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PubMed1990

Transvaginal sonographic detection of the pseudogestational sac associated with ectopic pregnancy.

Fifty-seven of 261 patients (21.8%) referred with a presumptive diagnosis of an ectopic gestation had an extrauterine pregnancy. Five of the 57 ectopic pregnancies (8.8%) had a pseudogestational sac on transvaginal sonography. In four of these five cases, a single beta-hCG level had been obtained and did not help in differentiating an ectopic gestation from an early intrauterine pregnancy. A thorough assessment of the adnexa and cul-de-sac should be performed if a patient suspected of having an ectopic pregnancy has an apparent intrauterine gestational sac without a normal yolk sac or without detectable fetal cardiac activity.

Extraembryonic Membranes↗
PubMed1990

Conservative surgical treatment of ectopic pregnancy. Avoiding partial salpingectomy.

Salpingostomy is the preferred surgical method of managing ectopic gestation when patients desire future fertility. Problems with that technique stem principally from difficulties with hemostasis. While ligation of a single mesosalpingeal vessel has been described, blood to the site of the ectopic gestation is supplied primarily by the tubal branch of the ovarian artery. We developed a technique for ligating that vessel at both ends of the ectopic site. The technique may be combined with mesosalpingeal vessel ligation and leads to excellent hemostasis. Although blood vessels to the tube are interrupted, tubal length is preserved. Salpingostomy is thus possible, even in cases of large, actively bleeding or ruptured ectopic gestations. The need for partial salpingectomy, frequently utilized under those circumstances, is thus obviated. Salpingostomy may result in spontaneous recanalization; if anastomosis is needed subsequently, maximal tubal length is preserved.

Cautery↗
PubMed1990

The association between Chlamydia trachomatis and ectopic pregnancy. A matched-pair, case-control study.

We performed a case-control study of the association of past exposure to Chlamydia trachomatis and ectopic pregnancy with 306 case patients with an ectopic pregnancy and 266 pregnant patients who served as controls. The geometric mean antichlamydial antibody titer among cases was 75 +/- 10.2 vs 13 +/- 11.0 among controls. The matched-pair odds ratio for ectopic pregnancy and IgG titer of 1:64 or greater to C trachomatis was 3.0 (95% confidence interval, 2.1 to 4.4). Adjusting for age at first intercourse, total lifetime partners, douching, history of infertility, and parity yielded a relative risk of 2.4 (95% confidence interval, 1.5 to 3.3). Current douching remained an independent risk factor after controlling for chlamydial exposure, with an adjusted relative risk of 2.1 (95% confidence interval, 1.3 to 3.5). The population attributable fraction for chlamydial infection was 0.47 and that for douching was 0.45. The results stress the need for control of C trachomatis infections and for further study of specific douching behaviors as risk factors for ectopic pregnancy.

Adult↗
PubMed1989

Expectant management of persistent ectopic pregnancy. A case report.

Monitoring serum human chorionic gonadotropin (hCG) titers after conservative surgery for ectopic pregnancy has been recommended to rule out persistent ectopic pregnancy. With this increased monitoring, the occurrence of persistent ectopic pregnancy has been reported with increasing frequency. Management techniques for this complication have thus far been surgical or medical. We used expectant management for a case of persistent ectopic pregnancy, monitoring serial serum hCG titers to the limits of detectability over a period of 69 days.

Adult↗
PubMed1989

[Ectopic pregnancy in intrauterine contraception].

39 patients between 24 and 40 years of age with ectopic pregnancy associated with an IUP comprised 17.9 per cent of ectopics in an 8 year period. The IUP is probably not causal in ectopic pregnancy but does not protect the predisposed patient from ectopic pregnancy.

Adult↗
PubMed1989

Ectopic pregnancy and recurrent spontaneous abortion: two associated reproductive failures.

The association between spontaneous abortion and ectopic pregnancy was evaluated in a case-control study conducted on 161 women (cases) with recurrent spontaneous abortions (two or more consecutive spontaneous abortions) and 170 control subjects who delivered normal infants. The risk of ectopic pregnancy in women with a history of recurrent spontaneous abortion was about fourfold that of controls (relative risk adjusted for age and number of pregnancies = 4.3; 95% confidence interval 1.4-14.7). This association was confirmed by comparing the observed number of extrauterine pregnancies in women with recurrent spontaneous abortions with the expected number computed from regional data on the frequency of ectopic pregnancies; the estimated relative risk was 3.7, with a 95% confidence interval of 2.2-7.0. The present report found an association between spontaneous abortions and ectopic pregnancies, suggesting some common risk/etiologic factors for these two reproductive failures.

Abortion, Habitual↗
PubMed1989

[An epidemic of ectopic pregnancies in Ostre Akershus. Looking for possible causes].

During the period 1969 to 1985, 640 women with a confirmed diagnosis of ectopic pregnancy were admitted to Sentralsykehuset i Akershus. The case histories were reviewed for possible predisposing factors. From 1969 to 1985 the frequency of ectopic pregnancy increased threefold in relation to the number of conceptions in the same region. Until 1978 the major part of this increase was observed among women with IUCD in situ. Women who had previously undergone surgery on the uterine tubes accounted for the greater part of the increase in extrauterine pregnancies after 1976. A large year-to-year variation was found among women with neither of the above predisposing factors. However, a rising frequency of ectopic pregnancies was also observed in this group. It appears that the risk of ectopic pregnancy is greater among women using IUCD than among women using other methods of contraception.

Female↗
PubMed1986

Early recognition of ectopic pregnancy in an infertility population.

On an infertility service, 170 patients were evaluated for possible ectopic pregnancy using tests for beta-human chorionic gonadotropin levels, ultrasound, and clinical examination. Thirty-four (20%) of those evaluated underwent laparoscopy, of whom 31 (91%) were found to have ectopic pregnancies. Only three of the ectopic pregnancies were ruptured; only two women had significant hemoperitoneum and only two required transfusion. Subsequent intrauterine pregnancy occurred in 5 of 11 patients who underwent salpingectomy (45%) and in 1 of 15 patients who underwent salpingotomy (7%). There were no subsequent pregnancies in five patients after expression of the ectopic from the tube. Early intervention in an infertile population decreases morbidity and may favor conservative tubal surgery, although our series could not confirm the benefits of such surgery.

Chorionic Gonadotropin↗
PubMed1988

The changing spectrum of ectopic pregnancy.

There was a 3.7-fold increase in ectopic pregnancies over the last 21 years, with the occurrence rate among blacks remaining higher than for white patients. The average age of patients with ectopic pregnancies has not changed. A history of ectopic pregnancy or tubal surgery is now found in 25% of patients with ectopic pregnancies. The traditional etiologic factors have remained about the same.

Adult↗
PubMed1985

Diagnosis of ectopic pregnancy: value of the discriminatory human chorionic gonadotropin zone.

A prospective study was conducted to test the hypothesis that the absence of an intrauterine gestational sac when the serum level of human chorionic gonadotropin (hCG) is above 6500 mIU/mL is indicative of ectopic pregnancy. A total of 383 patients who were clinically suspected to have ectopic pregnancies had pelvic ultrasound examinations with serum hCG determinations on the day of the scan. There were 217 (57%) intrauterine gestations, 104 (27%) ectopic pregnancies, and 62 (16%) spontaneous abortions. Forty-one percent of patients had an hCG level above 6500 mIU/mL. The absence of an intrauterine gestational sac at an hCG concentration above this level had a sensitivity of 100%, a specificity of 96%, a positive predictive value of 86%, a negative predictive value of 100%, and was 98% efficient, based on a 19.4% prevalence of ectopic pregnancies among this group.

Abortion, Spontaneous↗
PubMed1986

[Ectopic pregnancy].

In Finland there were 3 193 ectopic pregnancies registered during the years 1973-1976 (1,25% of the newborns) and 4 856 ectopic pregnancies (1,91%) during the years 1977-1980. Also in the State Maternity Hospital Helsinki the ectopic pregnancy rate rose from 0,8% to 1,4%. During the years 1977-1980 241 women were operated on. From 112 patients without postoperative contraception 48% gave birth, 33% remained infertile, 10% had a recurrent ectopic pregnancy and 9% had an abortion. The best results were achieved in the salpingectomy group. In cases of conservative operations expression was more favorable than salpingotomy. With the development of better diagnostic methods the possibility of conservative operations, partial resection of the tube, respectively, later followed by microsurgical anastomosis, will be increased.

Adolescent↗
PubMed1967

Ectopic pregnancy: a statistical review of 360 cases.

In a statistical analysis of 360 cases of ectopic pregnancy admitted to the Montreal General Hospital over a 20-year period ending December 1964, ectopic gestation occurred once in every 83 admissions to the gynecological service. This incidence has remained constant over the years. Only one out of four patients had had more than one child and 30% of the patients had absolute or relative infertility. Diagnosis was delayed or not made in 58 patients. There was evidence that neurogenic factors play a role in the etiology of ectopic gestation. Ten per cent of the patients had had a previous operation for the same condition. Symptomatology is variable and the possibility of ectopic pregnancy must never be overlooked in a woman of child-bearing age. Once the diagnosis is made the treatment is early operation. The morbidity rate in this series was 28% and there was one death.

Adolescent↗
PubMed1984

Chronic ectopic pregnancy. A survey of 54 cases.

The diagnosis of chronic ectopic pregnancy is very often difficult. The subtle and long-standing symptoms, the relative paucity of clinical signs and the high incidence of false-negative results of relevant investigations contribute to the mimicry of many other intraabdominal conditions by chronic ectopic pregnancy. Surgery for chronic ectopic implantation is frequently difficult since chronic inflammatory changes involving the bladder, bowel and ureters distort the normal anatomy, and the incidence of postoperative complications is high. There is a surprising shortage of literature in which this disease is recognized as an entity separate from the condition of acute ectopic pregnancy.

Adolescent↗
PubMed1982

Ultrasound evaluation of ectopic pregnancy.

The combined use of a serum radioimmunoassay pregnancy test and high resolution utrasonography allows a more direct approach to be made in the diagnosis of ectopic pregnancy. It is important for ultrasonographers to understand the limitations of the more readily available immunologic pregnancy tests in order to avoid misinterpreting ultrasonograms in the event that a pregnancy test is either falsely positive or falsely negative. Clinical suspicion is mandatory if the early diagnosis of ectopic pregnancy is to be made. The referring physician should take advantage of the highly accurate information resulting from the combined findings of a positive serum HCG and the ultrasonographic images. If the statistics regarding diagnostic delay and tubal rupture are to be improved, these tests should be obtained when a patient is initially evaluated. It is important to recognize that the ultrasonographic interpretation rests primarily upon the uterine findings. A normal viable intrauterine pregnancy essentially excludes the diagnosis of ectopic pregnancy. Other uterine appearances may result from an early intrauterine pregnancy, an abnormal intrauterine gestational event, or, as in approximately 1 per cent of pregnancies, an ectopic gestation. Subsequent evaluation in suspicious cases may require a variety of tests including serial HCG determinations, repeat ultrasound examination, uterine dilatation and curettage, culdocentesis, or laparoscopy. It is impossible to recommend a specific schematic approach for any given patient. In part, the pattern of management depends upon availability of tests, the presence or absence of adnexal or cul-de-sac findings, and, of course, the clinical status of the patient.U

Biopsy, Needle↗
PubMed1984

Human chorionic gonadotropin in maternal plasma after induced abortion, spontaneous abortion, and removed ectopic pregnancy.

Human chorionic gonadotropin (hCG) in maternal serum was analyzed by a hCG-beta-subunit, radioimmunoassay (hCG-beta-RIA) in 36 cases after induced first-trimester abortion, 35 cases of spontaneous abortion in the first trimester, and in 35 cases of ectopic pregnancy to determine the time between the apparent removal of all trophoblastic tissue by surgical intervention and the disappearance of hCG from the blood. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy d. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy d. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy and removal of the affected tube. There was a significant correlation between the initial hCG levels and the disappearance time in each series. The demonstrated disappearance times are longer than previously recognized, which should be appreciated when hCG is analyzed after termination of early pregnancy.

Abortion, Induced↗
PubMed1984

Trends in ectopic pregnancy in Canada.

The incidence in Canada of one complication of sexually transmitted disease, ectopic pregnancy, was examined by age group for the years 1971 through 1980 by means of hospital statistics provided by Statistics Canada. The denominator was "reported pregnancies"--the total of live births, stillbirths, legal abortions and ectopic pregnancies in a given year. In 1980, 4123 ectopic pregnancies (9.3/1000 reported pregnancies) were reported, a 63% increase from 1970. The incidence had increased in each age stratum. This trend may be related to increasing rates of gonococcal infection and of hospitalization for pelvic inflammatory disease and lends confirmation to data from other countries that relate the increase in the rate of ectopic pregnancy to rising rates of sexually transmitted disease.

Adolescent↗
PubMed1984

Incidence of ectopic pregnancy in Rochester, Minnesota, 1950-1981.

Trends in the occurrence of ectopic pregnancy from 1950 through 1981 were evaluated in the defined population of Rochester, Minnesota. The average ratio of ectopic pregnancies to live births was 1:171. The ratio declined from 1:141 to 1:217 from 1955-1959 to 1970-1974 and increased sharply to 1:122 by 1975-1980. Similarly, the average age-adjusted incidence rate of ectopic pregnancies per 100,000 women of childbearing age was 49 over the period studied. A peak rate of 79 per 100,000 was reached in 1955 to 1959, and a trough of 30 per 100,000 occurred in 1970 to 1974; this was followed by a sharp increase to 49 per 100,000 in 1975 to 1981. Methods of measuring ectopic pregnancy are contrasted, and possible risk factors are suggested.

Abortion, Induced↗
PubMed1984

Ectopic pregnancy subsequent to sterilization: histologic evaluation and clinical implications.

Ten ectopic pregnancies subsequent to tubal sterilization were histologically evaluated. In seven of the ten cases, the sites for the ectopic implantation appeared to be related to the presence of a distal remaining tubal segment that had a tuboperitoneal fistula on the medial side. As against a currently held opinion that the ectopic implantation occurs secondary to a relative disparity in the size of the sperm, the fertilized ovum, and the proximal tuboperitoneal fistula, we believe that the implantations are influenced by probable fluid movements within the remaining tubal segments. The need to consider conservative surgical approaches and good intraoperative notations in patients with an ectopic pregnancy subsequent to sterilization is stressed.

Body Fluids↗