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PubMed1980

Trophoblastic markers in the differential diagnosis of ectopic pregnancy.

The serum levels of pregnancy-specific beta-1-glycoprotein (PSBG) and human chorionic gonadotropin (hCG) were measured by radioimmunoassay in 79 women admitted to the hospital because of uterine bleeding and pain in the lower abdomen. In 25 out of 26 patients (96%) with operatively confirmed ectopic pregnancy, hCG was found; PSBG was found in 22 out of 23 (96%). There was 1 patient in whom neither marker was found. In all of 14 patients with clinical signs of intrauterine pregnancy both hCG and PSBG were present. The levels of hCG and PSBG in patients with ectopic pregnancy (1558 +/- 465 mIU/ml and 739 +/- 386 ng/ml) or with inevitable abortion (1282 +/- 810 mIU/ml and 1511 +/- 658 ng/ml) were lower than those found in uncomplicated pregnancy of the same gestational length (20,100 +/- 2200 mIU/ml and 2821 +/- 673 microgram/ml), whereas in cases of threatened abortion ending in delivery, the levels were normal for the gestational time. Of 39 patients without clinical signs of pregnancy, hCG was detectable in the serum in 3 women and PSBG in 11 others. Seven of these 14 had an intrauterine contraceptive device (IUD) in situ, suggesting the possibility of a subclinical abortion. Our results show that the diagnosis of ectopic pregnancy can be improved significantly by the highly sensitive radioimmunologic measurement of serum hCG and/or PSBG concentrations, but these tests do not distinguish intrauterine from extrauterine sources of trophoblastic markers.

Abortion, Spontaneous↗
PubMed1982

Ectopic pregnancy: a review of 147 cases.

From July 1, 1972, to June 30, 1979, 149 patients with ectopic pregnancy were treated at Truman Medical Center. The history and physical findings, diagnostic procedures, etiologic factors and patient management were reviewed. Abdominal pain (98.6%), amenorrhea (74.1%) and irregular vaginal bleeding (56.4%) were the most common presenting symptoms. Abdominal tenderness (97.3%) and adnexal tenderness (98%) were the most common physical findings. Culdocentesis was performed in 118 cases and was positive for nonclotting blood in 94.1%. In 115 cases (78.2%) the ectopic pregnancy was ruptured prior to the time of admission. The incidence of diagnostic error was 35.9%. There were no maternal deaths; however, the incidence of morbidity was 26.5%. Our data reemphasize the need for a high degree of suspicion and early utilization of definitive diagnostic procedures if the morbidity and mortality of ectopic pregnancy are to be reduced.

Adolescent↗
PubMed1978

A sensitive hemagglutination assay of human chorionic gonadotropin in the diagnosis of ectopic pregnancy.

Hemagglutination assay of human chorionic gonadotropin (hCG) in the urine of patients suspected of having ectopic pregnancies has proved to be a highly sensitive method of detecting the condition. Moreover, the technique is simple and inexpensive. Hemagglutination assays were used in 167 patients with a diagnosis of ectopic pregnancy and in screening 415 patients in whom there was a possibility of ectopic pregnancy. In the former group, hCG titers in urine of more than 500 IU/liter were detected in 136 patients: among the remaining 31, the pregnancies were clinically old and resolving in 22. Low hCG titers were associated with a significantly shorter period of amenorrhea and a protracted clinical course. In the second group, a false-positive rate of 1.7% occurred when the sensitivity of the assay was limited. Increasing the sensitivity of the assay to avoid false-negative results, though also increasing the false-positive rate, would help to reduce the number of cases in which more complex isotope assays are required.

Chorionic Gonadotropin↗
PubMed1981

Diagnosis of ectopic pregnancy.

The clinical records of 450 patients with ectopic pregnancy were reviewed with respect to provisional diagnosis, symptoms, findings at gynecological examination, and results of diagnostic procedures. Approximately 50% of the patients had the correct diagnosis at the time of admission. The urinary pregnancy test and curettage are not very reliable tests. Culdocentesis, and above all the beta subunit of HCG have improved the diagnostic accuracy of ectopic pregnancy. The beta subunit of HCG was positive in 97 out of 100 patients with ectopic pregnancy.

Biopsy, Needle↗
PubMed1981

[The Kleihauer-Bekte test in cases of suspected ectopic pregnancy].

Ectopic pregnancy is often difficult to diagnose, particularly in population groups that are prone to pelvic infections. In this study the use of the Kleihauer-Betke test for fetomaternal bleeding was examined in an attempt to improve diagnostic accuracy. The test was performed in 23 patients with ectopic pregnancies and in 19 control patients with normal intra-uterine pregnancies. Both groups were of more or less the same gestational age and parity. Whereas the test was positive in 31% of the control patients, indicating fetomaternal bleeding, it was positive in only 3 patients (13%) in the experimental group. The volume of fetomaternal blood in these 3 cases was 0,05 ml, 0,6 ml and 0.8 ml. These results indicate that the Kleihauer-Betke test is not a useful aid to diagnose cases of possible ectopic pregnancy, but confirm the fact that steps should be taken to prevent iso-immunization in susceptible cases.

Adult↗
PubMed1981

The value of pelvic ultrasound in the diagnosis of ectopic pregnancy.

Early recognition of ectopic pregnancy may be a diagnostic challenge despite the availability of a multitude of diagnostic procedures. Patient risk is particularly serious if a false-negative diagnosis postpones surgical exploration. On the other hand, exploratory surgery or laparoscopy should not be chosen hastily as the initial procedure in the evaluation of patients with suspected extrauterine gestation. A more conservative approach can usually be instituted prior to exposing the patient to operative and anesthetic risks. In recent years, ultrasonography has become one of the most important noninvasive diagnostic aids in obstetrics and gynecology. Despite the extensive literature related to ultrasound in the diagnosis of pelvic pathology, its use as a nonoperative diagnostic tool in the evaluation of patients with suspected ectopic pregnancy has been scarcely reported. Our intentions of this study were directed toward examining the diagnostic usefulness of pelvic ultrasonography in the clinical evaluation of patients with suspected ectopic pregnancy.

Adnexa Uteri↗
PubMed1980

Microsurgical technique in the management of tubal ectopic pregnancy.

Microsurgical techniques employing fine instruments and suture, microelectrocautery and continuous lavage, and careful handling of tissue have been applied to a variety of gynecologic procedures in which the microscope itself is not warranted. The thesis underlying this practice is straightforward: if successful outcome in chronic tubal disease is enhanced by these procedures, then they may have a beneficial role in acute tubal disease. To test this premise, in the past 2 years nine patients with tubal ectopic pregnancies have been managed by microsurgical techniques at Yale-New Haven Hospital. Five of the ectopic pregnancies were unruptured and four were ruptured. The products of conception were removed either by meticulous debridement or linear antimesenteric salpingostomy in association with the microsurgical methods noted above. Tubal healing was by secondary intention. All patients were treated with prophylactic antibiotics and intra-abdominal low molecular weight dextran. Four months postoperatively, all tubes operated upon were patent by salpingography. Subsequently, three of the five women with unruptured pregnancies and two of the four with ruptured pregnancies achieved intrauterine pregnancies. However, one has spontaneously aborted. According to these preliminary results, microsurgical techniques may be beneficially applied in the treatment of selected cases of ectopic pregnancy.

Adult↗
PubMed1995

Ectopic pregnancy: ultrasonographic diagnosis and interpretive pitfalls.

The ultrasonographic evaluation of ectopic pregnancy is fraught with potential pitfalls in image interpretation. Though recent advances in sonographic techniques have improved the precision and scope of the study, considerable expertise is still needed to perform and interpret the sonogram for a suspected ectopic gestation. In this article, we review the ultrasonic evaluation for ectopic pregnancy, emphasizing the difficulties in diagnosis.

Decidua↗
PubMed1993

[Transvaginal ultrasonography in 27 confirmed cases of ectopic pregnancy].

Twenty seven patients having Ectopic Pregnancies were studied prospectively with transvaginal sonography. Ten of them were treated surgically, thirteen with injection of methotrexate and four with expectant management. Ultrasound images were well correlated with clinics, surgical findings and pathology. We believe that the ultrasound image known as "tubal ring" is highly suggesting of early ectopic pregnancy. Since early detection is associated with conservative surgery, expectant management or treatment with methotrexate, and consequently to a better reproductive future, we consider that transvaginal sonography is a reliable method that must be added to traditional ones, in the ectopic pregnancy management.

Adult↗
PubMed1995

Laparoscopic management of ectopic pregnancy.

Management of ectopic pregnancy includes a high index of suspicion coupled with established algorithms of diagnosis using serum beta-human chorionic gonadotropin and transvaginal ultrasound. Early diagnosis and intervention usually leads to conservation of the involved tube. Careful follow up for persistent ectopic pregnancy leads to appropriate medical or surgical management. The use of methotrexate, either systemically or by local injection, may provide an alternative to surgery in selected patients with ectopic pregnancy.

Female↗
PubMed1995

[Treatment of ectopic pregnancy by transvaginal ultrasonography-guided puncture and local application of methotrexate].

The early detection of ectopic pregnancy--using transvaginal sonography, beta-human chorionic gonadotropin determination in blood and laparoscopy--allow us to perform conservative therapeutic approaches to preserve future fertility. The authors report their experiences on five patients treated by local administration of methotrexate. The drug was injected to the ectopic gestational sac by transvaginally performed, sonographically directed puncture. The technique of the method, the criteria of selection and follow-up of patients have been discussed. Giving an overview on the other conservative methods, their increasing role is suggested in the management of early ectopic pregnancies.

Administration, Topical↗
PubMed1994

[Is there a seasonal incidence of ectopic pregnancy?--A retrospective analysis].

The seasonal incidence of 472 ectopic pregnancies in the years 1984-1993 in the Departments Obstetrics and Gynaecology Greifswald and Neubrandenburg were analysed. While the birth rate was decreasing in the third and fourth quarter of the year there was a low, no significant increase of ectopic pregnancies from 1.30% (April-June) to 1.75% (October-December). The monthly analysis did not show any significant differences. In the area Vorpommern/East-Mecklenburg climatic and meteorological factors do not seem to have an important influence on the incidence of ectopic pregnancies.

Cross-Sectional Studies↗
PubMed1993

[Ectopic pregnancy risk factors after assisted reproductive technology].

Ectopic pregnancies are more frequent among pregnancies resulting from assisted reproductive technology (ART) than in natural conceptions (6% to 7% vs 1%). Fivnat registry has allowed us to analyse 349 ectopics among 6049 clinical pregnancies collected from 1986 to 1990. Ectopic rate decreased with increasing women's age, and since 1986. The risk was also decreased in infertilities of non tubal origin, except for those of unknown origin in which it was at the same level than for tubal infertility. The risk was increased by 65% in stimulation regimens involving clomiphene citrate (CC). The observed decrease from 1986 to 1990 was strongly related to the decrease in use of CC.

Adult↗
PubMedDate not supplied

[Experience of ectopic pregnancy].

This survey relates to the experience and the management of women who have received a treatment for an ectopic pregnancy. It is based on 31 clinical interviews, conducted a month after the end of surgical or medical treatment. Among these women, 42% had had previous treatment for sterility. The main results show that 16% had never previously heard of ectopic pregnancy, and 29% do not see any reason why they had had one. For the patients, the diagnosis had not been made early enough: 45% feel that the consequences could have been serious if they had not taken the matter seriously themselves. Women clearly express some strong feeling against the health professionals (74%) who were responsible for their medical care, in spite of the attention they received, which reveals the psychological trauma they suffered. Although 55% of women felt depressed, for some of them the ectopic pregnancy seemed to operate as an exorcism from a previous more serious situation. They place their hope in a future pregnancy under close medical supervision. When it appears necessary, psychological support should be offered to these patients.

Adaptation, Psychological↗
PubMed1993

[Risk factors for ectopic pregnancy. Results of a case control study in the Rhone-Alpes region].

A case-control study was conducted in 14 Rhône-Alpes area (France) maternity hospitals to evaluate the role of several risk factors, particularly infectious factors, in ectopic pregnancy. A total of 624 cases and 1,247 controls were compared for sociodemographic characteristics, cigarette smoking, sexual reproductive and surgical histories, and condition of conception. Different risk factors were found to be associated with an increased risk of ectopic pregnancy: pelvic inflammatory disease confirmed by celioscopy (OR = 3.8, 95%, CI = 2.1-6.9), Chlamydia trachomatis seropositivity (OR = 4.6, 95%, CI = 3.4-6.3), cigarette smoking at the time of conception with a dose-related effect (OR = 1.6 to 2.6), prior tubal surgery (OR = 1.8, 95%, CI = 1.0-3.1), prior uterus, surgery (OR = 3.2, 95%, CI = 1.4-7.1), prior ectopic pregnancy (OR = 6.4, 95%, CI = 3.6-11.3), induced conception cycle by clomiphene citrate (OR = 4.5, 95%, CI = 1.7-12.0), endometriosis (OR = 6.7, 95%, CI = 2.6-17.4) and maternal age, with a strong relation after the age of 35. These findings confirm the major role of pelvic inflammatory disease which could explain fifty percent of the cases and the one of cigarette smoking at the time of conception which could explain twenty percent of the cases.

Adolescent↗
PubMed1994

[Ablation of permanent left atrial ectopic tachycardia by high-frequency energy].

Catheter ablation of ectopic atrial tachycardia has been previously reported in a small number of patients in whom the ectopic focus was predominantly located in the right atrium. We report on a 53-year-old patient with atrial automatic tachycardia originating in the left atrium, in whom successful radiofrequency catheter ablation was performed via a transseptal puncture. The patient presented a permanent atrial tachycardia for several years, refractory to antiarrhythmic drug treatment and DC-cardioversion. Radiofrequency ablation terminated left ectopic atrial tachycardia and, therefore, should be attempted before resorting to open-heart surgical ablation.

Cardiac Pacing, Artificial↗
PubMed1994

[Unilateral ectopic twin pregnancy].

A case of a 12 week unilateral ectopic twin pregnancy is presented. The condition is rare with less than one hundred reported cases. Only three reported cases of unilateral ectopic twin pregnancy have been diagnosed sonographically. In this case the diagnosis of ectopic pregnancy was made by ultrasound, but, despite the length of the pregnancy only one fetus was seen.

Adult↗
PubMed1995

Suitability of fetal tissues from spontaneous abortions and from ectopic pregnancies for transplantation. Human Fetal Tissue Working Group.

OBJECTIVE: To assess the potential availability and utility of fetal tissues obtained from spontaneous abortions and from ectopic pregnancies for human transplantation therapy. DESIGN: Tissue collection and analysis by personnel skilled in tissue banking. SETTING: Procurement programs in five tissue banks located in diverse geographical areas that are funded by the National Institutes of Health. PATIENTS: All women entering obstetric clinics during 1993 who consented to participate in the study. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Evaluation of the products of conception by standard developmental, histological, microbiological, and cytogenetic criteria. RESULTS: From 22,235 obstetric admissions, 1250 spontaneously aborted embryos and 247 products of ectopic pregnancies were obtained. Of these, seven embryos (0.5%) were potentially useful for human transplantation therapy. CONCLUSION: Fetal tissues from spontaneous abortions and from ectopic pregnancies are quite limited as feasible sources for human transplantation therapy.

Aborted Fetus↗