term was designed, aiming at characterization of the association among previous pelvic operations, selected reproductive factors and ectopic pregnancy. All types of previous pelvic operations increase the risk of ectopic pregnancy from a 2-fold increase for appendectomy to a 9-fold increase for ectopic pregnancy, if maternal age, parity, history of spontaneous and induced abortions and history of infertility is controlled. This study suggests that a previous pelvic operation may increase the risk of ectopic pregnancy.

Abortion, Induced↗
PubMed1992

Ectopic pregnancy among past IUD users.

The relationship between return to fertility and pregnancy outcome in women with IUD removal for planned pregnancy as well as the frequency of ectopic pregnancy among all former IUD users in comparison with the general population was studied. The cumulative conception rate in the group of women with IUD removal for planned pregnancy (n = 748) was 93.7% after 5 years, 93.4% being intrauterine and 0.3% ectopic. Rates of ectopic pregnancy in women with IUD removed for planned pregnancy were 2.7/1000 women, 3.6/1000 deliveries and 2.9/1000 pregnancies vs. 3.9, 13.4 and 5.6 in the general population. Only when the number of deliveries is used as denominator, have these differences reached statistical significance (P less than 0.05). Except for bleeding/pain and PID removals (6.0 vs. 3.9), in all other groups of former IUD users the incidence of ectopic pregnancy was also lower than in the control group. From the results of this study it was concluded that former IUD users are not at an increased risk for ectopic pregnancy.

Adolescent↗
PubMed1992

Hysteroscopic diagnosis of ectopic pregnancy.

Although vaginal ultrasonography combined with plasma beta-hCG determination can provide a reliable diagnosis and location of ectopic pregnancy, the results can be difficult to interpret in the early stages when hCG levels are low. Hysteroscopy can be used in such cases to differentiate between ectopic pregnancy and non-viable uterine pregnancy when viable uterine pregnancy has been ruled out. General anaesthesia and laparoscopy are avoided. We performed 60 hysteroscopic procedures between January 1989 and December 1990 in patients with suspected ectopic pregnancies. The pregnancy had been located by means of vaginal ultrasonography in every case in which the hCG was above 1500 IU/ml and in 36% of cases in which the beta-hCG was below this level. Hysteroscopy was hindered by metrorrhagia in three cases and was inconclusive in one, necessitating laparoscopy. Diagnosis was possible in all the remaining cases, as follows: ectopic pregnancy in 41 cases, with an empty uterus and occasional bleeding from an ostium; non-viable uterine pregnancy in 18 cases, with the presence of material within the cavity. Hysteroscopy therefore confirmed the diagnosis in 55% of the cases and was itself diagnostic in a further 43% of cases. Its sensitivity for the diagnosis of ectopic pregnancy was 100% and its specificity 95%. We propose a diagnostic decision tree.

Chorionic Gonadotropin↗
PubMed1996

Life-threatening neutropenia following methotrexate treatment of ectopic pregnancy: a report of two cases.

BACKGROUND: Medical treatment of ectopic pregnancy with methotrexate is an increasingly common alternative to surgical management. Initial reports of methotrexate therapy described a very low incidence of complications. We report our experience with two patients who developed profound toxicity following methotrexate treatment of ectopic pregnancy. CASE: The first patient received a single dose of methotrexate (50 mg/m2 intramuscularly) for a confirmed ectopic pregnancy. The second patient received three doses of methotrexate (1 mg/kg). Both patients developed life-threatening neutropenia and febrile morbidity requiring hospitalization and supportive care. CONCLUSION: To our knowledge, this is the first description of significant morbidity secondary to bone marrow suppression following methotrexate treatment of ectopic pregnancy. Most patients with ectopic pregnancy who are treated with methotrexate can expect resolution of their symptoms and a low risk of mild complications. However, serious complications after this therapy are possible and may occur even with the single-dose regimen.

Adult↗
PubMed1988

Ectopic automatic atrial tachycardia in children: clinical characteristics, management and follow-up.

Ectopic automatic atrial tachycardia, an uncommon type of supraventricular tachycardia in children and adults, has been reported to be resistant to medical therapy, and surgical or cryoblation has been recommended. This report describes 10 infants and children (median age 6 months; range birth to 7.5 years) with automatic atrial tachycardia and their management and follow-up. Digoxin alone was unsuccessful in controlling tachycardia in all 10 patients but decreased the tachycardia rate by 5 to 20% in 8. Intravenous (0.1 mg/kg body weight per dose) and oral propranolol successfully suppressed tachycardia in three of five patients and oral propranolol successfully controlled tachycardia in two of five other patients. Class I antiarrhythmic agents--quinidine (three patients), procainamide (four patients) and phenytoin (three patients)--did not control tachycardia in any patients but made the tachycardia rate worse in three patients. Intravenous (5 mg/kg per dose) and oral amiodarone suppressed tachycardia in three of four patients and oral amiodarone suppressed it in another patient. Thus, intravenous propranolol and amiodarone were effective in acutely suppressing automatic ectopic atrial tachycardia and predicted the response to long-term oral therapy. One patient had persistent tachycardia after surgical ablation of the high right atrial ectopic focus, and another patient had unsuccessful catheter ablation of the high right atrial ectopic focus (25 J). During follow-up (10 to 28 months), ectopic atrial tachycardia resolved completely in four patients and was well controlled in four patients.

Administration, Oral↗
PubMed1993

Atypical ectopic pregnancy.

Most emergency physicians will agree that bleeding and abdominal pain in women of child-bearing age is considered an ectopic pregnancy until proven otherwise. Ectopic pregnancy remains the leading cause of maternal mortality in the United States. A high index of suspicion is necessary for early intervention and reduction in morbidity and mortality. Risk factors for ectopic pregnancy include previous salpingo-oophoritis, ectopic pregnancy, tubal surgery or ligation, use of an intrauterine device, hormonal therapy, and, more recently, in vitro fertilization. In addition, this case emphasizes the possibility of ectopic pregnancy in women with a history of hysterectomy without bilateral oophorectomy.

Adult↗
PubMed2004

Ectopic pregnancy diagnosis and the pseudo-sac.

OBJECTIVE: To evaluate the impact of an ultrasound finding of a pseudo-sac (PS), a uterine sac without a double decidual ring or a yolk sac, on the management of cases with possible ectopic pregnancy. DESIGN: A retrospective review of a series of cases. SETTING: A general hospital. PATIENT(S): Seventy-seven patients who had a diagnostic laparoscopy over a period of 3 years for suspected ectopic pregnancy. MAIN OUTCOME MEASURE(S): A logistic regression analysis was conducted to evaluate the effect of the ultrasound finding of a PS on predicting a negative finding at laparoscopy. RESULT(S): The report of a PS is significantly associated with a false-positive diagnosis of ectopic pregnancy. CONCLUSION(S): A diagnosis of PS should not be interpreted as indicative of an ectopic pregnancy because radiological differentiation between an early intrauterine pregnancy failure and an ectopic pregnancy is not possible.

False Positive Reactions↗
PubMed2004

A case of molar ectopic pregnancy.

OBJECTIVE: To evaluate the occurrence of molar pregnancy in tubal ectopic pregnancy. DESIGN: Case report. SETTING: Outpatient clinic. PATIENT(S): A 27-year-old woman. INTERVENTION(S): Salpingectomy. MAIN OUTCOME MEASURE(S): Molar ectopic pregnancy. RESULT(S): Ectopic partial molar pregnancy. CONCLUSION(S): Molar pregnancy can occur in ectopic pregnancy. Molar pregnancy clinically mimics normal tubal ectopic pregnancy.

Adult↗
PubMed2006

Conservative management of second-trimester cervical ectopic pregnancy with placenta percreta.

OBJECTIVE: To report successful conservative management of advanced cervical ectopic pregnancy with placenta percreta. DESIGN: Case report. SETTING: University tertiary care hospital. PATIENT(S): A 37-year-old woman with second-trimester cervical ectopic pregnancy and placenta percreta. INTERVENTION(S): Ultrasound-guided injection of potassium chloride into the fetal heart followed by multiple systemic methotrexate injections, removal of fetal bones, cervical cerclage suture, and Foley catheter placement for control of hemorrhage. MAIN OUTCOME MEASURE(S): Low maternal morbidity and successful conservative management with preservation of fertility. RESULT(S): The cervical ectopic pregnancy was treated successfully without significant morbidity; the uterus was preserved, and the woman was delivered of a full-term live fetus in the next pregnancy. CONCLUSION(S): Advanced cervical ectopic pregnancy with placenta percreta is associated with high morbidity with surgical intervention. Conservative management with attendant low morbidity and uterus preservation is possible in advanced cervical ectopic pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMedDate not supplied

Delayed spontaneous expulsion of a cervical ectopic pregnancy: a case report.

Cervical ectopic pregnancy is an uncommon event. Modern diagnostic and treatment options provide an opportunity for conservative treatment of this condition. A case of a profuse hemorrhage associated with delayed spontaneous expulsion of a cervical ectopic pregnancy is described, and the management is discussed. In this patient, the cervical ectopic pregnancy was treated successfully using systemic methotrexate and selective uterine artery embolization. The patient returned 1 week later with spontaneous expulsion of the ectopic pregnancy associated with profuse hemorrhage. The bleeding subsided following tamponade using a transcervical Foley catheter. We conclude that conservative treatment of cervical ectopic pregnancy is feasible, with careful posttreatment surveillance.

Adult↗
PubMed1989

Causes of the increase in the incidence of ectopic pregnancy. A study on 1017 patients from 1966 to 1985 in Turku, Finland.

The relationship between the increased incidence of ectopic pregnancy and the known risk factors of this disorder was examined by 5-year age groups and equivalent calendar periods to determine the causes of the recent "epidemic" of ectopic pregnancy. None of the known risk factors would alone explain the observed increase. Consequently, multivariate analysis by log-linear models was applied: age, past pelvic operation, previous pelvic inflammatory disease, antecedent legal abortion, and current use of an intrauterine contraceptive device were responsible for the increase in the occurrence of the disease. The strongest association with the observed temporal trend in the increase of ectopic pregnancy was found for pelvic operation (including previous ectopic pregnancy), pelvic inflammatory disease, and current use of an intrauterine contraceptive device. Improved diagnosis and changing demographic patterns also contributed to the increase in the annual number of ectopic pregnancies.

Adult↗