Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ectopic”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,387 records · Page 77Linked to original sources
PubMed1981

The use of ultrasonography in the diagnosis of ectopic pregnancy.

Ultrasonography was used to examine 196 cases of suspected ectopic pregnancy. The final diagnosis was established in 185 cases by means of surgical intervention or follow-up. The actual number of ectopic pregnancies was found to be 42, of which 30 (71%) had been correctly diagnosed by ultrasound. There was a false negative rate of 29%. Of the group of 185 patients followed up, a false positive diagnosis had been made in six cases (4.2%). On the basis of these results, we conclude that, while ultrasonography offers significant help when a non-invasive diagnostic method for ectopic is desired, it is not yet, in spite of the present level of technical development, a completely reliable method in such cases.

Adolescent↗
PubMed1983

Predictive value analysis of measurements of human chorionic gonadotropin, pregnancy specific beta 1-glycoprotein, placental lactogen, and cystine aminopeptidase for the diagnosis of ectopic pregnancy.

The diagnostic utility of serum and urinary human chorionic gonadotropin (hCG) measurements and serum measurements of pregnancy-specific beta 1-glycoprotein (PSBG), placental lactogen, and cystine aminopeptidase (CAP) was prospectively studied in 51 consecutive patients with suspected ectopic pregnancy who underwent laparoscopy or laparotomy. CAP was not detected in the sera of any patient with ectopic pregnancy. False-positive results in each assay were found in patients with intrauterine pregnancy or missed abortion. The overall efficiency of the tests were: urine hCG slide test, 47%; urine hCG tube test, 80%; serum hCG, 86%; serum PSBG, 82%; and human placental lactogen, 60%. Although measurement of serum hCG by radioimmunoassay is the most accurate biochemical test in predicting the correct diagnosis in patients with suspected ectopic pregnancy, the relatively high efficiency of the urinary hCG tube test, coupled with its ease of performance, low cost, and rapid turnaround time, makes it the most practical screening test.

Aminopeptidases↗
PubMed1984

Sex ratio in ectopic gestations.

Sex assignment was determined in 80 cases of ectopic pregnancy. Tissue sections of chorionic villi were stained with quinacrine for demonstration of either X or Y chromatin. Forty-one (51.2%) were X-chromatin (Barr body)-positive; 38 (47.5%) were Y-chromatin-positive, and 1 (1.3%) was Barr- and Y-positive in the same nuclei. The sex ratio of ectopic gestations in this study was 0.92 male to 1 female. Based on these data, there appears to be no predilection for ectopic implantation by either sex.

Chorionic Villi↗
PubMed1991

Risk factors for ectopic pregnancy in 556 pregnancies after in vitro fertilization: implications for preventive management.

OBJECTIVE: To analyze risk factors for ectopic pregnancy (EP) after in vitro fertilization (IVF). DESIGN: A retrospective study of IVF pregnancies was performed between November 1983 and December 1989. SETTING: This study was conducted in a tertiary care center, the Port-Royal University Hospital. PATIENTS: Patients' records were reviewed for 48 EP and 508 intrauterine pregnancies obtained by IVF. INTERVENTIONS: Forty-six salpingectomies were performed for EP after IVF. MAIN OUTCOME MEASURE: We evaluated the impact on the ectopic rate of tubal status, the type of ovarian stimulation and luteal phase support, and the number of embryos transferred. RESULTS: Forty-three of 48 EP occurred in patients with tubal infertility. The rate of EP was significantly higher when the indication was tubal (11.1%) than when it was endometriosis (2.1%) or unexplained infertility (3.4%). Pathological findings revealed tubal lesions in all 46 salpingectomies. CONCLUSIONS: Ectopic pregnancy after IVF appears related to pre-existing tubal pathology. However, routine prophylactic salpingectomy to prevent the risk of EP does not appear justified.

Adult↗
PubMed1995

Prognostic factors for successful expectant management of ectopic pregnancy.

OBJECTIVE: To determine the independent ability of initial hCG titers, trend of hCG titers, and ultrasonographic findings in the prediction of successful expectant management in ectopic pregnancy (EP). DESIGN: Case-control study. SETTING: University hospital. PATIENTS: Sixty-seven patients with EP managed expectantly, 49 of whom (73%) had a spontaneous resolution, whereas 3 (5%) underwent medical treatment, and 15 (22%) eventually underwent surgical treatment. RESULTS: Univariate analysis showed that the initial hCG titer, the trend in hCG titers between first and second sample, and ultrasonographic visualization of absence of an ectopic gestational sac were significant predictors of a successful expectant management. Using receiver operating characteristic curve analysis, an hCG titer < 1,000 mIU/mL was chosen as the optimal cutoff for this prediction, identifying 88% of women destined to have spontaneous resolution of the EP. Multivariate analysis showed that both initial hCG titer and trend in hCG titers but not ultrasonographic visualization of an ectopic gestational sac were independent predictors of a successful or failed expectant management. CONCLUSION: Expectant management of EP is successful in the majority of patients with initial hCG titer < 1,000 mIU/mL.

Abortion, Spontaneous↗
PubMed1995

Reversible alopecia after single-dose methotrexate treatment in a patient with ectopic pregnancy.

OBJECTIVE: To report a case of a women who received a single 50 mg/m2 dose of methotrexate (MTX) on two occasions for two separate ectopic pregnancies. After both treatments the patient experienced reversible alopecia. DESIGN: Case report. SETTING: Single human patient in a university-run clinic. PATIENTS: A patient with an ectopic pregnancy presenting for treatment on two separate occasions. INTERVENTIONS: A single dose of 50 mg/m2 MTX given to the patient on both occasions. MAIN OUTCOME MEASURE: Loss of scalp hair. RESULTS: On two separate occasions the patient lost a significant portion (33% to 50%) of her scalp hair. CONCLUSION: Even single-dose MTX as used for the treatment of ectopic pregnancy may induce alopecia in a susceptible patient.

Adult↗
PubMed1987

Detection of urinary human chorionic gonadotropin by rapid immunoconcentration method is the first-line test for suspected ectopic pregnancy.

Nine hundred nine patients with suspected ectopic pregnancy were tested for human chorionic gonadotropin (hCG) using two qualitative assays: the Tandem Icon urine assay (Hybritech, San Diego, CA) and a serum radioimmunoassay (RIA) employing a positive cut-off of 25 IU/l. Pregnancy status was determined by clinical or histologic examination, or detection of hCG or its metabolites in four quantitative immunoassays: two RIAs and two immunoradiometric assays (IRMAs). Both the Tandem Icon and the qualitative RIA detected all 71 patients with ectopic pregnancy. The predictive indices of the Icon were 100% for a positive result and 99.6% for a negative result, and those of the RIA were 96.7 and 99.6%, respectively. The Tandem Icon thus fulfils the need for a simple, rapid, and sensitive method for hCG in the detection of patients with suspected ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1988

Spontaneous pregnancies and pregnancies as a result of treatment on an in vitro fertilization program terminating in ectopic pregnancies or spontaneous abortions.

Five hundred three patients were accepted for the in vitro fertilization (IVF) program from 1983 to 1986. Two hundred ninety-nine patients had a total of 678 IVF treatment cycles during this period. Eighty-one clinical pregnancies resulted, of which 8 were ectopic pregnancies and 19 spontaneous abortions (group A). During this period 82 patients accepted for IVF became pregnant spontaneously: 44 before treatment and 38 after a failed IVF treatment cycle (group B). Of these, 14 were ectopic pregnancies and 8 were miscarriages. The main indications for acceptance on the IVF program were similar in the two groups if those patients who had a bilateral salpingectomy are excluded from group A. Causative factors for the high ectopic pregnancy rate are discussed. The authors suggest that after embryo transfer, migration of the embryo or embryos into the fallopian tubes occurs more frequently than realized, and the diseased tube is less likely than a normal tube to propel the embryo back into the uterus. The abortion rate in group B was similar to the rate in the general population.

Abortion, Spontaneous↗
PubMed1988

Serum progesterone in the diagnosis of ectopic pregnancy: a valuable diagnostic test?

The value of a single serum progesterone (P) assay in the diagnostic work-up of suspected ectopic pregnancy was investigated in 89 patients with ectopic pregnancy and 27 patients with incomplete abortion. Reference values for P in the blood were obtained from 77 patients with normal intrauterine pregnancies in the first trimester. With the use of a discriminatory level of 63 nmol/l (20 ng/ml), sensitivity of 92%, specificity of 84%, positive predictive index of 90%, and negative predictive index of 87% were achieved. Addition of pelvic ultrasound further improved the diagnostic accuracy. It is concluded that serum P measurement offers a valuable adjunct to existing methods of diagnosis of ectopic pregnancy.

Biomarkers↗
PubMed1989

Conservative management of ectopic gestation.

The management of ectopic gestation has become more challenging than ever before. The recent progress in diagnostic modalities, i.e., ultrasound and sensitive beta-hCG assays, has enabled early detection of ectopic gestation and a change in treatment goals. The traditional catastrophic presentation of a ruptured ectopic gestation and hemoperitoneum no longer is common. Today this condition is typically diagnosed before a rupture occurs, while the patient is only minimally symptomatic. Accordingly, treatment has shifted from an immediate life-saving intervention, into conservative methods of management, directed at preserving fertility and reducing morbidity. As experience is being gained rapidly in the various conservative treatment methods, their respective merits can be evaluated. Laparoscopic linear salpingostomy is the treatment of choice for small, unruptured, isthmic or ampullary gestations. Laparoscopic segmental resection is most suitable for ruptured tubal gestations. These procedures should be performed via laparotomy only if the patient is hemodynamically unstable. In selected cases, nonsurgical treatment methods, i.e., expectant management or methotrexate, may be considered. Serial serum beta-hCG measurements following a conservative treatment is mandatory to rule out persistence of trophoblastic tissue. Further prospective randomized studies are needed, to compare different conservative treatment methods in regard to their respective safety, reproductive outcome, and economic feasibility.

Chorionic Gonadotropin↗
PubMed1998

Serum human chorionic gonadotropin measurement in the diagnosis of ectopic pregnancy when transvaginal sonography is inconclusive.

OBJECTIVE: To assess the accuracy of initial and repeated serum hCG measurements in the diagnosis of ectopic pregnancy (EP) in patients in whom transvaginal sonography is inconclusive and to evaluate whether patient characteristics influence the accuracy of serum hCG measurements. DESIGN: Prospective study. SETTING: Two large teaching hospitals in Amsterdam, the Netherlands. PATIENT(S): Three hundred fifty-four consecutively seen pregnant patients with suspected EP and inconclusive transvaginal sonographic findings. INTERVENTION(S): Serum hCG measurements. MAIN OUTCOME MEASURE(S): The performance of repeated serum hCG measurements in the diagnosis of EP was evaluated through the analysis of receiver operating characteristic curves. RESULT(S): Initial serum hCG measurements were more diagnostic in conjunction with sonographic evidence of an ectopic mass or fluid in the pouch of Douglas than in the absence of sonographic abnormalities. On repeated measurement, the course of the serum hCG concentration provided more diagnostic information than did the absolute serum hCG concentration 2 and 4 days after the start of the diagnostic process. CONCLUSION(S): The interpretation of serum hCG measurements should depend on additional findings at transvaginal sonography. A cutoff level of 1,500 IU/L is recommended for patients with an ectopic mass or fluid in the pouch of Douglas; in patients without these findings, the cutoff level should be at least 2,000 IU/L. Four days after the start of the diagnostic process, any rise in the serum hCG concentration makes the diagnosis of EP very likely.

Chorionic Gonadotropin↗
PubMed1998

Viability of Chlamydia trachomatis in fallopian tubes of patients with ectopic pregnancy.

OBJECTIVE: To use standard molecular methods to define the prevalence and metabolic characteristics of Chlamydia trachomatis during infection of fallopian tubes in women with ectopic pregnancies. DESIGN: Polymerase chain reaction (PCR)- and reverse transcription-PCR (RT-PCR)-based assessment of presence of chlamydial DNA and various RNA species in fallopian tube biopsy samples. SETTING: Hospital and molecular genetics laboratory. PATIENTS: Ten women of varying ages, each presenting with ectopic pregnancy. MAIN OUTCOME MEASURE(S): Positive signal in specific chlamydia-directed PCR and RT-PCR assays. RESULT(S): Nucleic acid preparations from 7 of the 10 fallopian tube patient samples were PCR-positive for C. trachomatis DNA. Each of the 7 PCR-positive samples also showed the presence of several transcripts from the bacterium, including primary transcripts from the ribosomal RNA operons. CONCLUSION(S): A higher proportion of ectopic pregnancies than was believed previously may be attributable to infection of the fallopian tubes by C. trachomatis. The presence of various chlamydial RNA molecules suggests that viable, metabolically active bacteria were present in fallopian tubes of the patients studied.

Adult↗
PubMed2003

Autotransfusion for ruptured ectopic pregnancy.

OBJECTIVES: Clinical outcomes following the exclusive use of autotransfusion in the management of ruptured ectopic pregnancy are reviewed. METHODS: A MEDLINE search (1966-2002) for relevant articles documenting the exclusive use of autotransfusion, and data collection and analysis was made. RESULTS: There were 21 studies, 16 from developing and five from developed countries, involving 632 cases of ruptured ectopic pregnancies. Hypovolemic shock with significant hemoperitoneum (>500 ml) was the most common complication. The procedure was performed completely manually in developing countries and with the help of a device in developed countries. The mean volume of autotransfused blood was over 1000 ml, with mean hemoglobin levels ranging from 6 to 12.5 g/dl. Mean posttransfusion hemoglobin levels were higher than pretransfusion levels. There was one death, thought to be due to pulmonary embolism, and nine major and minor complications. CONCLUSIONS: Autotransfusion is useful in the management of ruptured ectopic pregnancy.

Blood Transfusion, Autologous↗
PubMed1990

Ectopic pregnancy in adolescents: a clinical review for pediatricians.

Pediatricians caring for sexually active female adolescents and young adults need to be aware of the history, symptoms, and signs of an ectopic pregnancy. A thorough history and physical examination, including the pelvic examination, as well as specific diagnostic tests such as repeated quantitative hCG measurements, and ultrasonography when indicated, are crucial to proper and early diagnosis of a nonruptured ectopic pregnancy manageable by laparoscopy. The key to early diagnosis is to include ectopic pregnancy in the differential diagnosis in any sexually active female patient who has abnormal vaginal bleeding or abdominal pain. With early diagnosis, close observation, and appropriate management, the outcome is more likely to be favorable, with minimal morbidity and risk of death.

Adolescent↗
PubMed1989

Ectopic pregnancy: current evaluation and treatment.

During the past 20 years, the diagnosis and treatment of ectopic pregnancy have improved considerably. With the current diagnostic modalities, patients at risk for ectopic pregnancy can be followed expectantly, and the diagnosis can be made within a few days of the time of anticipated menses. An enhanced understanding of the varied clinical course of ectopic pregnancy has been gained in the process, and greater individualization of patient care has been possible. Patients with spontaneous tubal abortion are being identified, and they may be better served by observation. The precise role and limitations of pharmacologic agents and the new surgical procedures are still being determined, but the ultimate goal with use of these modalities is an improved potential for fertility.

Chorionic Gonadotropin↗
PubMed2001

Expectant management of intramural ectopic pregnancy.

BACKGROUND: Intramural ectopic pregnancy is unusual, difficult to diagnose, and associated with a high rate of uterine rupture. CASE: A 35-year-old, gravida 3, para 0-0-2-0 was diagnosed with intramural ectopic pregnancy by ultrasound showing a gestational sac surrounded completely by myometrium. It was confirmed by laparoscopy. With expectant management, the gestation resolved spontaneously. CONCLUSION: Early diagnosis by ultrasound of intramural ectopic pregnancy permits expectant management which, if successful, would aid in maintaining fertility.

Abortion, Spontaneous↗
PubMed2002

Hysteroscopic management of cornual ectopic pregnancy.

BACKGROUND: Cornual ectopic pregnancies have traditionally been treated with systemic methotrexate, cornual resection, or hysterectomy. CASE: A 36-year-old newly gravida presented with an 8-week history of amenorrhea and a positive home pregnancy test. A transabdominal sonogram revealed a left cornual ectopic pregnancy. The patient was treated with multiple methotrexate doses, but the gestational sac persisted. Through the hysteroscope, the sac was ruptured, and the placental tissue was removed from the left cornu under sonographic guidance. Two weeks postoperatively, the patient's beta-human chorionic gonadotropin level was negative, and she had a normal pelvic examination and sonogram. CONCLUSION: Hysteroscopic removal under sonographic guidance after methotrexate treatment is a conservative option for the treatment of cornual ectopic pregnancy in some patients.

Adult↗
PubMed2002

Ectopic pregnancy after cesarean hysterectomy.

BACKGROUND: Ectopic pregnancy after a total abdominal hysterectomy is rare and, for this reason, delay in diagnosis may occur when such a patient presents with abdominal pain. CASE: A multiparous patient with a history of cesarean hysterectomy 12 years before presented to the emergency department with abdominal pain and incidental positive urine beta-human chorionic gonadotrophin (hCG). A computed tomography scan revealed a loculated left cystic mass in the pelvis. Laparotomy findings revealed a left adnexal mass; pathology revealed chorionic villi consistent with pregnancy. CONCLUSION: Ectopic pregnancy may occur after hysterectomy, but typically presents near the time of surgery and is more commonly associated with vaginal hysterectomy. However, because ectopic pregnancy is possible after hysterectomy, it should be considered in the differential diagnosis of adnexal mass in such a patient.

Adnexal Diseases↗