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 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Risk factors for ectopic pregnancy include previous ectopic pregnancy, current intrauterine device use, prior fallopian tube surgery, previous pelvic inflammatory disease and a prior history of infertility. Abdominal pain is the most common symptom, followed by amenorrhea or vaginal bleeding, nausea, vomiting, syncope and dizziness. Referred shoulder pain following the onset of abdominal pain is characteristic of intraperitoneal bleeding and, in the appropriate clinical setting, strongly suggests a ruptured ectopic pregnancy. A coordinated evaluation includes measurement of serum human chorionic gonadotropin concentration and transabdominal or, preferably, transvaginal ultrasonography. Treatment is primarily by one of a variety of surgical techniques. Medical therapy with methotrexate or other drugs is currently under investigation.
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PMID:Management of ectopic pregnancy. 218 38

The presentation, diagnosis, and treatment of ectopic pregnancy are reviewed. The current trend in treatment of tubal ectopic pregnancy is toward preservation of reproductive function whenever possible. The incidence of ectopic pregnancy has not increased as much over the past several years as some reports indicate; the discrepancy is due to bias introduced by excluding numbers of abortions from the denominators. Pelvic inflammatory disease (PID) is the principal etiologic factor in ectopic pregnancy, and Neisseria gonorrhoeae is the causative agent in most primary tubal infection. Patients with previous abdominal surgery, a history of PID, or who use IUDs have more ectopic pregnancies. The clinical presentation of ectopic pregnancy is variable, and women may be asymptomatic. Any sexually active woman with abnormal bleeding, abdominal pain, or an adnexal mass should be examined immediately to rule out ectopic pregnancy. Culdocentesis may be used to determine whether intraperitoneal hemorrhage is present. The beta human chorionic gonadotropin (hCG) radioimmunoassay is unsurpassed as an endocrine test for diagnosis of ectopic pregnancy, but is time consuming. Diagnostic laparoscopy should not be postponed if a ruptured ectopic gestation is suspected. Ultrasound identification of an intrauterine gestational sac and a serum concentration of beta hCG that exceeds 6500 IU/1 rules out ectopic pregnancy. A sonographically normal uterus and a serum concentration of beta hCG that does not exceed 6500 IU/1 is highly indicative of ectopic pregnancy. Diagnostic laparoscopy to confirm the presence of tubal pregnancy has become routine since technical improvements restored interest in the laparoscope in the early 1960s. Early diagnosis is crucial for preservation of fertility. When a tubal pregnancy is diagnosed, the physician must choose a radical or conservative approach based on the patient's immediate medical condition and desire for future fertility as well as the surgeon's experience. Salpingectomy is the procedure of choice if a fallopian tube is irreparably damaged or if there is a hemoperitoneum associated with shock or profuse bleeding. Rigorous cornual resection is not recommended because it does not exclude a subsequent interstitial pregnancy and may also weaken the myometrium. Colpotomy is rarely indicated, and the removal of a normally functioning ipsilateral ovary is unwarranted. If a conservative approach is feasible, salpingostomy and closure by secondary intention is preferred over salpingotomy and primary closure, which may be complicated by bleeding and edema. Fimbrial evacuation is the easiest procedure but has the highest number of undesirable effects. Midsegment anastomosis, tubouterine implantation, and the Gepfert procedure are either controversial or are associated with poor prognoses. Of all conservative procedures, only salpingostomy offers better results in term pregnancy rates than the radical operations. Salpingectomy is the most efficient treatment for tubal gestation if the patient does not desire future fertility.
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PMID:Ectopic pregnancy. 241 Jan 72

Therapeutic efficacy of acetomepregenol (synthetic progestogen) was evaluated in 104 women (average age was 28.3 years) with threatened habitual abortion at 7-16 weeks of gestation. The group included 69 primipara and 35 secundipara; 73 had a history of 2 miscarriages, 17 of 3 and 14 of 4. clinical manifestations of threatened abortion included lower back and abdominal pain, metrorrhagia, decrease in basal temperature (45.2%), and decrease in chorionic gonadotropin level in the urine (51.9%). Echographic examination indicated local thickening of the myometrium wall in 92% of the patients and increase in the internal diameter of the cervix uteri (2.3-2.6 cm, compared with 1.76 cm in normal pregnancy) in 52.9%. Acetomepregenol was given not earlier than 7-8 weeks of gestation in a daily dose of 0.5-1.5 mg. Total dose per course was 10-45 mg; daily dose was gradually tapered off to 0.26-0.125 mg. During the treatment, 77.9% of the patients showed alleviation or complete disappearance of pain (on day 2-4), 87.5% showed normalization of urinary chorionic gonadotropin levels (1.5-2 weeks after the onset of treatment), and 88.6% showed normalization of the basal temperature (on day 5-7). Treatment with acetomepregenol resulted in gradual disappearance of local thickening of the myometrium seen at ultrasonic examination and normalization of the internal diameter of the cervix uteri. Of 104 women treated with acetomepregenol during the 1st trimester, 87 gave birth to normal babies, 8 had miscarriage at 12-27 weeks of gestation, and 9 had premature labor. The only side-effect of acetomepregenol was nausea recorded in 24% of the patients.
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PMID:[Use of acetomepregenol in the treatment of threatened habitual miscarriage]. 277 75

Case reports are presented on 2 patients to show the importance of following up apparently false positive results of pregnancy tests. In case 1, a 25-year-old woman was admitted to the hospital with severe breathlessness in September 1987. After she had stopped using oral contraceptives (OCs) in 1985 her periods were irregular and on 4 occasions the results of pregnancy tests bought over the counter were positive. She was twice referred for ultrasound examinations, but the uterus was empty each time. In April 1987, dysfunctional uterine bleeding was diagnosed; she was treated with clomiphene. She then experienced intermittent pleuritic chest pain and breathlessness on exertion. In early September she was admitted with acute breathlessness and chest pain. A further pregnancy test was positive; results of laparoscopy of the pelvis were normal. A radioisotope ventilation-perfusion lung scan showed multiple filling defects in the left lung and no perfusion to the right. A presumptive diagnosis of choriocarcinoma was made with the syndrome of tumor growing in the pulmonary arteries. In case 2, a 32-year-old woman was admitted to the hospital in March 1988 with acute lower abdominal pain. A pregnancy test was positive, and she underwent laparoscopy for suspected ectopic pregnancy. A macroscopic tumor was found on the surface of the right ovary and a right salpingo-oophorectomy was performed. A subsequent histological examination showed choriocarcinoma. The 2 cases reported show the importance of seeking a definitive explanation for a false positive result of a pregnancy test. If the test has been performed correctly and proteinuria and drug interference, for instance, are ruled out, then a raised human chorionic gonadotropin concentration, particularly in young women, is virtually certain. In most cases this will be due to a pregnancy that ends in a 1st trimester abortion, but in a small minority it will be due to the hormone producing a tumor such as choriocarcinoma.
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PMID:Don't ignore a positive pregnancy test. 284 5

A retrospective review of the 119 patients with suspected ectopic pregnancy presenting to Duke University Medical Center during the two-year period ending June 30, 1983, was conducted. In order to determine significant differences between patients with and without ectopic pregnancy, the presenting complaints and physical signs were reviewed and analyzed. Significant findings in women with ectopic pregnancy were: (1) vaginal bleeding lasted longer, (2) abdominal rebound tenderness was more prevalent, and (3) abdominal pain was more prevalent in patients with ruptured ectopic pregnancy than in those with unruptured. There were no other significant differences among the signs and symptoms. Patients with and without ectopic pregnancy cannot be easily distinguished on the basis of presenting signs and symptoms. A combination of culdocentesis and quantitative human chorionic gonadotropin provides the maximal discriminative capacity when considering diagnostic laparoscopy for suspected ectopic pregnancy.
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PMID:Contemporary evaluation of suspected ectopic pregnancy. 332 1

In this study, we examined whether the doubling time of human chorionic gonadotropin is different at different stages of early pregnancy and whether the use of multiple nomograms for doubling time of human chorionic gonadotropin rather than a single critical value can improve the diagnosis of ectopic pregnancy. Forty-four women with intrauterine pregnancies who had abdominal pain and/or vaginal bleeding but who did not abort their pregnancies and 44 women with surgically proved ectopic pregnancies were studied. No difference was found in the doubling time of human chorionic gonadotropin when women were classified according to recently published criteria (Pittaway DE, Reish RL, Wentz AC. Doubling times of human chorionic gonadotropin increase in early viable intrauterine pregnancies. Am J Obstet gynecol 1985;152:299-302), and estimates of the doubling time of human chorionic gonadotropin were not influenced by the initial human chorionic gonadotropin values or the sampling interval used. In the human chorionic gonadotropin range of practical interest, multiple nomograms identified 26 of 33 (79%) women with ectopic pregnancy who had rising levels of human chorionic gonadotropin, whereas our previously reported criteria identified 28 of 37 (76%) cases. The false positive rate for each method was 9.7%. Seventeen (19%) of 88 patients could not be allotted to the human chorionic gonadotropin categories for which nomograms of the doubling time of human chorionic gonadotropin have been derived. We conclude that our previous recommendations for determining the rate of increase of human chorionic gonadotropin in serum from paired samples do not require revision at this time.
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PMID:Observations on the log human chorionic gonadotropin-time relationship in early pregnancy and its practical implications. 360 70

A fluoroimmunoassay for chorionic gonadotropin (hCG) was used to detect pregnancy-related disorders in 130 patients attending an outpatient ward because of lower abdominal pain or uterine bleeding. The test uses two monoclonal antibodies and is very rapid (20 min) and highly sensitive (2 IU/l). The number of positive results depends on the selection of cut-off level. All women with ectopic pregnancies were positive at a cut-off level of 10 IU/l, whereas 95% were positive at 25 IU/l. The lower cut-off level was more effective in detecting pregnancies, but it gave more apparently false-positive results and occasionally created problems in clinical management. These difficulties were overcome by serial quantitative estimations of hCG. These results give promise of an effective and simple side-room test for hCG which does not depend on the working hours of a laboratory equipped for handling radioisotopes.
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PMID:Ultrarapid and highly sensitive time-resolved fluoroimmunometric assay for chorionic gonadotropin. 613 96

This article examines causal factors of ectopic pregnancy, discusses management with emphasis on tubal conservation, and updates information on diagnosis, fertility maximization, and minimization of risks of recurrent ectopic gestations. The common factor in ectopic gestations appears to be a delay in the transport of the fertilized ovum to the uterus, allowing the embryo to develop invasive trophoblast. Factors that appear to have increased the incidence of ectopic pregnancy over the past include increased sexual exposure, more effective theraphy for pelvic inflammatory disease, IUDs, tubal surgery, and surgical sterilization reversals. 77% of extrauterine gestations occur in the middle and distal thirds of the fallopian tube, with clinical manifestations largely determined by the site of implantation. Abdominal pain, amenorrhea/vaginal bleeding, and a pelvic mass are the classic signs of an ectopic pregnancy. Newer diagnostic procedures including serum human chorionic gonadotropin-beta subunit assay pregnancy testing supported by ultrasonography and laparoscopy have allowed the vast majority of tubal pregnancies to be diagnoses before rupture, permitting surgery to be undertaken more for the purpose of preserving fertility than for saving the mother's life. Factors in selecting candidates for conservative surgery include medical stability of the patient, parity, desire for future pregnancy, age under 35, mid or distal tubal gestation, prior ectopic gestation or tubal surgery. Considerations influencing the surgical approach for appropriate candidates include location of the pregnancy, condition of the involved and contralateral tube and ovary, pelvic anomalies, previous surgery, and need for ancillary procedures. If the ectopic gestation is located in the mid to distal segment of the fallopian tube, a segmental resection or salpingostomy using microsurgery should give a good anatomic and functional result. A review of the literature indicates that, contrary to prevailing opinion, recurrent etopic gestations are not more common in patients undergoing tubal conservation than in those undergoing more radical procedures. Recent data have shown term pregnancy rates of 40-55% and recurrent ectopic pregnancy rates of 5% in patients with conservative procedures, the improved rate being attributed to availability of microsurgical techniques, finer suture and minimal surgical trauma, which lead to less adhesions and scarring. tudies have indicated that use of Dextran minimizes pelvic adhesion formation, decreasing anatomic distortion leading to subsquent infertility or ectopic pregnancy.
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PMID:Tubal conservation with ectopic gestations. A reappraisal. 623 72

The incidence, clinical presentation, diagnosis, and treatment of 2 problems of early pregnancy--spontaneous abortion and ectopic pregnancy--are reviewed. The incidence of spontaneous abortion is reported to be 10-20% of all pregnancies and may be decreasing. Abnormal development of the pregnancy, unsuccessful implantation, maternal disease, noxious agents, previous surgery, abnormalities of the genital tract, and psychological stress have all been implicated in the etiology of spontaneous abortion. The clinical presentations include threatened, inevitable, incomplete, complete, missed, septic, and habitual abortion. The management of threatened abortion has changed from strict limitations of activity and the use of progestational agents to more liberal recommendations regarding activity and the avoidance of progestins. Combined use of radioimmunoassay for the beta subunit of human chorionic gonadotropin and ultrasound examination of the pelvis can lead to accurate prediction of the pregnancy outcome in patients with 1st trimester bleeding. Evacuation of the uterus is the treatment of choice in inevitable or incomplete abortion. Clinicians should be aware of the guilt feelings, grief reactions, and fears about future pregnancies that often follow spontaneous abortion. Reports of the incidence of ectopic pregnancy have ranged from 1 in 250 to 1 in 70 pregnancies, and the rate has been increasing. The significant morbidity and mortality associated with this condition make early diagnosis essential. The 3 most common symtoms are abdominal pain, amenorrhea, and abnormal vaginal bleeding. Ultrasonography and new methods of measuring human chorionic gonadotropin facilitate early diagnosis. Culdocentesis remains the definitive method of diagnosis. Earlier diagnosis has led some physicians to advocate salpingostomy via laparoscopy rather than salpingectomy for treatment in selected cases.
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PMID:Spontaneous abortion and ectopic pregnancy. 655 28

A pregnancy-related disorder was identified by a rapid radioimmunoassay or serum chorionic gonadotropin in 151 out of 600 women (25%) with lower abdominal pain or bleeding, while a routine pregnancy test in urine was positive in only 7% of these cases. In 60 patients with ectopic pregnancy the rapid hCG-RIA was positive in 90% as compared with 10% for the routine pregnancy test. In patients with evidence of intrauterine pregnancy (80 cases) the rapid hCG-RIA was positive in 99% and routine pregnancy test in 39%. The clinical sensitivity of the hCG-RIA was 95%, specificity 96% and predictive value 88%. These figures should introduce a considerable improvement in the routine diagnosis of early intra- and extrauterine pregnancy-related disorders.
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PMID:[Improved diagnosis of pregnancy-associated gynaecological emergencies via rapid beta-HCG test (author's transl)]. 690 68


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