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At least 19 recordsLinked to original sources
PubMed1983

Ectopic pregnancy.

Ectopic pregnancy remains a significant contributor to maternal mortality and morbidity. Despite the obstetrician's awareness of the problems, ectopic pregnancy in many cases still remains a difficult diagnosis. Over the last 10 to 15 years diagnostic ultrasound has become an established means of supplying additional and occasionally diagnostic information on those patients suspected of having an ectopic pregnancy. In essence diagnostic ultrasound can provide information regarding the presence of an intra-uterine pregnancy, a finding which goes a long way to excluding an extra-uterine pregnancy, and can show that there is no gestation sac within the uterus, a finding which raises the level of suspicion of an ectopic pregnancy. In addition to these primary uses, diagnostic ultrasound can also provide information relating to the presence or absence of both an adnexal mass and free fluid in the pouch of Douglas. All of these features, however, are open to error and their appreciation leads to a more rational approach to the interpretation of the overall ultrasound findings. In using diagnostic ultrasound in at-risk patients, side-room urinary pregnancy tests, and if necessary the more sophisticated radioimmunoassays of beta-subunit hCG, should be used in conjunction. From the authors' own studies it was concluded that an empty uterus with an adnexal mass and/or the presence of free fluid in the pelvis, together with positive biochemistry, was able to give a very high level of diagnostic accuracy for ectopic pregnancy (95 per cent). However, an empty uterus alone in the absence of an adnexal mass or free fluid in the pelvis was not of itself a reliable guide to the presence of an ectopic pregnancy even in the presence of positive biochemistry. The finding of a living fetus outside the uterus was an uncommon event (6 per cent), but if present allows an absolute diagnosis of ectopic pregnancy. Finally a negative serum hCG assay virtually excludes the possibility of an ectopic pregnancy. A scheme involving the use of urine pregnancy testing, serum hCG assays and ultrasound has been proposed for the rational management of patients suspected of having an ectopic pregnancy and whose condition is stable. In all circumstances, however, it is stressed that should the patient's condition so warrant then surgical intervention is mandatory irrespective of the ancillary findings.

Adnexa Uteri↗
PubMed2005

Diagnosis and management of ectopic pregnancy.

Ectopic pregnancy is a high-risk condition that occurs in 1.9 percent of reported pregnancies. The condition is the leading cause of pregnancy-related death in the first trimester. If a woman of reproductive age presents with abdominal pain, vaginal bleeding, syncope, or hypotension, the physician should perform a pregnancy test. If the patient is pregnant, the physician should perform a work-up to detect possible ectopic or ruptured ectopic pregnancy. Prompt ultrasound evaluation is key in diagnosing ectopic pregnancy. Equivocal ultrasound results should be combined with quantitative beta subunit of human chorionic gonadotropin levels. If a patient has a beta subunit of human chorionic gonadotropin level of 1,500 mIU per mL or greater, but the transvaginal ultrasonography does not show an intrauterine gestational sac, ectopic pregnancy should be suspected. Diagnostic uterine curettage may be appropriate in patients who are hemodynamically stable and whose beta subunit of human chorionic gonadotropin levels are not increasing as expected. Appropriate treatment for patients with nonruptured ectopic pregnancy may include expectant management, medical management with methotrexate, or surgery. Expectant management is appropriate only when beta subunit of human chorionic gonadotropin levels are low and declining. Initial levels determine the success of medical treatment. Surgical treatment is appropriate if ruptured ectopic pregnancy is suspected and if the patient is hemodynamically unstable.

Abortifacient Agents, Nonsteroidal↗
PubMed2002

Transvaginal sonographic diagnosis of live monochorionic twin ectopic pregnancy.

Ectopic pregnancy is a leading cause of pregnancy-related deaths; its incidence has progressively increased in recent years. Spontaneous twin ectopic pregnancy, however, is extremely rare. Among more than 100 reported cases of twin tubal pregnancies, only 5 cases in which fetal cardiac motion has been visualized in both embryos have been reported. We describe an additional case of a live monochorionic twin ectopic pregnancy in a patient with no predisposing factor. With transabdominal sonography, we initially diagnosed a single ectopic pregnancy, visualized as an ill-defined mass in the left adnexa. However, with transvaginal sonography, we determined the left adnexal mass to contain a single monochorionic gestational sac with 2 embryos, each with cardiac motion. These findings were confirmed with color Doppler sonography and at laparotomy. The introduction of high-resolution transvaginal sonography has resulted in the earlier diagnosis of ectopic pregnancy and has contributed to a recent decrease in the maternal mortality and morbidity associated with this condition.

Adult↗
PubMed1996

Medical management of the patient with an ectopic pregnancy.

Ectopic pregnancies are the leading cause of pregnancy-related death during the first trimester. Historically, the treatment for an ectopic pregnancy was emergency laparotomy, which included salpingectomy. In 1987, research began at the Regional Medical Center at Memphis, in conjunction with the University of Tennessee, examining early detection and medical treatment for ectopic pregnancy. Pharmacologic management of an unruptured, size-appropriate ectopic pregnancy is now an established standard of care. The present protocol recommends single-dose methotrexate. This form of methotrexate has proven to be a successful, cost-effective alternative to traditional surgical management of ectopic pregnancies.

Decision Trees↗
PubMed2000

Ectopic pregnancy.

Ectopic pregnancy occurs at a rate of 19.7 cases per 1,000 pregnancies in North America and is a leading cause of maternal mortality in the first trimester. Greater awareness of risk factors and improved technology (biochemical markers and ultrasonography) allow ectopic pregnancy to be identified before the development of life-threatening events. The evaluation may include a combination of determination of urine and serum human chorionic gonadotropin (hCG) levels, serum progesterone levels, ultrasonography, culdocentesis and laparoscopy. Key to the diagnosis is determination of the presence or absence of an intrauterine gestational sac correlated with quantitative serum beta-subunit hCG (beta-hCG) levels. An ectopic pregnancy should be suspected if transvaginal ultrasonography shows no intrauterine gestational sac when the beta-hCG level is higher than 1,500 mlU per mL (1,500 IU per L). If the beta-hCG level plateaus or fails to double in 48 hours and the ultrasound examination fails to identify an intrauterine gestational sac, uterine curettage may determine the presence or absence of chorionic villi. Although past treatment consisted of an open laparotomy and salpingectomy, current laparoscopic techniques for unruptured ectopic pregnancy emphasize tubal preservation. Other treatment options include the use of methotrexate therapy for small, unruptured ectopic pregnancies in hemodynamically stable patients. Expectant management may have a role when beta-hCG levels are low and declining.

Biomarkers↗
PubMed1992

Changes in tubal blood flow in evaluating ectopic pregnancy.

Ectopic pregnancy is not recognized in 5523% of all cases using state-of-the-art diagnostic procedures. In this study, blood flow in tubal arteries was measured using a transvaginal duplex Doppler ultrasonography system. A 3.5 MHz Doppler transducer coupled to a 5 MHz imaging transvaginal sector probe was used to depict flow characteristics in the tubal branch of the uterine artery. This was performed in 102 patients. There was a significant increase in the blood flow on the tubal gestation side (p < 0.0001; z = -4.08). This between-side difference was determined using qualitative frequency shift analysis. The mean reduction in the resistance index on the side with the ectopic pregnancy as compared to the contralateral side was 15.6%. These changes appear to be due to trophoblast invasion. Between-side differences showed no dependence on gestational age (between gestational weeks 4 and 12 postmenstruation). We compared these data with those from three control groups ('early viable intrauterine pregnancy', 'early intrauterine pregnancy failure', 'non-gravid state'). In all these control groups, the impedance to flow, expressed as 'resistance index', showed no significant between-side difference. All control groups had significantly higher mean resistance index values than the ectopic pregnancy side, but did not differ from the contralateral side of the ectopic pregnancy group. The advantages of this new method in diagnosing ectopic pregnancy are early detection, non-invasivity, and immediate results.

Journal Article↗
PubMed2000

Ectopic pregnancy.

Ectopic pregnancy is a implantation occurring elsewhere than in the cavity of the uterus, whereas ninety-nine percent of extrauterine pregnancies occur in the fallopian tube. The incidence of extrauterine pregnancy has increased from 0.5% thirty years ago, to a present day 1-2%. The most frequent cause of tubal pregnancy is previous salpingitis. Mortality rates for tubal pregnancies used to be approximately 1.7% in the 1970s but dropped to 0.3% in 1980s. DIAGNOSIS: Using transvaginal ultrasound it is possible to obtain positive evidence of an ectopic pregnancy at a very early stage. In cases of hCG titers>2,000 IU/l, intrauterine pregnancy can be diagnosed with certainty. The most important differential diagnosis of ectopic pregnancy is early intrauterine pregnancy. CLINICAL MANAGEMENT AND THERAPY: Regardless of the therapeutic strategy selected by the physician, informing the patient is a major aspect of the management of ectopic pregnancy. If surgery is considered appropriate, the patient must be informed about the nature, side effects and complications of the procedure. However, it should be remembered that in some cases, the actual chances of cure first become apparent at surgery. In asymptomatic patients with a serum hCG titer <1,000 IU/l that is falling, it is appropriate to wait and watch. In clinically stable patients with an unruptured tubal pregnancy and steady hCG levels, systemic treatment with methotrexate might also be considered. In unruptured tubal pregnancy with a hCG titer between 1,000 and 2,500, a further therapeutic alternative is intratubal injection of prostaglandins, hyperosmolar glucose of NaCl. Generally speaking, the currently widespread laparoscopic surgical treatment of the fallopian tube hardly influences the risk of recurrence. If the gestational mass is larger, the serum hCG titer higher than the approximate limit of 2,500 mU/ml and/or the tube already ruptured, surgery is usually required. PREVENTION: The most effective prevention is to avoid tubal inflammation or, in cases of preexisting inflammation, to administer effective therapy.

Chorionic Gonadotropin↗
PubMed2000

Ectopic pregnancy.

Ectopic pregnancy occurs in approximately 2% of all pregnancies in the United States, and is the nation's leading cause of first trimester maternal death. Its incidence has increased sixfold in the past 25 years, despite significant improvements in techniques for early diagnosis and management. This article reviews the epidemiology, risk factors, and common clinical presentations of ectopic pregnancy. Both traditional and newly developed strategies for diagnosis and management are described. The primary care physician is in an excellent position to screen for and diagnose ectopic pregnancy, and to counsel patients regarding treatment options and future risks. With the increasing trend toward outpatient nonsurgical management of ectopics, it is expected that the roll of the primary care physician in managing patients with ectopic pregnancy will continue to increase.

Abortifacient Agents, Nonsteroidal↗
PubMedDate not supplied

Diagnosis of ectopic pregnancy.

Ectopic pregnancy is an increasingly common and potentially catastrophic condition for which patients often present to the ED with abdominal pain or vaginal bleeding. Recent developments in laboratory tests (sensitive beta hCG, progesterone assays), ultrasonography (transvaginal probes, Doppler ultrasound), and combinations of these modalities (hCG Discriminatory Zone for ultrasonographic evidence of intrauterine pregnancy) have allowed the earlier diagnosis of ectopic pregnancy, with an associated reduction in maternal mortality and morbidity. Understanding the strengths and limitations of the variety of diagnostic modalities available will allow the clinician to formulate a rational strategy for the early diagnosis of ectopic pregnancy. Numerous algorithms have been developed. All begin with high clinical suspicion in women of reproductive age with abdominal/pelvic pain or vaginal bleeding. Pregnancy testing with a sensitive beta hCG qualitative test is next. In stable patients found to be pregnant, sonography generally follows, first transabdominally, then transvaginally. Unstable patients require immediate resuscitation and gynecologic consultation; invasive diagnostic methods may supplant laboratory and sonography. Unclear cases may require the use of quantitative beta hCG (discriminatory zone), other pregnancy hormone (progesterone) testing, invasive procedures (laparoscopy, culdocentesis, D & C), or observation (serial beta hCG). A suggested algorithm incorporating these elements is presented (Figure 2).

Abdominal Pain↗
PubMed1985

Ectopic pregnancy.

Ectopic pregnancy is no longer dependent on laparotomy for definitive diagnosis. When patients present with massive hemoperitoneum, the diagnosis is usually obvious; but most patients do not present this way, so diagnostic aids are required. Culdocentesis is associated with unusually high false-negative and false-positive results. Laparoscopy is accurate but is an invasive procedure unwarranted in most cases for diagnosis. Although it is unusual to make the diagnosis of unruptured ectopic pregnancy by ultrasonography alone, when ultrasonography is combined with quantitative beta-subunit determinations of human chorionic gonadotropin, many ectopic pregnancies can be diagnosed before rupture occurs. The treatment of the woman with a ruptured ectopic pregnancy and in shock is immediate laparotomy and salpingectomy. Salpingostomy with removal of the ectopic mass and preservation of the tube may enhance a patient's subsequent fertility and may be useful in carefully selected women.

Diagnosis, Differential↗
PubMedDate not supplied

Ectopic pregnancy.

Ectopic pregnancy is an important cause of morbidity and mortality worldwide. Use of transvaginal ultrasonography and quantitative measurement of the beta subunit of human chorionic gonadotropin (beta-hCG) has led to a reduction in the need for diagnostic laparoscopy. Furthermore, with earlier diagnosis, medical therapy with methotrexate can be offered and surgery avoided in some women, though the best regimen remains unclear. In the surgical management of ectopic pregnancy, the benefits of salpingectomy over salpingostomy are uncertain. Although there have been advances in the management of ectopic pregnancy there are still questions to be answered.

Female↗
PubMed1997

Systemic methotrexate treatment in early unruptured ectopic pregnancy.

Ectopic pregnancy is one of the most common and dangerous complications of the early pregnancy period. Until now diagnosis has been late because major symptoms occur after tubal rupture and so only demolitive surgery has been possible. At present, with the appearance of ultrasound in obstetrics an earlier diagnosis of this pathology can be made before tubal rupture so medical treatment has become possible. We treated a series of twelve patients with early ectopic pregnancy (9 tubal and 3 with no localized site of implantation) with intramuscular 0.5 mg/kg methotrexate and oral 0.1 mg/kg of folic acid (Citrovorum Factor) on alternate days, in the attempt to reduce hospitalization and obtain more effective and safer medical management. We observed a fall in serum beta-HCG levels after one cycle of treatment in 11 out of 12 patients and after two cycles of therapy in the remaining case. Minimal side-effects were observed in four cases. Three pregnancies occurred after treatment before the advised interval time and ended in blighted ovum. Methotrexate systemic therapy can be considered an elective treatment and a sufficiently safe management in early unruptured ectopic pregnancy when a good clinical selection of patients is performed.

Administration, Oral↗
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↗
PubMedDate not supplied

Ectopic pregnancy.

Ectopic pregnancy remains a diagnostic and management challenge for nurse practitioners. The incidence and physiology of ectopic pregnancy, the current research on risk factors, detection methods, and management techniques, and counseling strategies are reviewed in this article. In addition, a protocol for nurse practitioners to improve the management and possibly lessen the serious impact of this challenging complication of pregnancy will be discussed.

Algorithms↗
PubMed1987

Ectopic pregnancy.

Ectopic pregnancy is a potentially lethal disorder that is often difficult to diagnose clinically. More than 70,000 ectopic pregnancies are reported annually in the United States, and the incidence is rising. A thorough knowledge of predisposing factors, clinical presentation, common misdiagnoses, and recent advances in diagnostic modalities should help the Emergency Department physician avoid the pitfalls that lead to misdiagnosis with resulting morbidity and, occasionally, mortality.

Diagnosis, Differential↗
PubMed1997

[Surgical treatment of ectopic pregnancy].

Ectopic pregnancy is a common occurrence. Laparoscopic surgery is the treatment of choice when possible. In this retrospective study we report that the type of surgical treatment of ectopic pregnancy is influenced by the degree of haematoperitoneum, but not by delay by doctor or patient.

Female↗
PubMed2002

[Treatment of ectopic pregnancy].

Ectopic pregnancy, a sometimes mortal complication, currently rests one of the more frequently seen problems in women being treated for sterility. The treatment, classically surgical, is now tending towards a medical treatment by methotrexate. Surgical excision of a tubular ectopic pregnancy is done by laparoscopy in preference to laparotomy, which is reserved for an acute haemoperitoneum. The conservation of the fallopian tube depends on multiple factors. Subsequent fertility is dominated by the risk of a recurrence, making call to in vitro fertilization (IVF) in the case of bilateral tubular lesions. Pharmacotherapy by methotrexate is simple to perform, but demands rigourous surveillance.

Abortifacient Agents, Nonsteroidal↗
PubMed2006

The non-surgical management of ectopic pregnancy.

Ectopic pregnancy can now be detected at earlier gestations in asymptomatic women. As a consequence conservative treatment strategies may be more appropriate than surgical intervention. This review aims to discuss the diagnosis and the non-surgical management options for ectopic pregnancy, in particular expectant management and the use of methotrexate.

Abortifacient Agents, Nonsteroidal↗