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At least 667 records · Page 37Linked to original sources
PubMed1990

Conventional B-mode and transvaginal color Doppler in ultrasound assessment of ectopic pregnancy.

The study was arranged in two parts. In the first part, 43 of the clinically suspected ectopic pregnancies were sent for a transvaginal color Doppler examination. Both cystic and complex adnexal masses were carefully scanned for their Doppler flow characteristics. The Pourcelot index (RI) was calculated and the RI 0.40 was used as a cut-off point to differentiate the trophoblastic (RI less than 0.40) and the normal blood flow (RI greater than 0.40). The diagnosis was confirmed by the beta hCG serum test. Three false-negative and one false-positive findings were obtained. The transvaginal color and pulsed Doppler study of the flow within ectopic pregnancy has a high degree of sensitivity (87.5%), specificity (94.7%) and accuracy (90.7%). Pelvic sonograms of another 110 patients with proven ectopic pregnancy were reviewed retrospectively. The ectopic gestational sac with the alive embryo was documented in 11.8% cases and without the embryo in 30.4% cases. A mixed, solid or cystic adnexal mass was detected in 57.8% patients. Intrauterine findings showed a pseudogestational sac in 13.6% cases, a cluster configuration in 18.6% cases and a linear configuration in 67.8% cases. Criteria for the ultrasound diagnosis of ectopic pregnancy influencing its specificity, sensitivity and accuracy are discussed.

Female↗
PubMed1987

Nonsurgical management of unruptured ectopic pregnancy: an extended clinical trial.

Unruptured tubal pregnancies diagnosed at laparoscopy were treated with either methotrexate/citrovorum factor (MTX/CF) (n = 21) or observation (n = 5). Entry criteria required that the ectopic pregnancy be visualized, less than or equal to 3 cm in diameter, with intact serosa and no active bleeding. Treatment selection was based upon preoperative levels of beta-human chorionic gonadotropin (beta-hCG), with MTX/CF given to subjects exhibiting a plateaued or rising pattern and observation alone given to those with falling levels. Twenty-five of 26 ectopic pregnancies resolved without need of laparotomy. Two subjects received blood transfusions and one required a second operation for intra-abdominal bleeding. In both cases, fetal cardiac activity was noted pretreatment on ultrasound. The authors conclude the following: (1) MTX/CF may be safely used to treat selected unruptured ectopic pregnancy; (2) many ectopic pregnancies resolve spontaneously; and (3) ectopic pregnancies that form fetal elements, as evidenced on ultrasound, should not be managed medically.

Adult↗
PubMed1986

Ultrasound findings in ectopic gestation.

To study the diagnostic accuracy of real-time ultrasonography in the evaluation of ectopic pregnancy, the case records and preoperative sonograms of 57 patients with surgically proven ectopic pregnancy were reviewed. Some 81% of these patients had abnormal sonograms. However, the ultrasonographic findings were often nonspecific and in only 8.7% of the cases was an ectopic fetal heart beat demonstrated. Two patients in this series had coexistent intrauterine and extrauterine gestations. Other findings such as an adnexal mass, an empty uterus, fluid in the cul-de-sac, and a decidual reaction in the uterus are all suggestive of an ectopic pregnancy but can be seen in other conditions. The presence of a normal intrauterine gestation practically rules out the possibility of ectopic pregnancy.

Adnexa Uteri↗
PubMed1988

A laparoscopic approach can be applied to most cases of ectopic pregnancy.

Recent studies have demonstrated lower cost and morbidity associated with laparoscopic treatment of ectopic pregnancy. However, the applicability of these techniques to unselected cases of ectopic pregnancy has not yet been proved. To test the efficiency of the laparoscopic approach, an attempt was made to apply these techniques to all patients who presented with ectopic pregnancy at a medical center during a 6-month period and who met the entry criteria of hemodynamic stability; location other than abdominal with fetus, interstitial, or cervical; and visibility of the mesosalpinx. None of the 22 patients referred to the study had to be excluded because of these criteria, indicating the relative infrequency of these contraindications. All were treated successfully by laparoscopic salpingectomy (N = 12), salpingostomy (N = 8), or removal of implantations from peritoneal surfaces (N = 2). The average size of the ectopic gestation was 3.9 cm, the average amount of hemoperitoneum was 168 mL, the average additional blood loss attributable to the procedure was 30 mL, and the average drop in hematocrit postoperatively was 4.7%. The average hospital stay was 1.1 days, and patients were released for work in 1-2 weeks. An analysis of the three patients not referred to the study indicated that they may have been appropriate candidates for laparoscopic resection. This study indicates that the majority of unselected patients with ectopic pregnancy may be treated by laparoscopic procedures, with low cost and low morbidity.

Adult↗
PubMed1988

Risk factors for ectopic pregnancy. A population-based study.

To evaluate the association between ectopic pregnancy and 22 potential risk factors, we conducted a population-based case-control study. The investigation included 274 cases diagnosed from 1935 through 1982 in residents of Rochester, Minn, and 548 matched controls selected from live-birth deliveries. Risk factor information documented prior to the last index menstrual period was obtained via medical record abstract. Univariate matched analyses revealed nine variables associated with a significantly elevated relative risk of ectopic pregnancy. Following conditional logistic regression, four variables remained as strong and independent risk factors for ectopic pregnancy: current intrauterine device use (relative risk, 13.7; 95% confidence interval, 1.6 to 120.6), a history of infertility (relative risk, 2.6; 95% confidence interval, 1.6 to 4.2), a history of pelvic inflammatory disease (relative risk, 3.3; 95% confidence interval, 1.6 to 6.6), and prior tubal surgery (relative risk, 4.5; 95% confidence interval, 1.5 to 13.9). Theoretically, any condition that prevents or retards migration of the fertilized ovum to the uterus could predispose a woman to ectopic gestation. Further research is needed to clarify the impact of other potential risk factors in the etiology of ectopic pregnancy.

Adolescent↗
PubMed1986

Ectopic pregnancy. A review of the etiologic factors.

Ectopic pregnancy was experienced by 103 women in our practice, for a total of 123 such pregnancies. These patients' histories were reviewed in an attempt to identify certain risk factors. The ectopic pregnancies were diagnosed prior to rupture in 73% of cases. Patients were followed for subsequent reproductive function. Among the 96 who were not sterilized during or after surgery for ectopic pregnancy, intrauterine pregnancy was achieved by 34, while 15 had at least one additional ectopic gestation. Risk factors were identified. Different surgical approaches to the affected tube influence future reproductive function and repeat ectopic gestation.

Adolescent↗
PubMed1987

Ectopic pregnancy: 'classic' vs common presentation.

Ectopic pregnancies are common, are increasing in incidence, and are preventable causes of reproductive morbidity and death. They are also frequently misdiagnosed, and are one of the most common causes for malpractice claims made against primary care physicians. The classic description of the presenting signs and symptoms of ectopic pregnancy was derived from a series of ruptured ectopic pregnancies. To decrease the complications and preserve fertility, ectopic pregnancies must be detected before they cause tubal rupture. A family medicine center experience with the diagnosis of ectopic pregnancy over a six-month period is presented. The study confirmed the expected frequency of this condition in this population but findings disclosed that the classic presentation was, in fact, uncommon. Implications for decision making derived from these case reports are discussed. A high level of clinical suspicion for this problem must be maintained.

Abdomen↗
PubMed1987

Maternal serum levels of estradiol, progesterone and human chorionic gonadotropin in ectopic pregnancy and their correlation with endometrial histologic findings.

Plasma levels of estradiol 17-beta (E2), progesterone (P) and beta-human chorionic gonadotropin (b-HCG) were measured in 59 patients with ectopic pregnancy and in control patients made up of ten women with normal intrauterine pregnancies and five patients with threatened abortion. The gestational ages of the three groups were not statistically different, the means being 6.6, 6.5 and 6.7 weeks, respectively. The endometria in the patients with an ectopic pregnancy were examined histologically and the correlation with the hormonal levels was studied. Mean levels of b-HCG, E2 and P in patients with ectopic pregnancies (4,893 +/- 5,435 S.E.M. milli-international units per milliliter, 311 +/- 191 S.E.M. picograms per milliliter and 8.3 +/- 5.5 S.E.M. nanograms per milliliters, respectively) were significantly lower than those measured in normal pregnant control patients (b-HCG = 22,173 +/- 2,696 S.E.M. microunits per milliliter, p less than 0.00001; E2 = 769 +/- 81 S.E.M. picograms per milliliter, p less than 0.0001 and p = 37.8 +/- 6.1 S.E.M. nanograms per milliliter, p less than 0.0001), and in patients with threatened abortion (b-HCG = 20,310 +/- 1,688 S.E.M. milli-international units per milliliter, p less than 0.0001; E2 = 803 +/- 91 S.E.M. picograms per milliliter, p less than 0.001 and P = 29.7 +/- 2.9 S.E.M. nanograms per milliliter, p less than 0.001). Mean levels of P in ectopic pregnancies with secretory type endometria (10.4 +/- 6.0 S.E.M. nanograms per milliliter), were significantly higher than those with proliferative endometria (5.0 +/- 3.2 S.E.M. nanograms per milliliter, p less than 0.001). Data is provided not previously known, on the levels of E2 and P in ectopic pregnancy and correlation with endometrial histologic factors.

Chorionic Gonadotropin↗
PubMed1985

Reliability of urinary pregnancy tests in the diagnosis of ectopic pregnancy.

Recently a new generation of urinary pregnancy tests with increased sensitivity and specificity for beta-human chorionic gonadotropin (beta-HCG) was introduced. The clinical sensitivity of seven of these tests was evaluated in patients with surgically proven ectopic pregnancy. Two enzyme-linked immunosorbent assays (Tandem Visual, Hybritech; Mod C1, Monoclonal Antibodies), with a sensitivity of 50 mIU of beta-HCG, were positive in 90% of ectopic pregnancies. The three-tube tests (Sensitex, Roche; UCG Beta Stat, Wampole; beta-Neocept, Organon), with a sensitivity of 150-250 mIU of beta-HCG, were positive in 81-85% of ectopic pregnancies. Two slide tests (UCG Beta Slide, Wampole, and Sensislide, Roche), with a sensitivity of 500-800 mIU of beta-HCG, were positive in 51-61% of ectopic pregnancies. Both the immunosorbent assays and the tube tests were statistically more sensitive than the slide tests (P less than .001). There was no statistically significant increase in sensitivity between the tube tests and the immunosorbent assays. The sensitivities of these tube tests in ectopic pregnancy are similar to those of tube tests from other manufacturers previously reported on.

Adolescent↗
PubMed1985

Value of culdocentesis in the diagnosis of ectopic pregnancy.

The diagnostic value of culdocentesis was examined in all patients admitted with hemoperitoneum during a three-year period. There was a total of 158 women with positive culdocentesis, of whom 132 (83.5%) had tubal ectopic pregnancies and 26 had other diagnoses. Of the 132 patients with ectopic gestations, the majority (62%) had unruptured tubes. A nondiagnostic culdocentesis should not be used either to raise or to lower the clinician's suspicion of ectopic pregnancy as 16% of patients with an ectopic pregnancy had a nondiagnostic culdocentesis, of which one-quarter were ruptured and three-quarters had hemoperitoneum diagnosed at the time of surgery. A positive culdocentesis along with a positive serum human chorionic assay was associated with an ectopic pregnancy in 99.2% of cases. This procedure should not be limited to the evaluation of patients with classic peritoneal signs, as 45% of the authors' patients with a positive culdocentesis did not have such findings.

Biopsy, Needle↗
PubMed1985

Ectopic pregnancy and antibodies to Chlamydia trachomatis.

Ectopic pregnancy is one of the most serious sequelae to acute salpingitis. Chlamydia trachomatis seems to be the most common etiologic agent of acute salpingitis. In the present study, we tested whether women with ectopic pregnancy had serologic evidence of a current or past chlamydial infection. Sixty-five percent of the women with ectopic pregnancy had IgG serum antibodies to C. trachomatis, and 21% of women pregnant in utero had such antibodies. Eleven percent of women with infertile husbands, 42% of women with cervicitis, and 69% of women with salpingitis had IgG serum antibodies to C. trachomatis. In women with ectopic pregnancy, there was a correlation between the occurrence of IgG antibodies and a history of salpingitis or gross evidence of a previous tubal inflammation. We conclude that previous chlamydial salpingitis may be a major etiologic factor leading to ectopic pregnancy.

Adult↗
PubMed1979

The value of sonography in suspected ectopic pregnancy.

Of 356 women undergoing sonography to diagnose or rule out an ectopic gestation, data sufficient to assign a final diagnosis were available on 260 of them. Ectopic gestation was diagnosed in 25 cases in this group and intrauterine pregnancy in 99, while the remaining 136 patients were found not to be pregnant. During sonography, ectopic gestations were suspected or diagnosed in 27 instances: In 17 cases this was in agreement with the final diagnosis, but neither an intrauterine nor an extrauterine gestation existed in 10 cases, although neoplastic or inflammatory masses were present. Of the 25 patients with the final diagnosis "ectopic pregnancy," this was not detected with sonography in 8 instances. Intrauterine pregnancies were diagnosed by sonar in 94 of the 99 cases. Although reliable sonar identification of ectopic gestation is not always possible, sonography is helpful in diagnosing intrauterine pregnancy so that surgical intervention can be avoided.

Adolescent↗
PubMed1980

Stimulation of N6,O2'-dibutyryl cyclic adenosine 3':5'-monophosphate of ectopic production of the free beta subunit of chorionic gonadotropin by a human brain tumor cell line.

Previous studies have favored a basic difference in the regulation of specialized protein production by cells derived from the usual tissue of origin (eutopic) and cancer cells derived from a tissue not normally producing the protein (ectopic). Thus N6,O2'-dibutyryl cyclic adenosine 3':5'-monophosphate was believed to stimulate only eutopic (but not ectopic) chorionic gonadotropin production, and butyrate to stimulate only ectopic (but not eutopic). However, in CBT, a human brain tumor cell line, we find that N6,O2'-dibutyryl cyclic adenosine 3':5'-monophosphate, but not butyrate, stimulated ectopic production of the beta subunit of chorionic gonadotropin. We conclude that neither butyrate nor cyclic adenosine 3':5'-monophosphate derivatives reliably discriminate ectopic from eutopic regulation.

Brain Neoplasms↗
PubMed1982

Diagnostic value of a rapid HCG-beta-subunit radioimmunoassay in cases of suspected ectopic pregnancies.

A rapid and sensitive RIA specific for the beta-subunit of HCG was developed. This RIA gives the results in less than 3 hours, and is able to detect the pregnancy 12 days after the midcycle LH-peak. The clinical reliability was evaluated by assaying plasma samples from 128 patients with acute gynecologic symptoms and suspicion of ectopic pregnancy. Other diagnostic methods including urinary pregnancy test (117 patients), culdocentesis (57 patients), and endometrial curettage (66 patients) were also performed. The final clinical diagnosis was ectopic pregnancy in 45 cases, intrauterine pregnancy in 31 cases, and no pregnancy in 52 cases. The rapid HGC-RIA gave a positive result in 93%, 97%, and 6% of these patient groups, respectively. The conventional diagnostic methods were less reliable and gave a positive result in only 52-59% of the ectopic pregnancies. Three false negative results (7%) in the HCG-RIA were obtained in cases of ectopic pregnancy. Three false positive results (6%) were obtained in patients not pregnant. The results show the superiority of the HCG beta-subunit RIA compared to the conventional diagnostic methods in the diagnosis of ectopic pregnancy.

Animals↗
PubMed1983

Limitations of qualitative serum beta-HCG assays in the diagnosis of ectopic pregnancy.

Seventy-four patients had ectopic pregnancies proven by surgery. Three of them had a serum beta-HCG test for pregnancy that was reported as negative (less than 25-35 mIU/ml). We sought a threshold for positive in the serum beta-HCG test that would maximize its usefulness in diagnosing ectopic pregnancy. Sera from 52 of the patients were available for reanalysis. Quantitative values of beta-HCG were determined. Lowering the threshold for positive from 25-35 to 10 mIU/ml might increase the test's sensitivity without sacrificing specificity but would still not ensure detection of all ectopic pregnancies. Of 445 cases of ectopic pregnancy described in the literature, 6 had serum beta-HCG values reported as negative. In the published reports and in our own cases, clinical histories and histologies indicated that a nonviable ectopic pregnancy can be expected to have an associated serum concentration of beta-HCG that may be below the sensitivity of detection even with current, commercially available quantitative tests.

Adult↗
PubMed1984

Ectopic pregnancy mortality, United States, 1979 to 1980: clinical aspects.

Ectopic pregnancy has recently become a major cause of maternal mortality in the United States. Despite its increasing public health impact, relatively little is known about the clinical epidemiology of this condition. Therefore, the authors investigated all reported deaths from ectopic pregnancy in the United States occurring in 1979 and 1980, to determine characteristics of, and risk factors for, fatal ectopic pregnancy. Most women (85%) died from hemorrhage. Abdominal and interstitial implantations were more likely to become symptomatic later in gestation and to be fatal than were tubal implantations. Of those deaths for which circumstances were known, more prompt diagnosis and treatment of ectopic pregnancy by health professionals might have prevented one-half of the deaths. One-third of the deaths might have been prevented if the women had notified or visited a physician more promptly after the onset of symptoms. Timelier action by women and health professionals could reduce ectopic pregnancy mortality.

Adult↗
PubMed1983

Ectopic pregnancies in upstate New York.

Data on ectopic pregnancies reported to the New York State Department of Health for upstate residents for the years 1971 through 1979 were analyzed by maternal age, race, and gravidity. Trends in the rate of ectopic pregnancies were also examined for this time period. The rate of ectopic pregnancies per 1,000 conceptions increased with increasing maternal age and was higher for nonwhite women compared with white women. There was a slight increase in the rate of ectopic pregnancies with increasing gravidity, but this was due in part to the interaction of age with gravidity. The rate of ectopic pregnancies per 1,000 conceptions increased by 217% from 1971 to 1979. This trend differed within subgroups of maternal age, race, and gravidity. The percentage of increase was greater for women 30 years of age or older compared with women 30 years of age or younger, greater for white women compared with nonwhite women, and greater for women with three or more previous pregnancies compared with women with fewer previous pregnancies.

Adolescent↗
PubMed1993

hCG, progesterone, alpha-fetoprotein, and estradiol in the identification of ectopic pregnancy.

OBJECTIVE: To enhance the laboratory diagnosis of ectopic pregnancy by determining levels of hCG, progesterone, estradiol (E2), and alpha-fetoprotein (AFP). METHODS: Serum samples and medical records were retrospectively analyzed from 100 gynecologic patients for whom quantitative hCG determination had been ordered. Clinical data and levels of hCG, progesterone, E2, and AFP were examined by univariate and multivariate logistic analyses. RESULTS: Progesterone, hCG, and E2 were highest in viable pregnancies, whereas AFP tended to be higher in ectopic pregnancies. A single progesterone value could differentiate between ectopic and viable pregnancy in more than 80% of patients. The combination of all four biochemical markers predicted ectopic pregnancy with 98.5% specificity and 94.5% accuracy. Clinical diagnosis was less than 75% accurate. CONCLUSION: A combination of biochemical markers including hCG, progesterone, E2, and AFP can be superior to a single progesterone level or clinical evaluation in the diagnosis of ectopic pregnancy.

Adult↗