New Evidence to Guide Ectopic Pregnancy Diagnosis and Management

Brady, Paula C.

doi:10.1097/ogx.0000000000000492

Cited by 47 publications

(80 citation statements)

References 55 publications

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“…3,4 The early diagnosis of this entity is a priority to initiate adequate management and provide the patient with a lower risk of morbidity as far as radical surgical treatment is concerned. 1…”

Section: Discussionmentioning

confidence: 99%

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Hysteroscopic treatment of cervical pregnancy: case report

Valdez¹,

Flores²,

Vilchis³

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Of ectopic pregnancies, cervical implantation pregnancy is an exceptional entity, corresponding to less than 1% of ectopic pregnancies. With an incidence calculated at 1: 2500 to 1: 12,000 pregnancies. The risk factors for cervical pregnancy are the same as for other ectopic pregnancies. This entity, a difference from tubaric pregnancy where bleeding is within the peritoneal cavity, the main risk is incoercible vaginal bleeding, which usually ends in a hysterectomy, which limits the reproductive future of patients. There are currently no established criteria for candidates for medical versus surgical treatment. This case reports a case of cervical ectopic pregnancy, treated with Methotrexate, and culminating with hysteroscopy resection.

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Section: Discussionmentioning

confidence: 99%

“…It occurs when the zygote is implanted in the path of the cervical canal. 1,2 It is an exceptional entity, corresponding to less than 1% of ectopic pregnancies. With an incidence calculated at 1:2500 to 1:12,000 pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Hysteroscopic treatment of cervical pregnancy: case report

Valdez¹,

Flores²,

Vilchis³

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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show abstract

“…Measurement of hCG, specifically the beta isoform (βhCG), is a well‐established diagnostic tool for the detection of early pregnancy, but also an important marker of the viable pregnancy 3 . Moreover, levels of βhCG, together with the absence of ultrasonographic signs of the intrauterine pregnancy, are indicative of the pregnancy of the unknown origin (PUO), especially the ectopic, tubar pregnancy 3,4 . It has also been reported that the levels of βhCG in the cases of PUO are often above discriminatory levels, while the initial rise of the βhCG in the first few days is less than 35%.…”

Section: Discussionmentioning

confidence: 99%

Case report of persistent elevation of βhCG in a nonpregnant woman: A diagnostic puzzle

Bonaci-Nikolic

Rakic

Ardalić

et al. 2020

J of Obstet and Gynaecol

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Detectable serum levels of beta subunit of human chorionic gonadotropin (βhCG) in nonpregnant, perimenopausal women bring confusion in both clinician and patient and could lead to unnecessary diagnostic and therapeutic procedures. A 45‐year‐old woman with the continuous elevation of βhCG underwent hysteroscopy, two laparoscopic surgeries, two explorative uterine cavity curettages and three cycles of cytostatic therapy. No ultrasonographic, macroscopic or histological signs of pregnancy, both uterine and ectopic or gestational trophoblastic disease were found. Both radiographic and computed tomography reports ruled out the presence of a nongynecological neoplasm. All recommended steps were taken for confirmation or ruling out the possibility of heterophile antibodies interference, but the results were not absolute. Finally, the referent laboratory confirmed the presence of the antibodies, but their exact type remains unknown. This case underlines the importance of the universally accepted protocol in the cases of persistent βhCG elevation in nonpregnant, perimenopausal women.

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“…Ectopic pregnancy is a common cause of maternal death, accounting for 10% of maternal deaths. In recent years, its incidence has increased [2][3] . Although traditional salpingectomy is a reliable treatment approach, it is likely to reduce the fertility of patients.…”

Section: Discussionmentioning

confidence: 99%

Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

Zhang

Gan

et al. 2019

Preprint

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Objective: The aim of this study was to summarize clinical features and identify success predictors of methotrexate (MTX) treatment in ectopic pregnancy. Methods: Retrospective study of 213 ectopic pregnancies (EPs) treated with MTX in the Department of Gynecology of the Shaanxi Provincial People's Hospital from January 2017 to December 2017. Results: Patients were divided into two groups: the successful treatment group (n=166) and the failed treatment group (n=47). The overall success rate of MTX therapy for ectopic pregnancy was 77.93%, and the total cost of MTX therapy ($437.83) was far lower than that of surgical treatment (>$1459.45). The mean initial β-hCG level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 mIU/mL versus 3195.91 mIU/mL, P=0.010). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (61.22%). The β-hCG levels were significantly increased on the 4th day in the failed treatment group (P=0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the ROC curve was 0.863 (95% CI: 0.805-0.920). Conclusions: MTX therapy as a treatment option is safe, effective and economical for asymptomatic, hemodynamically stable patients with EPs who are keen on fertility preservation, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the MTX therapy of ectopic pregnancy.

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New Evidence to Guide Ectopic Pregnancy Diagnosis and Management

Cited by 47 publications

References 55 publications

Hysteroscopic treatment of cervical pregnancy: case report

Hysteroscopic treatment of cervical pregnancy: case report

Case report of persistent elevation of βhCG in a nonpregnant woman: A diagnostic puzzle

Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

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