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At least 649 records · Page 36Linked to original sources
PubMed2000

Early diagnosis and treatment of ectopic pregnancy.

During the period from 1995 to 1999, 64 patients were treated for ectopic pregnancy. All patients admitted to the department passed the same procedure including (complete preoperative laboratory findings, Beta HCG, serum progesterone and transvaginal colour Doppler). In patients who had ultrasound finding typical for ectopic pregnancy in combination with positive Beta HCG, conservative treatment was primarily done. In the rest of the patients, Beta HCG was tested every second day and in combination with the clinical and vaginosonographical findings the patients underwent diagnostic or operative laparoscopy. Out of 64 patients 36 had visible ectopic pregnancy when admitted to the clinical department. Three patients had no visible ectopic pregnancy neither at the time of their admission to the department nor at the time of laparoscopy. One of them had cervical pregnancy and the other two had pregnancies in the uterine part of the tube. The patient with cervical pregnancy was treated with metrotrexat (MTX) 12 mg daily in 5 doses. One patient with cornual pregnancy was treated with high doses of oxytocin infusion in combination with MEB intravenously 3 x 1 amp. The other patient with cornual pregnancy underwent laparoscopy with cornual resection and salpingectomy. Four of other tubar pregnancies were treated with metrotrexat 12 mg/day for 5 days. Other ectopic pregnancies were treated as follows: 36 laparoscopic salpingectomies, 10 laparoscopic salpingotomies with ovum expression, 9 adnexectomies by laparotomy, and 2 laparoscopic adnexectomies.

Abortifacient Agents↗
PubMed2001

Ectopic pregnancies: a three year study.

OBJECTIVE: To analyze the risk factors and assess the results of management with respect to maternal morbidity and mortality of ectopic pregnancy during the last three years. SETTING: Ziauddin Medical University Hospital, North Nazimabad campus (ZMUH), Karachi. RESULTS: Forty-three patients were admitted with ectopic pregnancy at ZMUH from 1st January 1997 to 31st December 1999. Frequency of ectopic pregnancy was 1.3% of total 3252 pregnancies. Risk factors were found in 33% of cases. There was one case of heterotopic pregnancy. Surgical treatment was performed in 36 cases. Two patients were given intramuscular methotrexate and one un-ruptured ectopic resolved after expectant management. CONCLUSION: Conservative management was an option but surgical treatment was done more often because of late referrals. Screening of high risk cases, early diagnosis and early intervention would reduce the morbidity in ectopic pregnancies.

Female↗
PubMed2001

Medical vs. Surgical treatment of ectopic pregnancy. The University of New Mexico's six-year experience.

OBJECTIVE: To review and compare the treatments for ectopic pregnancy in a university setting serving an indigent population. STUDY DESIGN: Charts assigned an ICD-9 code for ectopic pregnancy from January 1, 1993, through December 31, 1998, were reviewed for presenting symptoms, hCG levels, ultrasound findings, treatment modality and need for subsequent treatment. RESULTS: Of 401 patients treated for ectopic pregnancy, 7 were managed expectantly. One hundred nineteen (30%) patients received methotrexate. Seventy percent (83/119) of these ectopic pregnancies resolved with a single dose and an additional 11 after a second dose, for a 79% overall success rate. Twenty-five patients (21%) failed methotrexate therapy and required surgical treatment, and 11 (9%) pregnancies were ruptured. Primary treatment was surgical in 275 (69%) patients: 172 (63%) underwent laparoscopy and 103 (37%) laparotomy. Primary laparoscopic treatment was successful in 90%. Success rates were significantly lower for medical therapy as compared to laparoscopic treatment (79% vs. 90%, odds ratio 2.2, 95% confidence interval 1.1, 4.3; P = .02). No discriminating predictors of successful treatment with methotrexate were identified. CONCLUSION: The success rate of methotrexate therapy for ectopic pregnancy was lower than that of surgical management in a university setting serving an indigent population.

Abortifacient Agents, Nonsteroidal↗
PubMed2002

Management of ectopic pregnancy at a military medical center.

OBJECTIVE: Advances in laparoscopic surgical techniques and ultrasound technology along with the popularization of treatment with methotrexate have revolutionized accepted algorithms for treating ectopic pregnancy. I analyzed the management of ectopic pregnancy at a military medical center. METHODS: A retrospective chart review of ectopic pregnancies at Womack Army Medical Center between January 1997 and July 1999 was conducted. RESULTS: A total of 129 cases of ectopic pregnancy were found. Of those, 77 patients received primary surgical management, 51 patients received primary therapy with methotrexate, and 1 patient was managed expectantly. Eleven patients failed methotrexate therapy and went on to surgical therapy. Of the 88 patients ultimately treated surgically, 76 underwent laparoscopic procedures, 12 received laparotomy, and 11 more converted from laparoscopy to laparotomy. CONCLUSION: The advent of methotrexate therapy has greatly facilitated the treatment of ectopic pregnancy and altered our institutional algorithm; however, primary surgery is still used more often.

Abortifacient Agents, Nonsteroidal↗
PubMedDate not supplied

[116 ectopic pregnancies observed in Bangui (Central African Republic)].

Although ectopic pregnancy continues to endanger the life of patients in the Central African Republic, data on this pathology is drastically missing. This study is the result of an observation carried out over a period of 1 year taking all ectopic pregnancy cases into account with a view to identify the risk factors of this pathology and to draw the epidemiological profile of the patients concerned. Controls were used for the identification of the risk factors. The frequency of ectopic pregnancies was of 1 case against 61.8 deliveries. Ectopic pregnancies were more frequent among young women, with a peak in the 20-29 age group. Gonococcus infections and multiple partners were found to be correlated with the occurrence of ectopic pregnancies. If paraclinical tests had helped establish the diagnosis, the presence of clinical symptoms was decisive, thus explaining late diagnosis with tubal rupture followed by an hemorrhage. Those patients who were attended at an advanced stage had to undergo tubal resection, a treatment jeopardizing their obstetrical future. Clearly, African practitioners must imperatively learn to identify the clinical symptoms of this pathology.

Adult↗
PubMed2003

Risk factors of ectopic pregnancy.

OBJECTIVES: To assess the risk factors of ectopic pregnancy in Thai women. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University. DESIGN: Case controlled study. MATERIAL AND METHOD: From 1999 to 2000, 208 cases of ectopic pregnancy and 781 controls (postpartum women) were included in the study. The women were interviewed by trained research interviewers using a standardized questionnaire. Detailed information regarding age at first intercourse, number of sexual partners, history of changing partners within 6 months, previous obstetric history, history of spontaneous and criminal abortion, history of pelvic inflammatory disease, smoking, history of endometriosis and history of previous ectopic pregnancy was collected. RESULTS: By multivariate analysis, 5 variables remained as strong and independent risk factors for ectopic pregnancy: the number of sexual partners > or = 2 (OR = 3.02, 95% CI (1.75-5.23), vaginal delivery > or = 1 (OR = 0.005, 95% CI (0.002-0.0015), history of pelvic inflamatory disease (OR = 3.17, 95% CI (1.40-7.19), smoking (OR = 2.49, 95% CI (1.36-4.55), infertility (OR = 2.74, 95% CI (1.35-5.54)). CONCLUSION: Problems of multiple sexual partners, pelvic inflammatory disease, smoking and infertility were the main risk factors of ectopic pregnancy in Thai women.

Adult↗
PubMedDate not supplied

[Minilaparotomy with a mini-pfannenstiel incision for the early diagnosis of ectopic pregnancy in Africa].

OBJECTIVE: to evaluate the usefulness of an exploratory minilaparotomy under local anaesthesia in cases of suspected ectopic pregnancy. PATIENTS AND METHODS: Prospective study of the management of all cases of unruptured suspected ectopic pregnancy at the Gynaecological and Obstetrical Clinic at the Dakar University teaching hospital from 1 January, 2000, to 31 December, 2002. RESULTS: 44 unruptured ectopic pregnancies were recorded. The typical patient had no or few previous deliveries and was 30 years old; 27% of the patients presented risk factors for ectopic pregnancy. The principal motive for consultation was abnormal menstruation and pelvic pain; however, these symptoms together with a lateral uterine mass appeared in only 29.5% of the cases. Ultrasound examination was performed systematically and beta-HCG assessed for 36.8% of patients. The diagnostic was considered certain in 13.6% of the cases, probable in 36.3% and possible in 50%. Laparotomy was performed when the diagnosis was sure or probable, and an exploratory minilaparotomy was undertaken when the ectopic diagnosis was possible but uncertain. The diagnosis was confirmed in 79. 5% of the cases. The laparotomy failure rate was 18.7%, compared with 27.2% for the exploratory minilaparotomy, but the difference observed was not statistically significant (p=0.80). CONCLUSION: In view of the equipment problems that make beta-HCG assays and laparoscopy difficult to perform in Africa, the minilaparotomy under local anaesthesia is a useful alternative.

Adult↗
PubMed2003

[Contribution of ultrasonography in the diagnosis of ectopic pregnancy].

High-resolution endovaginal sonography has considerably improved ectopic pregnancy imaging. In conjunction with serum hCG measurements, it allows early detection of ectopic pregnancy (EP) and has significantly reduced the morbidity and the mortality of this disease. The major sonographic finding is the uterine vacuity, the diagnosis of ectopic pregnancy is quite sure in case of absence of intra-uterine pregnancy (IUP) associated with serum hCG above 1500 mUi/ml. Conversely, the presence of IUP excludes practically the diagnosis of EP, but IUP must be distinguished from a pseudosac. The visualization of an ectopic sac that contains an embryo or a yolk sac clearly allows the diagnosis of EP, but its sensitivity is only 25%. The most common sonographic finding is a hematosalpinx, which looks like an echogenic adnexal mass, next to the ovary containing the corpus luteum. Color Doppler is useful to enhance ectopic trophoblastic flow, but it is only a complementary technique of endovaginal sonography. Finally, if the first sonography is inconclusive, a follow-up examination must be performed 2 or 4 days later.

Chorionic Gonadotropin↗
PubMed2003

[Color and pulsed Doppler ultrasonography imaging of tubal ectopic pregnancy: study of 100 cases].

OBJECTIVE: To describe the color-Doppler findings and the spectral forms of pulsed Doppler in tubal ectopic pregnancies. MATERIALS AND METHODS: A prospective study of one hundred patients with tubal ectopic pregnancies was carried out in the emergency ward by two operators from January 1993 to March 1999. Following transabdominal and/or endovaginal sonography of the pelvis, color Doppler of the adnexa and of any suspected latero-uterine abnormal vascularity were studied with pulsed Doppler. The diastolic index (D/S) was measured on 4 consecutive complexes. RESULTS: Sixty-six peripheral hypervascularizations, 27 irregular hypervascularizations and 7 false negatives were found with color Doppler. The pulsed Doppler spectrum revealed a low-impedance flow in 47 cases (D/S index > or = 0.35) and a high-impedance flow in 46 cases (D/S index < 0.35). The latter spectrum was found in 7 cases of tubal rupture with massive hemorrhage and 39 cases of barely evolutive ectopic pregnancies. CONCLUSION: Color Doppler facilitated the diagnosis of small ectopic pregnancies (gestational sac less than 1 cm and echogenic lesions less than 2 cm in maximum diameter). Our work with pulsed Doppler revealed the frequence of high-impedance flow which, in the absence of massive hemoperitoneum, strongly suggests a barely evolutive ectopic pregnancy.

Female↗
PubMedDate not supplied

Ruptured advanced tubal ectopic pregnancy simulating uterine rupture: a case report.

BACKGROUND: Ectopic pregnancy is one of the most critical and life-threatening emergencies in gynaecological practice and poses a diagnostic dilemma in advanced cases. This report highlights a case of ruptured advanced tubal ectopic pregnancy simulating uterine rupture. METHOD: Case-note of a patient managed for ruptured advanced tubal ectopic pregnancy was used with a review of the relevant literature. RESULT: A 24-year old primigravida who presented at 23 weeks gestation with signs and symptoms suggestive of ectopic pregnancy is presented. The advanced nature of the pregnancy posed a diagnostic dilemma as ruptured uterus shares the same characteristic dramatic presentation, especially in this patient with previous myomectomy. Prompt resuscitation and immediate laparotomy produced a good outcome. CONCLUSION: High index of suspicion is important in the diagnosis of ectopic pregnancy. Even when diagnosis is in doubt, exploratory laparotomy may be life saving.

Adult↗
PubMed1992

Methotrexate for treatment of unruptured ectopic pregnancy.

Clinical experience with and adverse effects of methotrexate for the treatment of unruptured ectopic pregnancy are described. Ectopic pregnancy is suspected in the presence of the following: positive results on pregnancy test (e.g., test for beta-human chorionic gonadotropin [beta-hCG]), lower abdominal pain, a normal or slightly enlarged uterus, and a mass on either side of the midline. When laparoscopy is required for diagnosis, surgical correction is done at the same time. However, use of serial beta-hCG titers, vaginal ultrasound examinations, serum progesterone concentrations, and dilation and curettage (when the pregnancy is confirmed to be nonviable) allows earlier detection of ectopic pregnancy without laparoscopy. If rupture has not occurred, i.v. or i.m. methotrexate is administered; usually, i.m. leucovorin is given, on alternate days, to prevent hematologic toxicity. Adverse effects of methotrexate include stomatitis, gastritis, and hepatic enzyme elevation. Use of a single-dose regimen of i.m. methotrexate without leucovorin has been associated with a lower frequency of toxicity. Selection criteria for patients are as follows: (1) an unruptured ectopic pregnancy less than or equal to 3.5 cm in greatest dimension on transvaginal ultrasound, (2) no active renal or hepatic disease, and (3) no evidence of leukopenia or thrombocytopenia. Intramuscular methotrexate therapy is a safe and effective alternative to surgery for the treatment of unruptured ectopic pregnancy.

Clinical Trials as Topic↗
PubMed2005

Barriers to health care and protocol-based treatment of ectopic pregnancy.

OBJECTIVE: To evaluate whether treatment provided for ectopic pregnancies was different for patients with identified barriers to health care, including ethnicity, lack of insurance, distance from the treating facility that provides services and undocumented residency, at an institution that utilizes a protocol-based algorithm for treatment of ectopic pregnancies. STUDY DESIGN: Charts of 401 patients who were diagnosed with ectopic pregnancy from January 1, 1993, through December 31, 1998, were reviewed to compare the use of medical treatment using methotrexate versus surgical treatment. Data were analyzed with respect to patient ethnicity, socioeconomic status (including insurance status and possession of a social security card [a proxy for legal residency status]), residence inside or outside the county of the treating facility, patient presentation and treatment outcomes. RESULTS: There was no difference in treatment modality or success of primary treatment for ectopic pregnancies between groups regardless of ethnicity, health care insurance, residence outside the county the treating facility was located in or possession of a social security number. CONCLUSION: The treatment of ectopic pregnancies at the University of New Mexico Health Sciences Center is consistent across ethnic and socioeconomic populations. A well-designed treatment protocol may help provide evidenced-based, consistent treatment for patients requiring care who also have identified barriers to medical and surgical treatment.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

[Diagnosis and treatment of ectopic molar pregnancy].

OBJECTIVE: To summerize the experience in the diagnosis and treatment of ectopic molar pregnancy. METHODS: Clinical data of 3 cases of women with ectopic hydatidiform mole in Peking Union Medical College Hospital were analyzed retrospectively. RESULTS: The clinical characteritics of ectopic molar pregnancy depend upon the site of the disease. It can be metastasized distantly in early stage. Digital subtraction angiography, colour ultrosound and laparotomy may play very important roles in the diagnosis of ectopic molar pregnancy. Regular chemotherapy and resection of drug-resistant focus are still the main methods of treatment. CONCLUSIONS: Prophylactic chemotherapy for ectopic molar pregnancy should be emphasized. It is very important to make an early diagnosis of malignant metastasis and to give a regular treatment for the patients.

Angiography, Digital Subtraction↗
PubMed1990

Serial beta-hCG measurements in the early detection of ectopic pregnancy.

We investigated the sensitivity and specificity of serial serum hCG assays to diagnose early ectopic pregnancy in 50 asymptomatic women at risk. The initial two hCG values obtained at 2-5-day intervals were used to calculate doubling time and percentage increase. Twenty-five women had a viable intrauterine pregnancy, 14 an ectopic gestation, ten a spontaneous abortion, and one a molar pregnancy. A normal percentage increase and/or doubling time was observed in 64% of women who eventually proved to have an ectopic pregnancy. Ultimately, 85% of our patients demonstrated abnormal values when subsequent hCG pairs were analyzed. The sensitivity of these tests to diagnose asymptomatic ectopic pregnancy was 36%, with a specificity of 63-71%. We conclude that a normal rise in hCG production does not reliably differentiate an ectopic from an intrauterine pregnancy in the asymptomatic patient.

Chorionic Gonadotropin↗
PubMed2006

[An evolution in the conduct for ectopic pregnancy in gynecological clinic, "UMBAL - D-r G. Stranski", Pleven for 7 years' period].

AIM: The aim of the present study is to show the evolution of the conduct for ectopic pregnancy for 7 years' period after introduction in gynecological practice of contemporary diagnostic and therapeutic methods for ectopic pregnancy. For the fulfillment of this aim was made a prospective study for 7 years' period of the patients with diagnosis "Ectopic pregnancy", treated in Gynecological clinic of "UMBAL - D-r G. Stranski" EAD, Pleven. MATERIALS AND METHODS: The objects of observation were 198 women with diagnosis: "Ectopic pregnancy". There were used the following methods: clinical, technical devices, statistical methods. RESULTS: The authors analyze the results of the use of laparoscopy, conventional surgery and application of Methotrexate describing the indications and the risk for the patient. CONCLUSION: The authors emphasized the advantages of the gynecological laparoscopy for precise diagnosis and contemporary treatment of the intact ectopic pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMed1991

Medicosurgical approach to diagnosis and treatment of ectopic pregnancy.

Early ectopic pregnancy screening using vaginal ultrasonographic technology together with measurement of beta human chorionic gonadotropin (beta-hCG) and human chorionic somatomammotropin is possible within the first 2 weeks of the missing menses, prior to the appearance of symptoms. This article summarizes the main available treatment modalities, focusing primarily on the pelviscopic surgical tube-conserving approach and on instillation of intrachorionic drugs (methotrexate alone or in combination with ornipressin) and injection of prostaglandin F2 alpha. While the pelviscopic surgical approach can be applied in nearly all cases of ectopic pregnancy, irrespective of pregnancy duration, the pelviscopic medicosurgical approach is only appropriate for the treatment of early ectopic pregnancies until the 8th week of gestation in patients without fluid collection in the pouch of Douglas and beta-hCG values below 2000 mU/mL. The transvaginal intrachorionic drug instillation as a simple medicosurgical approach performed under ultrasonographic guidance without anesthesia remains restricted to the treatment of early viable ectopic pregnancy. A brief account of the expectant treatment of patients with nonviable ectopic pregnancy is given, underlining the prerequisites of decreasing beta-hCG values and the absence of fluid in the pouch of Douglas. Although spontaneous resorptions have been observed in a number of cases of the disease, no clear evidence is available on the reconstitution of tubal function and patency.

Chorionic Gonadotropin↗
PubMed1991

Tubal sterilization and subsequent ectopic pregnancy. A case-control study.

OBJECTIVE: To assess the relative risk of ectopic pregnancy associated with postpartum or interval tubal sterilization. DESIGN: Case-control study using a comparison group of women of reproductive age at risk of pregnancy. SETTING: Group Health Cooperative of Puget Sound, a health maintenance organization based in Seattle, Wash. organization based in Seattle, Wash. PARTICIPANTS: Cases were 249 enrollees diagnosed as having an ectopic pregnancy between October 1, 1981, and September 30, 1986. Controls were 835 randomly selected enrollees matched to cases on age and county of residence. MEASUREMENTS: Information on interval sterilization history was obtained from interviews, examination of medical records, automated hospitalization files and a previously validated algorithm. A logistic regression model was used to estimate relative risks (RRs) for sterilized women compared with women using other types of or no contraception at the reference date. RESULTS: Controlling for age, county, race, smoking, income, gravidity, and prior use of a Dalkon Shield intrauterine device, the risk of ectopic pregnancy in women who had undergone interval sterilization was 3.7 (95% confidence interval [CI], 1.7 to 8.0) times that of women currently using oral contraception and 2.8 (95% CI, 1.5 to 5.5) times that of women currently using barrier contraceptive methods. Use of interval sterilization was associated with a risk of ectopic pregnancy similar to that of women using intrauterine devices (RR, 0.8; 95% CI, 0.4 to 1.7) and a risk lower than that of women who were not using contraception (RR, 0.2; 95% CI, 0.1 to 0.3). The corresponding RRs associated with postpartum sterilization were lower: 1.2 (95% CI, 0.3 to 3.9), 0.9 (95% CI, 0.3 to 2.8), 0.3 (95% CI, 0.1 to 0.8), and 0.1 (95% CI, 0.0 to 0.2), respectively. CONCLUSION: Tubal sterilization provides some protection against extrauterine as well as intrauterine pregnancy. It is likely that postpartum sterilization can be a safe alternative to all types of temporary contraception in terms of risk of ectopic pregnancy, while some types of interval sterilization may lead to an increased risk, in comparison with use of oral contraceptives or barrier methods.

Adolescent↗
PubMed1990

Ectopic pregnancy surveillance, United States, 1970-1987.

In 1987, both the rate of hospitalizations due to ectopic pregnancy and the number of women hospitalized increased from those reported in 1986. Although ectopic pregnancy represented 1.7% of all pregnancies in 1987, complications of this condition accounted for 12% of all maternal deaths in that year. The case-fatality rate was 3.4 deaths per 10,000 ectopic pregnancies, a decline of 30% from the rate of 4.9 deaths reported in 1986, and a 90% decline from the 35.5 deaths per 10,000 ectopic pregnancies reported in 1970. Although the racial gap decreased slightly in 1987, the risk of ectopic pregnancy remained 1.4 times higher for women of black and other minority races than for white women. The risk of death from this condition remained 1.8 times higher for women of black and other minority races.

Adolescent↗