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PubMedDate not supplied

Nonsurgical management of unruptured isthmic ectopic pregnancy: preliminary experience.

Five unruptured isthmic tubal pregnancies diagnosed at laparoscopy were treated with either methotrexate/citrovorum factor rescue (MTX/CF) (n = 4) or observation alone (n = 1). Entry criteria required that the ectopic be fully visualized, no greater than 3 cm in diameter, with intact serosa, and without active bleeding. Treatment selection was based upon preoperative levels of beta-hCG with MTX/CF given to subjects exhibiting a plateaued or rising pattern and observation alone given those with falling levels. Subjects were followed with serial measurements of beta-hCG, complete blood counts, and liver function tests. In all subjects the ectopic pregnancy resolved without further surgery. Time to resolution (first day of treatment to undetectable beta-hCG) ranged from 12 to 55 days. Of the five subjects studied, follow-up hysterosalpingograms in four demonstrated tubal patency on the side of the ectopic gestation.

Adult↗
PubMedDate not supplied

Microscopic evidence of silent inflammation in grossly normal fallopian tubes with ectopic pregnancy.

A normal laparoscopic examination of the pelvis in an infertile patient is usually considered sufficient evidence of normal tubal function. Twelve of 27 tubal ectopic pregnancies which occurred over a 4-year period in patients attending an infertility clinic were in patients with a previously "normal" laparoscopy. In eight patients, salpingectomy was performed, and the whole tube was available for examination by a single pathologist. The eight fallopian tubes, thoroughly examined histologically, all had evidence of ongoing, low-grade salpingitis or postinflammatory endosalpingeal disorganization in areas away from the ectopic pregnancy. These findings suggest that laparoscopy does not exclude significant microscopic tubal disease in at least some women with an apparently normal pelvis, and that this may be a cause of ectopic pregnancy and perhaps "idiopathic" infertility.

Fallopian Tubes↗
PubMed1986

Fertility after nonsurgical treatment of ectopic pregnancy.

There is no question that the treatment of choice for ectopic pregnancy is surgery. However, since some ectopic pregnancies terminate in tubal abortion or complete resorption, it is questionable whether surgery is necessary in every case. Some patients can be managed by monitoring rising or falling levels of beta-human chorionic gonadotropin (beta-HCG) until tubal abortion or resorption occurs. This approach, which may be the best means of preserving tubal function and fertility, was used in 14 patients who fulfilled extremely selective criteria. In some of the patients, surgery later proved to be necessary, but in 11 nonsurgical management was followed by a fall in beta-HCG levels, and there were no further untoward effects. Three of these patients subsequently developed intrauterine pregnancies, and one patient had a repeat ectopic.

Abortion, Missed↗
PubMed1987

Role of qualitative choriogonadotropin assays in diagnosis of ectopic pregnancy.

We compared the clinical sensitivity and cost-effectiveness of a qualitative assay for choriogonadotropin in human urine ("Icon" hCG) with a quantitative assay of serum from 142 women with pathologically-diagnosed ectopic pregnancy. Results show that although the qualitative assay had a clinical sensitivity for pregnancy of 98.6%, as compared to 100% for the quantitative assay, it was more economical to use, and had a significantly shorter turnaround time. We conclude that qualitative hCG assay of either urine or serum is a good screening method for detecting pregnancy, and can replace the stat quantitative assay in women with suspected ectopic pregnancy. We present a diagnostic algorithm to illustrate the role of qualitative and quantitative hCG assays in conjunction with ultrasonography, culdocentesis, and laparoscopy for diagnosis of ectopic pregnancy.

Algorithms↗
PubMed1987

Laparoscopic salpingostomy for ectopic pregnancy.

Seventy-nine ampullary tubal ectopic pregnancies were managed using laparoscopic linear salpingostomy. An incision was made on the antimesenteric side of the fallopian tube, over the point of maximum bulge, with unipolar electrocautery, the argon laser, or CO2 laser. Bleeding was controlled by micropinpoint cautery. After completion of the procedure, the abdomen was lavaged with Ringer's lactate, and 200 mL of Hyscon was placed in the peritoneal cavity. Patients were also treated with doxycycline 100 mg twice daily. There were two major complications, both involving continued bleeding recognized within one hour of the original procedure. One resulted from faulty equipment, and the other was associated with removal of an ectopic pregnancy greater than 3 cm in greatest diameter. All patients were discharged within 24 hours of the procedure. There were no long-term complications. Of 69 patients actively trying to conceive, 43 (62%) conceived. Seven (16%) of the conceptions were repeat ectopic pregnancies, divided between the contralateral and ipsilateral tube. Ten of forty-three (23%) aborted. The viable pregnancy rate of 38% is comparable to that with other techniques. It would appear from our observations that a skilled laparoscopist can remove a small tubal pregnancy in this manner with minimal complications.

Electrocoagulation↗
PubMedDate not supplied

Combined use of serial serum human chorionic gonadotropin testing, ultrasound and panoramic diagnostic microhysteroscopy in the early diagnosis of ectopic pregnancy.

It is not always easy to make an early diagnosis of ectopic pregnancy in patients with suspected ectopic pregnancy who in any case appear to be clinically stable, and in whom the serial serum study of human chorionic gonadotropin (hCG) testing and ultrasound (US) showed an abnormal pregnancy without adding any useful information for obtaining a differential diagnosis between ectopic pregnancy and non-viable intrauterine pregnancy (IUP). Typical management of these patients comprises expectant observation or carrying out a diagnostic laparoscopy. The purpose of this study was to examine the value of microhysteroscopy as an adjunctive procedure in the above-mentioned patients; the results of this clinical test show that in these patients, the microhysteroscopy may represent a simple and valid alternative to expectant observation or immediate laparoscopy.

Adult↗
PubMed1988

Blood or urine measurement of human chorionic gonadotropin for detection of ectopic pregnancy? A comparative study of quantitative and qualitative methods in both fluids.

One hundred seventy-five patients with features of ectopic pregnancy were studied, of whom 95 were subsequently shown to have an ectopic pregnancy. Paired blood and urine samples were assayed for human chorionic gonadotropin (hCG) by two radioimmunoassays, one immunoradiometric assay for intact hCG and an immunoradiometric assay for free beta subunit that also detects the "beta core" of hCG in urine. Qualitative testing was also performed using the Tandem Icon method of immunoconcentration on a membrane. The quantitative results for intact hCG showed an approximately unitary relationship between concentrations in both fluids, with a close correlation (r = 0.84, gradient = 1.01). The qualitative tests for hCG in both serum and urine were positive in all patients with ectopic pregnancy. The Tandem Icon is equally useful in blood and urine, whereas quantitative assays are more reliable in the blood. Quantitation of urinary hCG is not recommended because of the variable dilution of the glycoprotein in this fluid.

Abortion, Incomplete↗
PubMed1986

Various methods for determining urinary choriogonadotropin evaluated for the early diagnosis of ectopic pregnancy.

We evaluated the accuracy, sensitivity, specificity, and performance characteristics of seven methods for determining urinary choriogonadotropin in the early diagnosis of ectopic pregnancy in 46 patients with gynecological emergencies. The kits examined included immunoenzymometric assays (Tandem Icon hCG, Model Plus, Diapreg-25, Pregnastick, Nimbus) and reverse hemagglutination inhibition assays (NeoPregnosticon 75 Duoclon, Pregtest). We found immunoenzymometric assays to be the most sensitive procedures (lowest detection limits) for qualitatively detecting hCG secreted by ectopic pregnancy. We concluded that the Tandem Icon best meets our criteria and we advocate its use in the emergency room or ward as the first-line investigation of ectopic pregnancy. In addition, the use of Diapreg-25 has many theoretical advantages as an extremely sensitive index of choriogonadotropin status because of its ability to detect very low concentrations of beta subunit.

Chorionic Gonadotropin↗
PubMed1987

[Surgical treatment of children with ectopic atrial tachycardia].

Up-to-date electrophysiologic investigations of the heart, carried out in 212 children with arrhythmias, demonstrated a focus of ectopic atrial tachycardia in 21 (9.9%); 17 of those underwent long-term treatment (up to 10 years) with antiarrhythmic drugs. Kordaron produced a positive effect (discontinuation of the attacks) in 1 case only. Combined use of several antiarrhythmic drugs controlled the frequency of tachycardia in 4 patients. Signs of dilatation cardiomyopathy were in evidence in 60% of children with permanent ectopic tachycardia. Seven of 12 patients who failed to respond to medication were eventually subjected to radical surgery. All but one were discharged from hospital without additional medication and with normal heart rhythm. One child developed groups of extrasystoles generated by the lower right-atrial portion during the 2nd week after surgery. They diminished and eventually disappeared after a supportive digoxin treatment. Surgery is therefore regarded as an effective and radical treatment for ectopic atrial tachycardia in children.

Adolescent↗
PubMed1987

Persistent ectopic syndrome: a case report and literature review.

A case report is presented of an ampullary ectopic pregnancy which was treated by salpingostomy. Twenty-six days later, the patient underwent repeat operation due to the persistence of trophoblastic tissue within the fallopian tube. A review of the English literature reveals nine cases including our own that have been reported to date. In eight of nine cases, trophoblastic tissue was recovered at the time of the second operation. In the four cases where human chorionic gonadotropin (hCG) titers were available before and after the second procedure, the titers were positive initially and reverted to negative postoperatively. The disappearance curve for human chorionic gonadotropin after excision of an ectopic gestation is discussed. A recommendation is made for a single determination of beta-hCG two weeks after a conservative procedure for an ectopic gestation to screen for persistence of trophoblastic tissue.

Adult↗
PubMed1985

Accurate diagnosis of early ectopic pregnancy.

Commonly used preoperative diagnostic procedures were analyzed for their ability to predict the presence of early ectopic pregnancy. Patients presenting to the emergency room with acute onset of pelvic pain were evaluated with culdocentesis, pelvic ultrasonography, and qualitative serum and urine pregnancy testing. Clinical examination and urine pregnancy testing were found to be poor predictors of either the presence or absence of an early ectopic pregnancy. The combination of a sensitive serum human chorionic gonadotropin (hCG) determination and pelvic ultrasonography accurately predicted ectopic pregnancy in 93% of proved cases. This predicted accuracy was superior to that of culdocentesis alone or in combinations of culdocentesis and ultrasound or qualitative serum pregnancy testing.

Adult↗
PubMed1986

Occult ectopic secretion of corticotropin.

The clinical, biochemical, radiographic, and morphologic features of ectopic corticotropin (ACTH)-dependent Cushing's syndrome are often indistinguishable from those of Cushing's disease (pituitary-dependent Cushing's syndrome). We encountered ten patients whose ectopic ACTH-secreting neoplasms were not clinically apparent for two months to 12 years after the diagnosis of hypercortisolism or in whom the site remains unknown. Five of these patients underwent unnecessary pituitary microsurgery, and a sixth was referred for surgery. The occult ectopic ACTH syndrome occurs with equal frequency in men and women and hypokalemia is present in 60%, in contrast to the female predominance and rarity of hypokalemia in Cushing's disease. We emphasize the importance of selective venous sampling for ACTH to establish the correct diagnosis. Thirty-nine similar cases from the literature help characterize this syndrome further.

ACTH Syndrome, Ectopic↗
PubMed1981

[Application of a rapid serum beta-hCG assay in the early diagnosis of the ectopic pregnancies (author's transl)].

We have assessed the clinical utility of a rapid serum beta chorionic gonadotropin ( beta-hCG) assay. The assay employed a commercial kit that we have modified to assure its validity. We reach a sensitivity of 10 mIU/ml, and inter assay precision of 8,1% and an intra assay precision of 6.4 and 4.7% for concentrations of 7.6 +/- 0.5 mIU/ml and 1 825 +/- 86.3 mIU/ml respectively. This work was carried out on 106 radioimmune determinations of beta-hCG during the first trimester of 56 normal pregnancies and on 168 levels estimed in 116 suspected ectopic pregnancies. In normal pregnancies, a trophoblastic secretion of beta-hCG is detected on the 10th day following the thermal nadir; the levels quickly rise to reach a peak between the 42th and the 52th post-ovulation day, and then gradually decrease. In the 116 suspected pregnancies, 40 of them were surgically proven ectopic gestations: there were no false positive or false negative results. This rapid and accurate assay may contribute to the early diagnosis of an ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1982

Nonoperative management of ectopic pregnancy. A preliminary report.

The incidence of ectopic pregnancy is increasing throughout the Western world; at present it is uncertain how much of this increase is due to the disease and/or its antecedents and how much due to better means of diagnosis. That the treatment of the obvious or ruptured ectopic pregnancy should be surgical is beyond doubt. However, in view of the natural tendency of some ectopic pregnancies to terminate in tubal abortion or complete resorption, it is questionable whether surgery is always necessary in every early case or whether some patients can be monitored by means of rising or falling levels of beta subunits of human chorionic gonadotropin (HCG) until tubal abortion or resorption occurs. This may be the best means of preserving tubal function and fertility.

Adult↗
PubMed1983

Ectopic pregnancy: incidence and review of determinant factors.

The incidence of ectopic pregnancies has been expressed in various ways that are not comparable and provide widely differing estimates due to individual definitions of the denominator. Population-based data are presented based on a count of all ectopic pregnancies reported in short stay hospitals in Maine, Rhode Island, and Vermont in 1974-1976. The incidence is 40 per 10(5) female population age 14-44 and is more consistent across 80 hospital service areas than other gynecological diagnoses. The data do not reveal an increasing incidence over these 3 years in contrast to national surveys based on a longer period of observation. A review of determinant factors for ectopic pregnancy is presented, and current theories concerning the etiology, changes in contraceptive practices, innovations in sterilization procedures, or advances in diagnosis do not appear individually or collectively to explain the increasing incidences reported by others. Further basic biologic and epidemiologic research is needed to determine causes and trends in this principal cause of first trimester mortality among pregnant women.

Abortion, Induced↗
PubMedDate not supplied

Biology of nidation and ectopic implantation.

The incidence of ectopic pregnancy has been steadily growing during the past decade; this fact can only partially be related to known factors (PID, use of IUDs, minipill, inductors of ovulation, sterilization reversal). Ectopic pregnancy is still a frequently misdiagnosed pathology; nevertheless, the recent advances in early diagnosis have allowed a decrease in the mortality rate and an improvement in subsequent fertility. In absence of obvious tubal abnormalities it is difficult to assess the cause of an ectopic implantation. Yet the factors regulating and nidation of the embryo in the human are far from clear. The transport of the embryo in the oviductal fluid depends on ciliary beat (generally regarded as the leading factor) and on muscle contractions mainly in the ampullary-isthmic and in the utero-tubal junction, where a sphincter action is stimulated by estrogens and relaxed by progesterone. Other substances (catecholamines, prostaglandins, oxytocin) are thought to be involved in ovum transport, although their role is unclear. Even less is known about local influence of the embryo on the oviduct. During preimplantation and implantation both the embryo and the mother engage in an elaborate interaction, elsewhere referred to as a 'conversation', involving long-and short-range signals. An essential role is played by the endocrine luminal milieu. A local action of estrogens on a progesterone-primed endometrium may be required for either the release of crucial signals for the blastocyst activation, or to make epithelial cells sensitive to the presence of the embryo, thus inducing the decidualization. In some animals, these estrogens are not ovarian, but synthesized by the blastocyst itself.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1981

A fifteen year experience with ectopic pregnancy.

The increasing importance of an ectopic pregnancy as a cause of maternal death presents a challenge that will be met when primary care physicians combine a high index of suspicion with the ability to recognize the patient most at risk. The major symptoms, abdominal pain, secondary amenorrhea and abnormal vaginal bleeding are well known, as are the major signs, abdominal tenderness, adnexal mass and tenderness on motion of the cervix. Less well known are factors in the clinical history which indicate the patient to be at high risk. These include primary or secondary infertility, previous abortion or ectopic pregnancy and previous tubal operation, either reconstructive or sterilizing. In addition, the use of an intrauterine contraceptive device or its recent removal because of abdominal pain or bleeding, or both, is highly significant. Of major importance is a history of recent uterine evacuation. Should the diagnosis of ectopic pregnancy be under consideration, procrastination by observation is no longer acceptable. An active effort must be made to confirm or deny the diagnosis, Culdocentesis should be performed in the emergency department or clinic. If positive, prompt laparotomy is indicated. Should the result of culdocentesis be unsatisfactory or negative, laparotomy should be undertaken with further delay.

Adult↗
PubMed1984

Treatment of ectopically erupting permanent molars.

Eruption of a first permanent molar ectopically is a common occurrence in any office in which a significant number of children are treated. Approximately 65 per cent of the ectopically erupting molars will self-correct. It is imperative that the dentist closely examine all preschool children to determine the possibility that the condition will occur and follow the child closely to determine the subsequent need for treatment. If clinical treatment is advisable the dentist can use a modified version of the Humphrey appliance to successfully and rapidly correct ectopically erupting molars with relative ease.

Child↗