CPK: The new tool in the diagnosis of ectopic pregnancy

Ganta, Suvarna Jyothi; Kulkarni, Sunanda R.; Muralidhar, Vidya

doi:10.18203/2320-1770.ijrcog20172341

Cited by 3 publications

(6 citation statements)

References 3 publications

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“…Plewa et al [4] , in 1998 found a significant increase in creatinine phosphokinase levels among ectopic pregnancies compared to abortive and normal pregnancies, but concluded that a significant overlap in CPK values makes the use of this serum marker unreliable for detecting ectopic pregnancy. Following this Birkhahn et al [5] in 2000, Wazir et al [6] , in 2009 and Ganta et al [7] , in 2017 studied that creatinine kinase values to be significantly increased in ectopic gestations ~ 157 ~ compared to normal intrauterine pregnancies. Serum CPK levels in women with pregnancy of unknown location, has not been studied till date.…”

Section: Discussionmentioning

confidence: 97%

Pregnancy of unknown location- can serum creatinine phophokinase point towards tubal ectopic gestation?: A pilot study

B¹,

Vijayarghavan²

2019

Int. J. Clin. Obstet. Gynaecol.

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Background: Pregnancy of unknown location (PUL) is defined as the situation when the urine or serum pregnancy test is positive but there are no signs of intrauterine or extra-uterine pregnancy on ultrasonography and serum beta HCG is in the window period. Among all possible outcomes of pregnancy of unknown location, ectopic pregnancy is the most feared outcome. A delay in diagnosis might increase the maternal mortality and morbidity. Methods: A prospective observational study conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, between February 2018 and April 2019. Women who had beta HCG in the discriminatory zone with an inconclusive transvaginal ultrasound were included in the study. Serum Creatinine phosphokinase levels were measured along with beta HCG. Results: Among the 12women with PUL, 11 of them were eventually diagnosed with ectopic gestation and one of them remained to be a pregnancy of unknown location. All the patients diagnosed with ectopic gestation had their initial serum CPK levels above the cut off value of 51IU/lit. Conclusion: Serum CPK levels in PUL can be used as a marker for early diagnosis of ectopic gestation when beta HCG and ultrasound are inconclusive. Larger studies are required to ascertain the significance.

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Section: Discussionmentioning

confidence: 97%

Pregnancy of unknown location- can serum creatinine phophokinase point towards tubal ectopic gestation?: A pilot study

B¹,

Vijayarghavan²

2019

Int. J. Clin. Obstet. Gynaecol.

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“…Despite the use of sensitive assays for β-HCG and high-definition transabdominal and vaginal ultrasound, it is believed that 40%–50% of EP cases remain unidentified in the early stages, particularly below the discriminative zone of β-hCG, thus posing a great diagnostic challenge. [ 5 ] It is also important to note the fact that almost half of the tubal pregnancies report when they have already ruptured,[ 11 ] thereby pointing the necessity for early detection to prevent fatal consequences and the requirement of a diagnostic marker with good accessibility and reliability to diagnose tubal EP at the earliest.…”

Section: Discussionmentioning

confidence: 99%

“…In one-way ANOVA test, the mean levels of total CPK and CPK-MB were significantly higher in EP compared to other groups ( P < 0.001). Similar findings were echoed by Ganta et al .,[ 5 ] where the mean CPK was found to be significantly higher in EPs in comparison to AP and intrauterine pregnancies. Several studies such as those by Birkhahn et al ,[ 6 ] Kurzel et al, [ 15 ] and Chandra and Jain[ 16 ] also reported significantly higher CPK level in the EP group.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the use of high-resolution transvaginal scans and sensitive assays for β -hCG, EP is still a diagnostic dilemma and challenge to the obstetricians, with 40%–50% of the cases being initially missed. [ 5 ] Misdiagnosis can lead to delay in treatment resulting in adverse maternal outcomes, thereby necessitating early and accurate diagnosis. Early identification of EP allows successful medical management, thereby obviating the need for surgical intervention and preventing the complications and long-term sequelae associated with it, thus once again reiterating the importance of timely diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Role of creatine phosphokinase as a diagnostic marker in tubal ectopic pregnancy

Sharma,

Kharkongor,

Basu

et al. 2023

Journal of Family Medicine and Primary Care

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Background and Aim: Ectopic pregnancy (EP) is still one of the leading preventable causes of maternal morbidity and mortality in the first trimester. Amidst the use of sensitive assays for β-HCG and high-definition ultrasonography for the identification of EP, the search for a more reliable and sensitive marker remains a challenge till date. Our aim was to determine the validity of creatine phosphokinase (CPK) and its isoenzyme (CPK-MB) in the prediction of tubal EP. Materials and Methods: A prospective and comparative diagnostic accuracy study was conducted among 105 pregnant women in the first trimester who met the eligibility criteria in the Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS). The study included 35 patients each with tubal EP (EP), abortive intrauterine pregnancy (AP), and normal intrauterine pregnancy (NP). CPK, CPK-MB, and β-HCG were measured among all the participants, and the participants were followed up longitudinally. Results: A total of 105 pregnant women were included. The mean CPK and CPK-MB levels were significantly higher among the women with EP when compared to NP (P < 0.05) and AP (P < 0.05) women; however, there was no significant difference between the NP and AP groups (P > 0.05). Moreover, the receiver operating characteristic (ROC) curve showed that both CPK and CPK-MB were good predictors of EP, with CPK (area under the curve [AUC] = 0.764) being a better predictor than CPK-MB (AUC: 0.650) in the diagnosis of EP. Conclusion: Early diagnosis of EP allows appropriate and timely management, which would not only reduce mortality and morbidity associated with the condition but also enable preservation of fertility and improve future pregnancy outcome. Hence, the need of the hour is a reliable biochemical diagnostic marker for EP, such as CPK.

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“…With a cut-off concentration of 200 pg/ml, serum VEGF could distinguish normal IUP from EP with a sensitivity of 88% [31] . In-addition, an earlier report suggest that women with EP have significantly greater Serum creatine kinase (CK) activity as compared to the women with normal pregnancies, suggesting that CK could be a crucial predictive marker for EP [32] . However, a few previous studies have demonstrated poor sensitivity and positive predictive values for this marker, suggesting that it alone, is insufficient for use in clinical practice [33] .…”

Section: Diagnosis Of Ectopic Pregnancymentioning

confidence: 99%

Incidence, diagnosis and management of ectopic pregnancies: A review

Pillai¹,

Rs²

2020

Int. J. Clin. Obstet. Gynaecol.

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Background: Ectopic pregnancy; the conceptus implanting outside the uterine cavity, arises in 1.3-2.4% of all pregnancies which put the lives of many young women in peril. It causes major maternal morbidity and mortality and its incidence is increasing worldwide. Though the set medical practices to address the grave situation are improved, it still remains worrying to note in third world countries. Methods: We review the incidence, causes, diagnosis, and management of ectopic pregnancy. The evidence presented is from a combination of selected published papers identified from Medline and a reflection of clinical practice in our unit. Results: Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management with methotrexate is an effective option in most clinically stable patients. Patients, who have failed medical management or presented with ruptured ectopic pregnancy are most frequently managed with excision by laparoscopy or, less commonly, laparotomy. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. Conclusion: This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic pregnancies, and reviews the existing data regarding recurrence and future fertility.

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CPK: The new tool in the diagnosis of ectopic pregnancy

Cited by 3 publications

References 3 publications

Pregnancy of unknown location- can serum creatinine phophokinase point towards tubal ectopic gestation?: A pilot study

Pregnancy of unknown location- can serum creatinine phophokinase point towards tubal ectopic gestation?: A pilot study

Role of creatine phosphokinase as a diagnostic marker in tubal ectopic pregnancy

Incidence, diagnosis and management of ectopic pregnancies: A review

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