Biomarkers for ectopic pregnancy and pregnancy of unknown location

Senapati, Suneeta; Barnhart, Kurt T.

doi:10.1016/j.fertnstert.2012.11.038

Cited by 41 publications

(29 citation statements)

References 110 publications

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“…For many of these markers, studies are inconclusive, and for all markers, more research is needed before any of these supplants β-hCG as the primary serologic method of differentiating intra- and extrauterine pregnancies [81]. …”

Section: Reviewmentioning

confidence: 99%

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Panelli

Phillips

Brady

2015

Fertil Res and Pract

208

251

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BackgroundEctopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar.FindingsDiagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality.ConclusionThis review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.

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Section: Reviewmentioning

confidence: 99%

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Panelli

Phillips

Brady

2015

Fertil Res and Pract

208

251

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“…4 As far as diagnosis of ruptured ectopics is concerned no particular investigation including serum or urinary beta human chorionic gonadotropin and transvaginal ultrasonography are conclusive and sometimes a surgical approach is required for the differential diagnosis. 5,6 In addition to high risk for mortality, rupture of an ectopic pregnancy could affect future fertility of a woman.…”

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confidence: 99%

Clinicosociodemographic profile of ruptured ectopic pregnancies at a tertiary care centre

Panda

Rani

Meena

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONRupture of an ectopic pregnancy remains the most common cause of maternal mortality in the first trimester of pregnancy.1,2 Fallopian tubes are the most common site for ectopic pregnancies. Cervix, ovaries, abdomen or the caesarean section scar could be other rare sites that are involved by an ectopic gestation and have an incidence of less than 10% of the patients. 3 Risk of rupture remains the most important concern among such patients and the ABSTRACT Background: Rupture of an ectopic pregnancy remains the most dreaded complication of a pregnancy related event and is the commonest cause of maternal mortality in the first trimester of pregnancy. In the developing countries, the maternal death rate among patients admitted with ectopic pregnancy was found to be as high as one in ten. In addition to high risk for mortality, rupture of an ectopic pregnancy could affect future fertility of a woman. The objectives of this study are to analyse the sociodemographic and clinical characteristics and find out the incidence rate and risk factors associated with ruptured ectopic pregnancies in a tertiary care institution. Methods: This is a retrospective study and was conducted over a period of one year from September 2015 to September 2016 in Department of Obstetrics and Gynecology at Institute of Medical Sciences, BHU, Varanasi, India. It is a tertiary care centre getting referrals not only from nearby cities and hospitals but also from major cities of neighbour states. During this time frame a total of 2601 deliveries have taken place and 57 cases of ruptured ectopic pregnancies were reported. Data were collected in a preconceived format. Results: Total numbers of vaginal deliveries were 2601 during the study period. Out of which 63 (2.42%) were found to be ectopic pregnancies and 57 (1.99%) were diagnosed as ruptured ectopic pregnancies. Maximum number of patients (70.17%) were between 21 and 30 years of age. As far as parity is concerned only 12.29 % of patients were primigravida where as 70.71% patients were multigravida. Previous history of pelvic inflammatory disease was associated among maximum number of cases i.e 50.87% of total number of cases. Among other risk factors, previous abortions, previous ectopic pregnancies and history of infertility treatment were the prime ones. Maximum number of patients were from lower and lower middle class socioeconomic status. Ampullary type of Tubal ectopic pregnancies were found to be the commonest ones. Two cornual pregnancies and two ovarian pregnancies were also found in this series. In 85.97 % of patients the amount of hemoperitoneum was found to be more than 500 ml. Conclusions: There is high incidence rate of ectopic pregnancy and low rate of diagnosis before rupture occurs in developing nations as in our scenario. Pelvic inflammatory disease, Maternal education, socioeconomic status, parity and history of subfertilty are the risk factors associated with ruptured ectopic pregnancy. Effective efforts should be taken to encourage the level of education and imp...

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“…A longer evaluation time can delay the treatment of an ectopic pregnancy increasing risk of rupture, potentially leading to dangerous hemorrhage, compromised fertility, and increased mortality [2, 3, 12]. However, presumptive treatment may lead to misdiagnosis, inappropriate treatment, and adverse events related to treatment (and not the underlying condition) including embryo toxicity and teratogenicity [13, 14].…”

Section: Discussionmentioning

confidence: 99%

“…The presence of abdominal pain with or without vaginal bleeding in the first trimester of pregnancy raises concern for ectopic pregnancy or miscarriage [1-3]. To delineate between a viable intrauterine pregnancy and an abnormal pregnancy, it is common practice to monitor serial βhCG measurements.…”

Section: Introductionmentioning

confidence: 99%

Trends in the Management of Nonviable Pregnancies of Unknown Location in the United States

Parks

Barnhart

Howard

2018

Gynecol Obstet Invest

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Background: When managing a nonviable pregnancy of unknown location (PUL), a debate has emerged in the literature whether to perform uterine curettage for definitive diagnosis of pregnancy location or administer methotrexate for a presumed ectopic pregnancy. The purpose of this study is to describe the treatment patterns when managing a PUL. Methods: A prospective, anonymous Internet based-electronic survey of PUL case scenarios was administered to a random sample of physicians across the United States. Results: A total of 214 physicians responded. When presented with a PUL by ultrasound and a βhCG measurement of 3,270 mIU/mL, which is above the discriminatory level, 88.3% (188) would choose an additional βhCG measurement before recommending any intervention. When presented with a PUL by ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable gestation, 36.5% would offer uterine curettage and 31.3% would offer methotrexate. Resident and private clinicians had a fourfold lower adjusted odds of choosing uterine curettage compared to academic physicians. Conclusions: Based on our findings, there does not appear to be a consensus regarding the management of a PUL.

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Biomarkers for ectopic pregnancy and pregnancy of unknown location

Cited by 41 publications

References 110 publications

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Clinicosociodemographic profile of ruptured ectopic pregnancies at a tertiary care centre

Trends in the Management of Nonviable Pregnancies of Unknown Location in the United States

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