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At least 937 records · Page 52Linked to original sources
PubMed1998

Derivation of a clinical prediction model for the emergency department diagnosis of ectopic pregnancy.

OBJECTIVE: To derive a clinical prediction model for estimating the pretest probability of ectopic pregnancy in ED patients with first-trimester abdominal pain or vaginal bleeding. METHODS: All hemodynamically stable first-trimester patients presenting to the ED of a tertiary care military teaching hospital over a 14-month period with a chief complaint of abdominal pain and/or vaginal bleeding had clinical data coded prior to determining outcome. They were then followed longitudinally until a criterion standard pregnancy outcome was established. RESULTS: Of the 486 patients enrolled, 280 (58%) had viable intrauterine pregnancies, 167 (34%) had nonviable intrauterine pregnancies, and 39 (8%) had ectopic pregnancies. Using a recursive partitioning model, a high-risk group was derived (that was separated from intermediate and low-risk groups), consisting of patients with abdominal peritoneal signs or definite cervical motion tenderness, with a sensitivity of 31% (95% CI: 17-48%), a specificity of 93% (95% CI: 90-95%), a positive likelihood ratio of 4.3, and a negative likelihood ratio of 0.74. A low-risk group, consisting of patients with either fetal heart tones or tissue at the cervical os, or the absence of pain other than midline menstrual-like cramping and lacking any pelvic tenderness, was differentiated from an intermediate-risk group, with a sensitivity of 96% (95% CI: 81-100%), a specificity of 22% (95% CI: 18-26%), a positive likelihood ratio of 1.2, and a negative likelihood ratio of 0.17. CONCLUSION: A clinical prediction model for estimating the probability of ectopic pregnancy in ED patients has been derived. It may prove to have practical clinical application for estimating pretest probability of ectopic pregnancy as well as assisting in medical decision making when laboratory and ultrasonographic findings are nondiagnostic. Clinical application should await prospective validation in an independent sample.

Abdominal Pain↗
PubMed1999

The utility of a dilatation and evacuation procedure in patients with symptoms suggestive of ectopic pregnancy and indeterminate transvaginal ultrasonography.

OBJECTIVES: To ascertain the overall frequency of obtaining chorionic villi (CV) in patients with indeterminate transvaginal ultrasound (US) examinations who have had a dilatation and evacuation (D+E) procedure performed, to determine whether the frequency of obtaining CV is dependent on whether the endometrial cavity is empty at US, and to determine the likelihood of ectopic pregnancy in patients without CV after D+E and with or without an empty endometrial cavity at US. METHODS: A retrospective review was made of consecutive ED patients presenting to an urban teaching hospital from August 1991 through August 1997 with abdominal pain or vaginal bleeding and a positive beta-human chorionic gonatropin (beta-hCG) test. Patients who had a transvaginal US that was read as indeterminate (no extrauterine findings of ectopic pregnancy, and no intrauterine fetal pole or yolk sac) and who had a D+E performed within 48 hours of the ED visit were eligible. US exams were subdivided into two groups, those with empty endometrial cavities and those with endometrial cavities that contained fluid, echogenic material, or sac-like structures. The presence or absence of CV was based on the official pathology report. Patients were excluded if pathology results were not available. RESULTS: A total of 255 patients met eligibility criteria. Of these, pathology results were not available for five patients. Of the remaining patients, 177 of 250 (70.8%: 95% CI = 64.7% to 76.3%) had CV identified in the pathology specimen. The difference in the frequencies of obtaining CV in those with empty endometrial cavities (35/78; 44.9%: 95% CI = 34% to 56%) vs. those without empty endometrial cavities (142/172; 82.6%: 95% CI = 76% to 88%) was significant (p<0.001). Ectopic pregnancy was diagnosed in 17 of 42 (40.0%) with empty uteri at US and no CV at pathology vs 5 of 26 (19.2%) in whom the uterus was not empty and no CV were obtained (p = 0.07). CONCLUSION: In symptomatic patients with indeterminate transvaginal ultrasound exams, CV will be identified after D+E in approximately 70% of cases. Although CV were found with increased frequency when the endometrial cavity was not empty, still almost half of the patients with empty uteri had villi identified. Finally, although the frequency of ectopic pregnancy was higher in the patients with empty uteri and no CV at D+E, vs. those without an empty uterus and no CV, this difference did not reach statistical significance.

Abortion, Therapeutic↗
PubMedDate not supplied

Ectopic pregnancy: a growing concern.

Ectopic pregnancy rates have increased threefold since 1970. Ectopic pregnancy continues to be the leading cause of maternal death in the first trimester of pregnancy. The identification of clients with ectopic pregnancies may be difficult. In this article, risk factors, assessment techniques, and treatment strategies are reviewed. A questionnaire is included for use during pregnancy verification to identify those clients who may be at risk of having an ectopic pregnancy. The role of the nurse practitioner in providing comprehensive care is also addressed.

Diagnosis, Differential↗
PubMed1991

Conservative treatment of ectopic pregnancy.

As a conservative nonsurgical treatment of an early ectopic pregnancy, local prostaglandin, parenteral or local methotrexate, local hyperosmolar glucose, and also expectant management have been used successfully in selected cases. The success rate of conservative treatment has been 71%-100% and that of tubal patency after different kinds of conservative treatment 72-93% of patients. In the present study of expectant management in early ectopic pregnancy in patients with decreasing serum hCG levels, spontaneous resolution was observed in 64.6% of patients and in the total series of 207 ectopic pregnancies in 15.0% of patients. Expectant management of early ectopic pregnancy is recommended when emergency surgery is not needed on admission and the serum hCG level is decreasing as noted in two consecutive estimations with an interval of 1-2 days.

Adnexa Uteri↗
PubMed1999

Management of ectopic pregnancy.

Each year, around 11,000 women in the UK (around 1% of all pregnancies) present with an ectopic pregnancy, in which a fertilised ovum implants elsewhere than in the uterine cavity, usually a Fallopian tube. Left untreated, tubal ectopic pregnancy can lead to rupture of the Fallopian tube and life-threatening haemorrhage, and never results in a live birth. Improvements in management have led to a fall in the mortality rate from 2.9 per 1000 ectopic pregnancies in the early 1970s to 0.4 per 1000 in 1994-1996. Here we review the current management of tubal ectopic pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMed1978

Grey scale ultrasonography in the diagnosis of ectopic pregnancy.

Grey scale pelvic ultrasonography was performed in 36 patients with suspected ectopic pregnancy and in 3 with pelvic mass and bleeding. Thirteen cases were diagnosed as extrauterine pregnancy which was confirmed at operation. There were one false-positive and 2 false-negative studies. The overall diagnostic accuracy was 92.3%. The major diagnostic criteria in unruptured ectopic pregnancy were an extrauterine gestational sac or fetus and an abnormal uterine echo pattern. In addition, a complex mass due to hematoma was seen in ruptured ectopic pregnancy. Chronic ruptured ectopic pregnancy simulated pelvic inflammatory disease and was difficult to diagnose.

Adolescent↗
PubMed1990

Ectopic pregnancy: features at transvaginal sonography.

A retrospective review of the transvaginal sonograms of 50 women with laparoscopically confirmed ectopic pregnancy was performed to determine whether certain sonographic findings can be detected to confirm the diagnosis. Forty-seven of the 50 pregnancies were tubal. A tubal ring (a 1-3-cm mass consisting of a 2-4-mm concentric, echogenic rim of tissue surrounding a hypoechoic center) was seen in 23 of 34 (68%) ectopic pregnancies in which the fallopian tube had not ruptured, and the tubal ring could be distinguished from a corpus luteum cyst in most cases. Transvaginal sonography also depicted simple (n = 22) or particulate (bloody) (n = 13) peritoneal fluid associated with ectopic pregnancy. In each case in the series, at least one abnormal uterine, adnexal, or peritoneal finding was detected at transvaginal sonography. Because of its improved resolution of uterine and adnexal structures, transvaginal sonography is recommended as a means for detailed evaluation of patients suspected of having an ectopic pregnancy.

Adnexa Uteri↗
PubMed1991

Extrauterine findings of ectopic pregnancy of transvaginal US: importance of echogenic fluid.

Transvaginal ultrasound (US) studies of 232 consecutive patients with positive serum pregnancy tests who were considered to be at risk for ectopic pregnancy were prospectively evaluated to determine the significance of various extrauterine findings, including echogenic fluid in the cul-de-sac. All patients were found to have a surgically proved ectopic gestation (group 1, 68 patients [29.3%]), reliable evidence of intrauterine pregnancy at initial transvaginal US (group 2, 83 patients [35.8%]), or no evidence of pregnancy at initial transvaginal US, but subsequent proof of an intrauterine pregnancy (group 3, 81 patients [34.9%]). Adnexal findings were demonstrated in 45 (66%) group 1 patients, including a living extrauterine embryo in 10 (15%), an extrauterine gestational sac in 21 (31%), and an adnexal mass in 14 (21%). Intraperitoneal fluid was detected in 43 (63%) group 1 patients and in 81 (31%) group 3 patients. Echogenic fluid was the only abnormal finding at US in 10 (15%) group 1 patients and added confidence to the diagnosis of ectopic pregnancy in many others. Echogenic fluid correlated with hemoperitoneum at the time of surgery. The presence of echogenic fluid indicates a high risk for ectopic pregnancy in women referred with this clinical indication.

Female↗
PubMed1993

Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy.

PURPOSE: To evaluate the relationship of the endometrial canal and decidua vera to the interstitial gestational sac and to determine if this relationship can be used to increase the predictive value of ultrasound (US) in the diagnosis of interstitial ectopic pregnancy. MATERIALS AND METHODS: The US findings in 12 patients with interstitial ectopic pregnancy were reviewed. Radiologists also reviewed the cases of 40 patients with various diagnoses to assess the accuracy of the interstitial line sign. RESULTS: US showed a definite gestational sac in four of the 12 patients (33%); the rest had a heterogeneous mass in the cornual region. Thinning of the myometrial mantle was seen in these four patients. The gestational sac appeared eccentric in three of these but in only three of 12 (25%) overall. The endometrial canal or interstitial portion of the tube was identified in 11 of 12 patients (92%). The interstitial line had better sensitivity (80%) and specificity (98%) than eccentric gestational sac location (sensitivity, 40%; specificity, 88%) and myometrial thinning (sensitivity, 40%; specificity, 93%) for the diagnosis of interstitial ectopic pregnancy. CONCLUSION: The interstitial line sign is a useful diagnostic sign of interstitial ectopic pregnancy.

Adult↗
PubMed1998

Measurement of intrauterine human decidua-associated protein 200 and diagnosis of ectopic pregnancy.

The aim of the current study was to examine whether the measurement of intrauterine human decidua-associated protein (hDP) 200 might be of clinical value in the diagnosis of ectopic pregnancy versus early missed abortion. Uterine fluid levels of hDP 200 were measured in two groups of patients: 20 women with ectopic pregnancy, diagnosed by laparoscopy, and 20 women diagnosed (after curettage) as having a missed abortion. No significant difference in hDP 200 levels was observed comparing patients with ectopic pregnancy (mean 114.0+/-58.2 mU/ml) and patients with early missed abortion (mean 222.0+/-116.0 mU/ml), although a trend towards lower levels of uterine fluid hDP 200 was noted in the group of patients presenting with tubal pregnancy. Thus, according to our data, intrauterine hDP 200 is not sufficiently discriminative to be of clinical value in the diagnosis of ectopic pregnancy.

Abortion, Missed↗
PubMed2005

Detection of chromosome abnormalities by quantitative fluorescent PCR in ectopic pregnancies.

OBJECTIVE: To evaluate the potential value of quantitative fluorescent polymerase chain reaction (QF-PCR) in the detection of chromosome abnormalities in ectopic pregnancies. METHODS: Seventy chorionic villi samples of ectopic pregnancies were studied by QF-PCR. Primers for chromosomes 16, 21, X and Y in chorionic villi were evaluated. Fluorescence in situ hybridization (FISH) was performed when results of QF-PCR showed aneuploidy, in case of unexplicable QF-PCR peaks, and in 10 cases with normal QF-PCR results. RESULTS: QF-PCR produced a result for chromosomes X and Y in 66 cases (94%), for chromosome 16 in 62 cases (89%) and for chromosome 21 in 55 cases (79%). Overall, QF-PCR produced a result for the chromosomes tested in 54 ectopic pregnancy cases (77%). Fifty-two of these results were normal disomic (96%) and two were abnormal, one trisomy 16 (2%) and one triploidy (2%). In 16 cases (23%) no definite QF-PCR results could be obtained for all chromosomes, 11 due to amplification failure, and 5 due to unexplicable QF-PCR peaks. In 10 cases with normal QF-PCR results, disomy was confirmed by FISH. The trisomy 16 was also confirmed by FISH. Furthermore, a result was obtained with FISH in 5 of the cases without definite QF-PCR results. CONCLUSION: Although QF-PCR can establish the chromosomal status in ectopic pregnancies for chromosomes 16, 21, X and Y in the majority of cases, the technical failure rate is still considerable and does not improve results when compared to cytogenetic techniques.

Adult↗
PubMed1987

Ectopic corticotrophin-releasing-factor and growth hormone releasing factor secretion: diagnosis using human pituitary cell culture.

Cell culture of human pituitary tissue has been used to diagnose a patient with Cushing's syndrome due to ectopic secretion of corticotrophin-releasing factor (CRF; case 1) and a case of acromegaly associated with ectopic secretion of a growth-hormone releasing factor (GRF; case 2). In both patients a pituitary tumour was not detected. Case 1 had a small cell carcinoma and symptoms of the ectopic ACTH syndrome, but in culture the carcinoma failed to secrete detectable ACTH. However, the culture medium used to maintain this carcinoma in vitro was found to contain a substance which stimulated ACTH secretion by human pituitary corticotrophs in cell culture. Radioimmunoassays and HPLC indicated that this substance had similar elution characteristics to human CRF and cross-reacted with antiserum to ovine CRF. Case 2 was found to have a lung tumour, the removal of which led to regression of her acromegalic symptoms. In culture, this tumour did not secrete GH, but did secrete a GRF. We conclude that the Cushing's syndrome and acromegaly, in cases 1 and 2, respectively, were due to ectopic secretion of CRF and GRF leading to hyperstimulation of the pituitary gland.

Acromegaly↗
PubMed1997

Sigmoid volvulus after medical management with subsequent operative laparoscopy of unruptured ectopic pregnancy.

The use of methotrexate (MTX) as a first-line treatment of ectopic pregnancies has become popular recently. This report details a previously unreported complication of MTX treatment. Presumptive ectopic pregnancy with an initial beta-hCG level of 3,500 mIU/ml was treated with a single intramuscular dose of 50 mg/m2 MTX. Three weeks later with a beta-hCG level of 870 mIU/ml, the patient was operated for suspected rupture of ectopic pregnancy. Laparotomy revealed left aborted tubal pregnancy with active bleeding from left fimbria and estimated 2,000 ml of blood in the cul-de-sac. Left salpingectomy was performed. Two days later the patient developed signs of large bowel obstruction. The second laparotomy revealed sigmoid volvulus, that was treated with detorsion of the sigmoid loop. Although generally safe and effective, MTX should be used with utmost care in treatment of ectopic pregnancies.

Adult↗
PubMed1991

Transabdominal and transvaginal ultrasonographic diagnosis of ectopic pregnancy: clinical implications.

Thirty-five patients attending an emergency room with a positive pregnancy test and suspected ectopic pregnancy underwent an ultrasonographic examination with both the transabdominal and the transvaginal techniques. Twenty-four out of 26 ectopic pregnancies were correctly diagnosed on admission, combining results of the two techniques, the sensitivity of the two techniques used separately being 88.4% (transvaginal) and 76.9% (transabdominal). In our unselected symptomatic patients, the transvaginal technique showed to be advantageous but not essential in the management of ectopic pregnancy. The surgical outcome of these patients suggested that a prompt diagnosis of ectopic pregnancy did not warrant a conservative treatment.

Emergencies↗
PubMed1992

Transcatheter ablation of ectopic atrial tachycardia in young patients using radiofrequency current.

BACKGROUND: Ectopic atrial tachycardia (EAT) is a reversible cause of cardiomyopathy but may be quite difficult to control with conventional therapy. Transcatheter ablation with radiofrequency current was tested as an alternative to medical or surgical treatment of this condition. METHODS AND RESULTS: Twelve young patients (aged 10 months to 19 years) with drug-resistant EAT were treated with direct transcatheter ablation of the ectopic focus using radiofrequency (RF) energy. All had depressed left ventricular contractility by echocardiographic criteria, involving shortening fractions of 10-26% (median, 20%; normal, 28-35%). The EAT was mapped to the left atrium in seven cases and to the right atrium in five. Local atrial activation at the ectopic site preceded the onset of the surface P wave by 20-60 msec (median, 42 msec). Tachycardia terminated 0.5-13.0 seconds (median, 2.0 seconds) into a successful RF application. The ablation effectively eliminated EAT in 11 of 12 patients (92%), all of whom were discharged in sinus rhythm without medications after a median hospital stay of 48 hours. Ablation was unsuccessful in one patient with diffuse dysplasia of the anterior right atrium, who eventually did well after surgical resection of abnormal atrial tissue. Transient depression of sinus node function was noted in one patient who had successful ablation of an EAT focus in close proximity to the sinus node, although normal sinus node function returned within 72 hours. No other complications were encountered. During follow-up (3-21 months; median, 13 months), one patient had recurrence of a slower and less-sustained EAT that was successfully eliminated at a second ablation session. All others remained in sinus rhythm, and all 12 subjects recovered normal ventricular function. CONCLUSIONS: RF ablation appears to be a safe and effective therapeutic option for drug-resistant ectopic atrial tachycardia and may be the preferred first-line therapy for those patients with depressed ventricular function.

Adolescent↗
PubMed1975

Differences between purified ectopic and normal alpha subnits of human glycoprotein hormones.

"Ectopic" proteins, not distinguished immunologically from the common alpha subunit of the human glycoprotein hormones, were purified approximately 10,000-fold from a gastric carcinoid tumor (A.L.-alpha) and from tissue culture medium of bronchogenic carcinoma cell lines (ChaGo-alpha). The purified A.L.-alpha was homogeneous by sodium dodecyl sulfate (SDS) gel electrophoresis while the purified ChaGo-alpha showed multiple components, some of which represented aggregated species. In SDS gel electrophoresis, the apparent molecular weights of A.L.-alpha (15,000) and dithioerythritol-reduced ChaGo-alpha (13,000) were significantly lower than those of the alpha subunits of human chorionic gonadotropin (hCG-alpha), luteinizing hormone, follicle-stimulating hormone, or thyroid-stimulating hormone (22,000-23,000). Binding experiments with [35S]-SDS suggested that these apparent differences in molecular weight resulted, at least in part, from diminished binding of the SDS by the normal compared to the ectopic alpha subunits. In gel chromatography, the apparent molecular weights of A.L.-alpha (27,000) and ChaGo-alpha (30,000) were slightly higher than those of normal alpha subunits (23,000-24,000). Both A.L.-alpha and ChaGo-alpha were not distinguished from hCG-alpha in ion-exchange chromatography. The composition of A.L.-alpha was similar to that of hCG-alpha in 13 amino acids but showed decreased phenylalanine and increased valine; glucosamine was identified in both A.L.-alpha and hCG-alpha. Under conditions in which hCG-alpha combined with the hCG beta subunit (hCG-beta) to produce 95% of the expected gonadotropin-binding activity in a rat testis radioreceptor-assay, A.L.-alpha incubation with hCG-beta resulted in only 2% of the expected activity, and ChaGo-alpha incubation with hCG-beta produced no detectable activity. These characteristics of ectopic alpha subunits may reflect abnormalities of neoplastic protein synthesis or carbohydrate attachment which result in polypeptides with chemical and immunologic similarity to normal subunits but with differences in physical and combining properties; alternatively, the ectopic subunits may represent as yet unrecognized alpha precursor forms.

Amino Acids↗
PubMed1996

The pituitary V3 vasopressin receptor and the corticotroph phenotype in ectopic ACTH syndrome.

Ectopic ACTH secretion occurs in highly differentiated and rather indolent tumors like bronchial carcinoids or, in contrast, in various types of aggressive and poorly differentiated neuroendocrine tumors. We explored this phenomenon using the recently cloned human pituitary V3 vasopressin receptor as an alternate molecular marker of the corticotroph phenotype. Expression of V3 receptor, corticotrophin releasing hormone (CRH) receptor, and proopiomelanocortin (POMC) genes was examined in tumors of pituitary and nonpituitary origin. A comparative RT-PCR approach revealed signals for both V3 receptor and CHR receptor mRNAs in 17 of 18 ACTH-secreting pituitary adenomas, and 6 of 6 normal pituitaries; in six growth hormone- or prolactin-secreting adenomas, a very faint V3 receptor signal was observed in three cases, and CRH receptor signal was undetected in all. Six of eight bronchial carcinoids responsible for the ectopic ACTH syndrome had both POMC and V3 receptor signals as high as those in ACTH-secreting pituitary adenomas; in contrast, no POMC signal and only a very faint V3 receptor signal were detected in six of eight nonsecreting bronchial carcinoids. Northern blot analysis showed V3 receptor mRNA of identical size in ACTH-secreting bronchial carcinoids and pituitary tumors. Other types of nonpituitary tumors responsible for ectopic ACTH syndrome presented much lower levels of both POMC and V3 receptor gene expression than those found in ACTH-secreting bronchial carcinoids. In contrast with the V3 receptor, CRH receptor mRNA was detected in the majority of neuroendocrine tumors irrespective of their POMC status. These results show that expression of the V3 receptor gene participates in the corticotroph phenotype. Its striking association with ACTH-secreting bronchial carcinoids defines a subset of nonpituitary tumors in which ectopic POMC gene expression is but one aspect of a wider process of corticotroph cell differentiation, and opens new possibilities of pharmacological investigations and even manipulations of this peculiar ACTH hypersecretory syndrome.

ACTH Syndrome, Ectopic↗
PubMed1999

Ectopic pregnancy in Korle Bu Teaching Hospital, Ghana: a three-year review.

A retrospective study of ectopic pregnancies seen in Korle Bu Teaching Hospital from January 1991 to December 1993 was conducted. The incidence was 39.5/1000 deliveries; patients with ectopic were not of lower parity than those with normal pregnancies. The incidence of historical predisposing factors was 11.08%, although findings at operation indicated a much higher incidence of previous pelvic inflammatory disease (PID). Dizziness/fainting and abdominal distension were more frequent than has been reported elsewhere. This was due to a very high incidence of ruptured ectopic pregnancies (98.1%) with mean volume of haemoperitoneum of 1.37 l. 16.3% of patients were misdiagnosed initially. The second commonest site of tubal pregnancy, after the ampullary region, was cornual. The case fatality rate was 27.9/1000, with more than half of the deaths occurring before or soon after arrival in hospital. In order to reduce the incidence of ruptured ectopic pregnancies we suggest, among other measures, that appropriate diagnostic facilities be provided.

Adolescent↗