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At least 991 records · Page 55Linked to original sources
PubMed2004

Chronic ectopic pregnancy diagnosed incidentally in an infertile woman: a case report.

BACKGROUND: Chronic ectopic pregnancy is an enigma. The clinical presentation can be mild, with absent or subtle symptoms. The high incidence of negative pregnancy tests and the poor specificity of sonographic patterns can be misleading, and the correct diagnosis is sometimes established only at surgery or even histopathologically after the operation. We report the first case of a woman who was accidentally diagnosed with chronic ectopic pregnancy during diagnostic laparoscopy performed as part of a routine investigation for primary infertility. CASE: A 28-year-old woman underwent laparoscopyfor infertility. She had a regular menstrual cycle and was asymptomatic. She gave a history of a possible but unconfirmed miscarriage earlier. Her hormone profile was normal apart from a slightly raised prolactin level. An earlier ultrasound showed a polycystic appearance of the ovaries. Laparoscopy was done on the 25th day of the menstrual cycle, and beta-human chorionic gonadotropin was negative. At laparoscopy, a 2-cm mass wasfound in the right fallopian tube. There was no free blood in the pelvis, and no adhesions. Both tubes were patent at hydrotubation. The mass was excised laparoscopically, and histology confirmed a diagnosis of chronic ectopic pregnancy. CONCLUSION: A review of articles on chronic ectopic pregnancy confirmed the difficulty in diagnosing this condition preoperatively.

Adult↗
PubMed2005

[Clinical analysis of 13 cases of gestational trophoblastic tumor misdiagnosed as ectopic pregnancy].

OBJECTIVE: To evaluate clinical-pathological features, diagnosis and therapy of gestational trophoblastic tumor (GTT) misdiagnosed as ectopic pregnancy. METHODS: From 1999 to 2003, a total of 13 patients with GTT misdiagnosed as ectopic pregnancy were retrospectively analyzed. RESULTS: The main symptoms were amenorrhea, abdominal pain, irregular vaginal bleeding. Serum beta-human chorionic gonadotrop in (hCG) was measured in 10 patients. Eight had hCG values above 10,000 IU/L; 3 had hCG values above 50,000 IU/L. The lesions of GTT misdiagnosed as ectopic pregnancy were fallopian tube, horn of uterus, peritoneal cavity, greater omentum, recto-uterine pouch. According to standards of the International Federation of Gynecology and Obstetrics (FIGO) the 13 patients were categorized as 6 of stage I, 2 of stage II, 3 of stage III and 5 of stage IV. Histologically they included 10 cases of choriocarcinoma and 3 of invasise mole. All patients were treated by complete surgical resection combined with subsequent adjuvant chemotherapy. CONCLUSIONS: Misdiagnosis leads to delay in therapy with resultant increased morbidity of GTT. Analysis on serial hCG is helpful to differential diagnosis between ectopic pregnancy and GTT.

Adolescent↗
PubMed1992

Progesterone in diagnosis of ectopic pregnancy.

Previous reports suggest that serum progesterone value may be useful in the diagnosis of ectopic pregnancy. These studies have based discriminatory thresholds on a limited number of patients without using statistical correction for biologic variability in an infinitely large population. This study was designed to determine the ability of a single progesterone value to discriminate between normal, ectopic and blighted pregnancies. Sera were obtained from all positive beta HCG tests at Shands Hospital, University of Florida. All samples were assayed simultaneously with a solid phase RIA for progesterone and the results compared with pregnancy outcome. The mean progesterone for normal pregnancies was 32.8 +/- 4.25 ng/ml (n = 49), for ectopic pregnancies 7.8 +/- 0.79 ng/ml (n = 51), and pregnancies which spontaneously aborted 8.1 +/- 0.91 ng/ml (n = 74). Using individual prediction limits progesterone greater than 24 ng/ml would exclude an ectopic pregnancy in 99% of patients. Thus, this test may be useful in selected patients when the diagnosis is unsure after beta HCG and transvaginal ultrasound have been performed.

Abortion, Spontaneous↗
PubMedDate not supplied

Simple treatment of ectopic eruption with a triangular wedging spring.

The purpose of this clinical report was to introduce a simple and effective way of performing ectopic eruption treatment utilizing a triangular wedging spring. This consists of 3 helical loops in a triangular shape with 0.018-inch Australian wire. The middle helical loop is made for wedging spring action, while the other 2 helical loops are action arms inserted between the second primary molar and ectopically erupting permanent first molar. In this report, the ectopic eruption case was successfully treated with a triangular wedging spring in 2 months. This clinical report demonstrates that a triangular wedging spring can be utilized as a simple, less irritable, and more effective way of correcting ectopic eruption of the permanent first molar.

Child↗
PubMed2005

[Smoking and ectopic pregnancy: is there a causal relationship?].

Tobacco smoking is often studied as a risk factor in epidemiology. The impact on fertility and pregnancy is significant. At conception, maternal smoking may have an effect on the occurrence of ectopic pregnancy. Experimental studies on hamsters show interactions between tobacco and the oviduct. These interactions may explain the role of tobacco in ectopic pregnancy. Eleven case-control studies compared smoking in two groups of women: a cases group with ectopic pregnancy, and a control group. Ten of them found a relationship between tobacco smoking and ectopic pregnancy (increased relative risk). Considering this results, we must encourage women to reduce or better to stop smoking.

Fallopian Tubes↗
PubMed1991

Ectopic ACTH secretion. A misnomer.

Ectopic ACTH production is a common cause of Cushing's syndrome. In most patients, the neoplasm is obvious and is readily identified as the source of ACTH. However, in some patients, the neoplasm is not obvious and differentiating the tumor from a pituitary source is difficult. Current data demonstrate that virtually all normal tissues produce small amounts of a biologically inactive precursor ACTH molecule, probably proopiomelanocortin (POMC). All cancers produce this same substance in increased quantities. Selected cancers, correlated with histologic type, convert POMC to biologically active ACTH to produce the so-called ectopic ACTH syndrome. In this context, ectopic ACTH production is not ectopic.

ACTH Syndrome, Ectopic↗
PubMed2006

[Dynamic monitoring of serum human chorionic gonadotropin beta-subunit levels for early diagnosis of ectopic pregnancy].

OBJECTIVE: To assess the value of monitoring serum human chorionic gonadotropin beta-subunit (beta-HCG) level changes in early diagnosis of ectopic pregnancy. METHODS: Totalling 106 cases of ectopic pregnancy and 69 cases of threatened abortion were included in the study. Blood samples were collected to examine beta-HCG levels, which was repeated 2-3 days later. RESULTS: Initial serum beta-HCG levels of the women with ectopic pregnancy and different were significantly lower than those in women with threatened abortion (P<0.05), and the increment rate of serum beta-HCG in the former was also significantly lower (P<0.05). CONCLUSION: Compared with single-time serum beta-HCG detection, dynamic monitoring of serum beta-HCG provides more important and reliable evidence for early diagnosis of ectopic pregnancy. Transvaginal ultrasonography and in should also be considered in the clinical analysis.

Adult↗
PubMed2006

Ectopic pregnancy--risk factors and diagnosis.

BACKGROUND: Ectopic pregnancy is still the most common cause of first trimester maternal deaths, accounting for 73% of early pregnancy mortalities. OBJECTIVE: Detailed management will not be discussed in this review. However, risk factors for tubal ectopic pregnancy, ultrasound diagnosis and the benefits of early pregnancy units will be discussed. DISCUSSION: All women in the reproductive age group who present to a general practitioner or hospital emergency department with lower abdominal pain, with or without vaginal bleeding, have an ectopic pregnancy until proven otherwise. A urinary pregnancy test is mandatory in this clinical situation and if positive, these women should then have a transvaginal--not transabdominal--ultrasound scan (TVS) performed. The diagnosis of ectopic pregnancy should be based on the positive visualisation of an adnexal mass using TVS rather than on the basis of a scan that fails to demonstrate an intrauterine gestational sac. Diagnosing the condition earlier in its natural history using TVS has changed management options and reduced the associated mortality, with collapse and subsequent emergency laparotomy being the exception rather than the rule in modern practice. Early pregnancy units have been shown to benefit women with early pregnancy complications, reduce unnecessary admissions, reduce costs and are an effective use of resources.

Female↗
PubMed1991

Diagnosis of ectopic pregnancy by ultrasound in Siriraj Hospital.

The study of the diagnosis of ectopic pregnancy was carried out during the whole year of 1988 in the Department of Obstetrics & Gynaecology, Siriraj Hospital, in order to find out the characteristics of ultrasonographic findings by using real time ultrasound. Real time ultrasound examination was carried out on 121 patients with suspicion of ectopic pregnancy. The final diagnosis among these patients was ectopic pregnancy, ruptured corpus luteum, ruptured appendicitis, normal pregnancy, abortion, adnexal mass and no gynecologic abnormality encountered in 21 (17.35%), 3 (2.48%), 1 (0.83%), 27 (22.31%), 4 (3.3%), 43 (35.54%) and 22 (18.18%) respectively. Of 21 patients with ectopic pregnancy 17 (80.95%) cases were between 15-30 years of age with the gestational age ranging from 6 to 12 weeks in 16 patients (76.19%). The majority of the patients 18 (85.7%) were para 0-3. The ultrasonographic findings were pelvic mass and fluid in the cul de sac, pelvic mass and fluid in the cul de sac, pelvic mass only and the presence of free fluid alone encountered in 17 (80.95%), 3 (14.28%) and 1 (4.76%) cases respectively.

Adolescent↗
PubMed1991

Controlled ovarian hyperstimulation as a risk factor for ectopic pregnancy.

As part of a case-control study of ectopic pregnancy, we evaluated the potential etiologic role of controlled ovarian hyperstimulation in a population with no previous history of ectopic pregnancy. Ovulation induction alone was associated with an increased risk of ectopic pregnancy (adjusted odds ratio = 3.98; 95% confidence interval 1.10-14.30). In contrast, ovulation induction for in vitro fertilization did not increase the risk further (adjusted odds ratio = 2.45; 95% confidence interval 0.54-11.13). These results suggest that hormonal factors may be involved in the development of ectopic pregnancy.

Adult↗
PubMed1991

Serum CA-125 levels in women with ectopic and intrauterine pregnancies.

In women with ectopic pregnancies the extrauterine compartments are exposed to fetal tissue. Since such tissue is known to express CA-125, we measured serum levels of CA-125 in patients with ectopic pregnancies and compared them to those in patients with intrauterine pregnancies. A total of 44 pregnant women were included in the study; all were in the first trimester. Twenty-seven of them had ectopic pregnancies, and 17 had intrauterine ones. Our results show that women with ectopic pregnancies, ruptured or unruptured, were more likely to have elevated levels of serum CA-125 than were women who had intrauterine pregnancies.

Adult↗
PubMed1991

[The role of culdocentesis in the diagnosis of ectopic pregnancy. Prospective study of 478 cases].

Four hundred and seventy height Culdocenteses were carried out in cases of possible ectopic pregnancy between the 20th September 1986 and 31st December 1987. Culdocentesis was considered to be positive if 2 cm3 or more of dark non-coagulated blood was removed, and negative if only a yellow liquid or blood stained serum was removed. It was not conclusive if nothing could be aspirated or if the blood was coagulated. Of the 94 cases where culdocentesis was positive, 74 were found to have an ectopic pregnancy. There were 20 false positive cases (due to 5 haemorrhagic ruptures of follicles, 3 refluxes of menstrual blood, 2 with other aetiology, and 10 without known cause). There were 21 cases of ectopic pregnancy in the 293 cases where culdocentesis was non-conclusive. Of the 91 cases where culdocentesis was negative, a second culdocentesis showed an ectopic pregnancy. It was positive 11 days after the first. In our series this diagnostic test was reliable in 77.1% of cases. Laparotomy was carried out in 22.3% of cases and only 18.6% had to have laparoscopy thanks to the use of culdocentesis.

Clinical Protocols↗
PubMed1991

Repeated ectopic pregnancy.

The literature concerning ectopic pregnancy is reviewed with regard to the information on multiple ectopic pregnancies. The epidemiology, causes, and treatments for multiple ectopic pregnancies are summarized. In addition, the results of radical and conservative surgical management procedures and medical management are discussed in the context of the fertility of patients with multiple ectopic pregnancies, and procedures appropriate for the infertile patient are discussed.

Adult↗
PubMed1991

Comparison of transvaginal and transabdominal ultrasonography in ectopic pregnancy.

The authors retrospectively reviewed 45 consecutive cases of proven ectopic pregnancy for which both transvaginal (TV) and transabdominal (TA) ultrasonography had been performed to compare the diagnostic efficacy of the two imaging techniques. The criteria for a diagnosis of ectopic gestation included an extrauterine gestational sac containing a fetus or a fetal pole, or an empty extrauterine sac. Solid or complex adnexal masses with evidence of hemoperitoneum were considered suggestive but nondiagnostic. TV ultrasonography was superior to TA ultrasonography in 22 cases (49%) and inferior in 3 (7%). In the remaining 20 cases (44%) the two methods yielded similar information. For cases in which TV ultrasonography was superior, this method provided clear evidence of ectopic pregnancy in 11 cases in which TA ultrasonography demonstrated nonspecific masses or normal adnexa; in the other 11 cases both methods led to the correct diagnosis, but TV ultrasonography provided additional useful information. The authors conclude that TV ultrasonography has a definite role in improving the diagnosis of ectopic pregnancy.

Abdomen↗
PubMed1991

Simultaneous ectopic pregnancy with intrauterine gestation after in vitro fertilization and embryo transfer.

A case of combined intrauterine and tubal ectopic pregnancy is described following in vitro fertilization and the transfer of two four-cell and one two-cell embryos. This phenomenon is known to be related to ovarian stimulation by gonadotropin therapy, and there is an increased risk with tubal disease. Techniques applied at the time of embryo transfer, the use of culture medium with 50% fetal cord serum to convey the embryos to the uterus, the catheterization method, and the position of the patient during transfer are presented. The risk of multiple pregnancies and combined intrauterine and ectopic gestations increases with increasing numbers of transfers and large volume of transfer medium. We would therefore recommend that after IVF-ET treatment in women with tubal disease, intensive care should be taken in the early follow-up period to rule out the possibility of ectopic pregnancy. In this case, a viable ongoing intrauterine pregnancy was confirmed after surgery for right ampullary ectopic pregnancy. And a 2925gm male in excellent condition was delivered by cesarean section without complications.

Adult↗
PubMed1991

[An analysis of factors associated with ectopic pregnancy following in vitro fertilization and embryo transfer].

Five ectopic pregnancies occurred in 75 in vitro fertilization and embryo transfer (IVF-ET) pregnancies (6.7%) in Ogikubo Hospital IVF program between 1985 and 1989. The indication for IVF in 70 pregnancies was a tubal factor. Thirty cases were among 70 pregnancies with hydrosalpinx, and 40 cases were with other tubal conditions. All of the five cases had tubal disease. Four of them had hydrosalpingos. The percentage of ectopic pregnancies for the 30 pregnancies with hydrosalpinx was 13.3%, while for 40 pregnancies with other tubal conditions it was 2.5%. However, there was no significant difference between the two groups. No correlation was found in other parameters including superovulatory methods, oocyte recovery procedure, number of embryos transferred, embryo transfer procedure, and endocrine changes after embryo transfer. In this study, we were unable to identify a difference between ectopic pregnancy and intra-uterine gestation in IVF-ET. However, further study is required to clarify whether hydrosalpinx increases the risk of ectopic pregnancy in IVF-ET.

Adult↗
PubMed1991

Single-dose methotrexate for treatment of ectopic pregnancy.

Methotrexate treatment of unruptured ectopic pregnancy is safe and effective and preserves reproductive potential. Previous protocols have required multiple methotrexate doses with or without citrovorum rescue. The purpose of this study was to determine whether patients with an unruptured ectopic pregnancy 3.5 cm or less in greatest dimension could be treated with single-dose intramuscular methotrexate (50 mg/m2) without citrovorum rescue. Thirty-one patients were eligible for this outpatient treatment protocol. One patient withdrew from follow-up, leaving 30 patients (96.8%) in the study group. Patients had a mean age of 28.5 years (range 18-37) and a mean gravidity of 3.0 (range 1-8); nine of 30 (30%) had previously undergone a salpingectomy for ectopic pregnancy. Pre-treatment hCG titers ranged from 130-16,700 mIU/mL (mean 4558). Pre-treatment transvaginal sonography visualized the ectopic in 28 of 30 patients (93.3%) and revealed cardiac activity in six patients. Patients were monitored with hCG titers three times per week for the first week, and then weekly until the hCG was less than 15 mIU/mL. A complete blood count and liver enzymes were obtained before treatment and on day 7. All patients had a continued rise in hCG titer for at least 3 days after methotrexate injection, although all levels began to decline by day 7. No patient required a second dose of methotrexate and no patient experienced any side effects. Twenty-nine of 30 patients (96.7%) were successfully treated. Six of 30 (20%) experienced an increase in lower abdominal pain between days 5-10, and two were hospitalized overnight for observation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Ectopic eruption of the maxillary first permanent molar].

Ectopic eruption of the first maxillary molars shows a prevalence of 2 to 6% and is classified in two different types: I) "Jumping type" or "reversible ectopic eruption" II) "holding type" or "irreversible ectopic eruption". Different local as well as hereditary factors have been considered as responsible for the ectopic eruption. "Right on time" diagnosis and treatment subsequently, make the latter efficient and mainly easier for both the patient and the treating dentist.

Child↗