RESUMO
OBJECTIVE: Chronic ectopic pregnancy is a variant of ectopic pregnancy featured with a low or normal serum beta-human chorionic gonadotropin (ß-hCG) test. Obscure clinical presentations and non-specific images make chronic ectopic pregnancy a diagnostic dilemma until now. CASE REPORT: A 40-year-old female was misdiagnosed as tubo-ovarian abscess initially due to chronic lower abdominal pain, negative pregnancy test, and a complicated pelvic mass on abdominal CT scan and serial follow-up ultrasonography. Diagnostic laparoscopy was performed because of persistent pelvic mass with abdominal pain and irregular vaginal bleeding. Left tubal salpingectomy was performed and pathology reported a hematocele with inactive trophoblast tissue. Chronic ectopic pregnancy was proved. The symptoms resolved completely after our surgery. CONCLUSION: An abnormal adnexal mass with a history of recent pregnancy could still be possible for chronic ectopic pregnancy even with a negative pregnancy test. Diagnostic laparoscopy and pathology confirmation could be helpful when the clinical manifestation is confusing.
Assuntos
Laparoscopia , Gravidez Tubária , Salpingectomia , Humanos , Feminino , Gravidez , Adulto , Gravidez Tubária/diagnóstico , Gravidez Tubária/cirurgia , Gravidez Tubária/sangue , Erros de Diagnóstico , Doença Crônica , Testes de Gravidez , Dor Abdominal/etiologia , Diagnóstico Diferencial , Gonadotropina Coriônica Humana Subunidade beta/sangue , Ultrassonografia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy remain controversial. This study investigated the outcomes of ectopic pregnancy after one and two MTX doses and their independent predictors. METHODS: Retrospective cross-sectional study of women who consented to MTX treatment in 2017-2018 at our institution (N = 317). Of these, patients with Caesarean scar pregnancies were excluded because they require different treatment protocols (n = 25). All patients were treated according to our institution's protocol based on international guidelines and standardised across the three hospitals included in the current study. We retrieved patients' demographics, laboratory, ultrasonography, and clinical characteristics from our hospital database. Serum ß-human chorionic gonadotropin (ß-hCG) was measured using electrochemiluminescence immunoassay; ectopic pregnancy was diagnosed using ultrasonography (transvaginal probe). RESULTS: Two ninety-two patients were included in the current analysis. Age, pre-treatment ß-hCG levels, sonographic presence of yolk sac, presence of foetal cardiac activity, and pelvic pain were significantly different between patients with successful and unsuccessful outcomes. Younger age (adjusted odds ratio [aOR] 2.33, 95% confidence interval (CI) 1.16-4.66, p = .017), no pelvic pain (aOR 2.65, 95%CI 1.03-6.83, p = .043), lower initial ß-hCG level (aOR 1.32, 95%CI 1.08-1.59, p = .005), and absence of foetal cardiac activity (aOR 12.63; 95% CI 1.04-153.6; p = .047) were independently associated with success. Treatment failure odds were >2 folds higher for each 10-year age increase (p = .017), 32% higher for each 1000 IU/L increase in initial ß-hCG level (p = .005), and >2 folds higher in presence of pelvic pain (p = .043). CONCLUSIONS: MTX is effective in most patients, averting invasive surgery, which might affect fertility. Pre-treatment ß-hCG levels, age, pelvic pain, and foetal cardiac activity was independently associated with outcomes. Research should assess the relationship between the ectopic pregnancy size and treatment outcomes and refine ß-hCG titres where treatment would be ineffective.
Ectopic pregnancy is a pregnancy that occurs outside the uterus. It needs to be identified and treated quickly to prevent serious health complications. Ectopic pregnancies can be treated surgically or medically using a drug called methotrexate. Medical treatment of ectopic pregnancy is not always successful. Identifying the factors that predict the failure of medical treatment helps patients and doctors to choose more accurately between surgical and medical treatment options.A total of 292 women who received methotrexate for ectopic pregnancy and the factors that influence the outcomes of treatment were examined, 39 patients had treatment failure and required surgery. Older age, higher initial levels of ß-human chorionic gonadotropin (ß-hCG) hormone, the presence of pelvic pain, and foetal cardiac activity had increased risk of treatment failure. In the future, research could consider the relationship between the size of the ectopic pregnancy and the treatment outcomes and refine the ß-hCG level cut-off for better treatment effects.
Assuntos
Abortivos não Esteroides , Gonadotropina Coriônica Humana Subunidade beta , Metotrexato , Gravidez Tubária , Humanos , Feminino , Metotrexato/uso terapêutico , Gravidez , Adulto , Estudos Retrospectivos , Estudos Transversais , Abortivos não Esteroides/uso terapêutico , Gonadotropina Coriônica Humana Subunidade beta/sangue , Gravidez Tubária/sangue , Gravidez Tubária/tratamento farmacológico , Resultado do TratamentoRESUMO
We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an ultrasound examination 70 days after the onset of menopause. She had a history of ovulation induction. The ultrasound findings suggested a partial hydatidiform mole. She was then pathologically confirmed to have a complete hydatidiform mole after uterine suction dilation and curettage. On postoperative day 4, an ultrasound examination before discharge showed an inhomogeneous mass in the left adnexal region with mild lower abdominal pain. On postoperative day 17, the blood human chorionic gonadotropin level did not drop as expected, and a follow-up examination still indicated a mass in the left adnexal region. We were unable to rule out an ectopic hydatidiform mole. Hysteroscopy with laparoscopic exploration of the left adnexal mass and salpingotomy suggested a diagnosis of intrauterine hydatidiform mole combined with left tubal pregnancy.
Assuntos
Mola Hidatiforme , Gravidez Tubária , Humanos , Feminino , Gravidez , Mola Hidatiforme/cirurgia , Mola Hidatiforme/diagnóstico , Mola Hidatiforme/diagnóstico por imagem , Mola Hidatiforme/patologia , Gravidez Tubária/cirurgia , Gravidez Tubária/diagnóstico , Gravidez Tubária/diagnóstico por imagem , Gravidez Tubária/sangue , Adulto , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia , Gravidez Heterotópica/cirurgia , Gravidez Heterotópica/diagnóstico , Gravidez Heterotópica/diagnóstico por imagem , UltrassonografiaRESUMO
OBJECTIVE: We aimed to assess the impact of the coronavirus disease 2019 pandemic on the clinical presentation of tubal ectopic pregnancies. METHODS: This retrospective cohort study was conducted at a tertiary center and included 76 cases of tubal ectopic pregnancies. The study period was divided into two groups: the pre-coronavirus disease group (January 2018 to February 2020, Group 1; n=47, 61.8%) and the coronavirus disease group (March 2020 to February 2022, Group 2; n=29, 38.2%). Subgroup analysis was also performed for tubal ruptured ectopic pregnancies as Group 1 (n=15, 62.5%) and Group 2 (n=9, 37.5%). RESULTS: No statistically significant differences were observed between the pre-coronavirus disease and coronavirus disease groups in terms of demographic characteristics. Although the serum beta-human chorionic gonadotropin level was found to be higher in Group 2, the difference was not statistically significant (p=0.7). The groups appeared to be similar in treatment management, duration of hospitalization, and blood transfusion needs (p=0.3, p=0.6, and p=0.5, respectively). Additionally, no significant difference was observed between the groups in the evaluation of ruptured ectopic pregnancies (p=0.5). In the subgroup analysis of tubal ruptured ectopic pregnancies, no significant difference was observed. CONCLUSION: To the best of our knowledge, there are few studies evaluating the effect of the pandemic on tubal ectopic pregnancies in the literature. Although we did not report statistically significant differences between groups in our study, given the potential prolonged duration of the pandemic, healthcare professionals should actively prompt their patients to seek necessary medical assistance.
Assuntos
COVID-19 , Gravidez Tubária , Humanos , Feminino , Estudos Retrospectivos , COVID-19/epidemiologia , Gravidez , Adulto , Gravidez Tubária/sangue , Gravidez Tubária/epidemiologia , SARS-CoV-2 , Pandemias , Adulto Jovem , Gonadotropina Coriônica Humana Subunidade beta/sangueRESUMO
PURPOSE: This work aimed to explore the relationship between epidermal growth factor (EGF) and ß-human chorionic gonadotropin (ß-HCG) and ectopic pregnancy types and impact on prognosis. METHODS: Twenty women with normal pregnancies (NPs) were recruited as control group, and twenty women each with tubal pregnancy (TP) and cervical pregnancy (CP) were recruited. Blood samples were collected to detect EGF and ß-HCG. Data on length of hospital stay and incidence of complications were collected. The differences in serum EGF and ß-HCG levels were compared among groups and within various types of ectopic pregnancy using analysis of variance and Pearson correlation analysis. RESULTS: Serum EGF and ß-HCG were notably lower in TP and CP group vs. controls (P < 0.05). In subgroup analysis within the types of ectopic pregnancy, serum EGF levels were drastically higher in TP group vs. CP group (P < 0.05). Serum EGF levels were negatively correlated with pregnancy outcomes and incidence of complications (P < 0.05). In patients with TP and CP, serum EGF and ß-HCG recovery time and hospital stay differed drastically (P < 0.05). Serum EGF and ß-HCG levels showed optimal cutoff values identified at 2.65 µg/L and 11,745.35 IU/L, respectively. The corresponding area under the curve (AUC) values were 0.885 and 0.841. CONCLUSION: Elevated levels of EGF may be associated with the occurrence of ectopic pregnancy and may impact the type of ectopic pregnancy, pregnancy outcomes, and the incidence of complications. Further clinical research is warranted to investigate these findings.
Assuntos
Gonadotropina Coriônica Humana Subunidade beta , Fator de Crescimento Epidérmico , Gravidez Ectópica , Humanos , Feminino , Gravidez , Adulto , Gonadotropina Coriônica Humana Subunidade beta/sangue , Gravidez Ectópica/sangue , Gravidez Ectópica/diagnóstico , Fator de Crescimento Epidérmico/sangue , Prognóstico , Estudos de Casos e Controles , Gravidez Tubária/sangue , Gravidez Tubária/diagnóstico , Tempo de Internação/estatística & dados numéricos , Resultado da GravidezRESUMO
OBJECTIVE: To identify risk factors for readmission following methotrexate treatment for tubal pregnancy. METHODS: A retrospective study undertaken in two tertiary medical centers, including all individuals with medically treated tubal pregnancy (N = 511), between December 2009 and June 2021. Individuals with and without readmission following methotrexate treatment were compared. The primary outcome was the readmission rate. Secondary outcomes included the rate of post-discharge gynecological emergency department visits, tubal rupture rate, and the eventual need for surgical treatment. RESULTS: Readmission following methotrexate treatment occurred in 224/511 patients (43.8%). Most readmissions were due to abdominal pain or suspicion of treatment failure. Readmitted individuals were more likely to have a history of pelvic inflammatory disease and pretreatment serum human chorionic gonadotropin (hCG) >2000 mIU/mL. Both factors remained significantly associated with higher readmission rates in a logistic regression analysis (adjusted odds ratio [OR] 6.28, 95% confidence interval [CI] 1.30-30.45, and adjusted OR 2.73, 95% CI 1.83-4.07, respectively) after adjustment for age, endometriosis, tubal pathology, abdominal pain, and presence of yolk sac or embryo at diagnosis. A dose-dependent association was observed between pretreatment serum hCG levels and readmission rate (P < 0.001). Pretreatment hCG levels were also associated with tubal rupture and the eventual need for surgical treatment (P < 0.001 for both). A prediction model using hCG was not sufficiently accurate to predict readmission risk. CONCLUSION: Readmission following methotrexate treatment for tubal pregnancy was independently associated with previous pelvic inflammatory disease and pretreatment serum hCG levels. The latter was also associated with surgical intervention rate.
Assuntos
Abortivos não Esteroides , Metotrexato , Readmissão do Paciente , Gravidez Tubária , Humanos , Feminino , Metotrexato/uso terapêutico , Metotrexato/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Gravidez , Adulto , Estudos Retrospectivos , Gravidez Tubária/tratamento farmacológico , Gravidez Tubária/sangue , Gravidez Tubária/cirurgia , Abortivos não Esteroides/uso terapêutico , Abortivos não Esteroides/efeitos adversos , Fatores de Risco , Gonadotropina Coriônica/sangue , Dor Abdominal/etiologia , Doença Inflamatória Pélvica/tratamento farmacológico , Modelos LogísticosRESUMO
OBJECTIVE: The objective of this study was to evaluate whether a single measurement of vascular endothelial growth factor could distinguish between intrauterine pregnancy and ectopic pregnancy and to correlate the levels of vascular endothelial growth factor with serum levels of progesterone andß-human chorionic gonadotropin in each subgroup. METHODS: Ninety patients with a positive human chorionic gonadotropin test and either abdominal pain or vaginal bleeding were selected; pregnancies were singletons, spontaneously conceived, 42-56 days of gestational age. All patients had a transvaginal ultrasound examination and were divided into three subgroups: abnormal intrauterine pregnancy, tubal pregnancy, and normal intrauterine pregnancy. Tubal pregnancies were surgically treated and histologically confirmed. Blood samples were collected for the determination of ß-human chorionic gonadotropin, progesterone, and vascular endothelial growth factor and their concentrations were compared in each subgroup. Receiver operating characteristic curve was calculated by comparing the subgroup of tubal pregnancy to the other groups. A Fisher discriminant function analysis was performed. The level of significance was 5%. RESULTS: One-way analysis of variance revealed a significant correlation between the different subgroups and ß-human chorionic gonadotropin, progesterone, and vascular endothelial growth factor serum levels (p<0.001). Vascular endothelial growth factor concentration was significantly higher for patients with tubal pregnancy than for other subgroups (p<0.05). ß-Human chorionic gonadotropin and progesterone levels were higher in the subgroup with normal intrauterine pregnancies compared with the subgroups with tubal and abnormal intrauterine pregnancies (p<0.05). Serum vascular endothelial growth factor level >188.7 ng/mL predicted tubal pregnancy with 96.7% sensitivity, 95.0% specificity, 90.6% positive predictive value, and 98.3% negative predictive value. CONCLUSIONS: Serum vascular endothelial growth factor could be a marker in discriminating intrauterine pregnancy from tubal pregnancy; its levels are increased in women with ectopic pregnancy compared with women with normal and abnormal intrauterine pregnancies.
Assuntos
Gravidez Tubária , Gravidez , Fator A de Crescimento do Endotélio Vascular , Biomarcadores/sangue , Gonadotropina Coriônica/sangue , Feminino , Humanos , Gravidez/sangue , Gravidez Tubária/sangue , Gravidez Tubária/diagnóstico por imagem , Progesterona/sangue , Fator A de Crescimento do Endotélio Vascular/sangueRESUMO
OBJECTIVE: To evaluate serum protein calponin 2 (CNN2) as a candidate biomarker for tubal ectopic pregnancy (EP). DESIGN: Retrospective study. SETTING: Single University affiliated tertiary hospital. PATIENT(S): Serum samples were obtained from 84 patients with EP, 39 with viable intrauterine pregnancy (vIUP), and 42 with miscarriage. Moreover, 10 fallopian tube and corresponding villous tissue samples from patients with EP, 6 villous tissue samples from patients with vIUP, and 10 villous tissue samples from patients with miscarriage were collected. INTERVENTION(S): Serum CNN2 concentrations were measured using enzyme-linked immunosorbent assay; CNN2 expression in tissues was evaluated via immunohistochemistry and quantitative real-time polymerase chain reaction analysis. MAIN OUTCOME MEASURE(S): The diagnostic performance of serum CNN2 to discriminate an EP from vIUP and miscarriage. RESULT(S): CNN2 was highly expressed in villous stromal cells isolated from patients with EP, and CNN2 messenger ribonucleic acid expression was upregulated in villous tissues from women with EP compared with that in women with vIUPs and miscarriages. Serum CNN2 concentration was higher in women with EP than that in women with vIUP and miscarriage. The serum CNN2 predicted EP from vIUP and miscarriage with areas under the curve (AUCs) of 0.931 (95% confidence interval: 0.889-0.975). For discriminating EP from miscarriage only, the AUC was 0.906 (95% confidence interval: 0.835-0.977). In contrast, the AUCs for serum human chorionic gonadotropin were 0.809 and 0.637, respectively. CONCLUSION(S): Our data highlight the possibility of serum CNN2 as a single biomarker for the diagnosis of EP. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR 1900020483.
Assuntos
Aborto Espontâneo/sangue , Proteínas de Ligação a Calmodulina/sangue , Proteínas dos Microfilamentos/sangue , Gravidez Tubária/sangue , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/genética , Adulto , Biomarcadores/sangue , Proteínas de Ligação a Calmodulina/genética , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imuno-Histoquímica , Proteínas dos Microfilamentos/genética , Valor Preditivo dos Testes , Gravidez , Gravidez Tubária/diagnóstico , Gravidez Tubária/genética , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Regulação para Cima , Adulto JovemRESUMO
PURPOSE: The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality. METHODS: This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, ß-human chorionic gonadotropin (ß-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA). RESULTS: The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10- 5) that was diagnosed in the 7th gestational week. The only association found was between the ß-HCG level and LOS, with a linear regression ß coefficient of 0.01 and a P-value of 0.04. CONCLUSION: EP is a relatively common condition affecting approximately 1% of all pregnancies. ß-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.
Assuntos
Dor Abdominal/fisiopatologia , Gonadotropina Coriônica Humana Subunidade beta/sangue , Tempo de Internação/estatística & dados numéricos , Gravidez Ectópica/epidemiologia , Abortivos não Esteroides/uso terapêutico , Adulto , Cesárea/estatística & dados numéricos , Escavação Retouterina , Feminino , Humanos , Incidência , Dispositivos Intrauterinos , Laparoscopia , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Gravidez , Gravidez Ectópica/sangue , Gravidez Ectópica/fisiopatologia , Gravidez Ectópica/terapia , Gravidez Heterotópica/sangue , Gravidez Heterotópica/epidemiologia , Gravidez Heterotópica/fisiopatologia , Gravidez Heterotópica/terapia , Gravidez Ovariana/sangue , Gravidez Ovariana/epidemiologia , Gravidez Ovariana/fisiopatologia , Gravidez Ovariana/terapia , Gravidez Tubária/sangue , Gravidez Tubária/epidemiologia , Gravidez Tubária/fisiopatologia , Gravidez Tubária/terapia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Salpingectomia , Salpingostomia , Fumar/epidemiologia , Adulto JovemRESUMO
We present a case of a tubal ectopic pregnancy (EP) in a patient with an initially undetectable serum ß-human chorionic gonadotropin (ß-hCG) level. A 33-year-old woman in a same-sex relationship underwent timed donor intrauterine insemination. Her serum ß-hCG level was <5 mIU/mL 14 days after the intrauterine insemination. She reported menstrual bleeding 3 days after her negative pregnancy test and returned to the office 10 days later to begin a new treatment cycle. Her serum levels of estradiol, progesterone, and ß-hCG were 119 pg/mL, 6.1 ng/mL and 1157 mIU/mL, respectively. Transvaginal ultrasonography did not show an intrauterine pregnancy. Her ß-hCG level increased to 1420 mIU/mL the next day. She was diagnosed with a pregnancy of unknown location and treated with methotrexate. Her ß-hCG levels continued to increase despite 3 methotrexate doses, necessitating laparoscopy. The diagnostic laparoscopy demonstrated approximately 100 mL of hemoperitoneum in the posterior cul-de-sac with an intact right fallopian tube that was dilated at its distal end by the EP. A total right salpingectomy was performed. Her ß-hCG level was <5 mIU/mL 3 weeks later. The current case supports that although rare, an undetectable serum ß-hCG level does not completely rule out the diagnosis of an EP.
Assuntos
Gonadotropina Coriônica Humana Subunidade beta/sangue , Gravidez Tubária/diagnóstico , Adulto , Diagnóstico Tardio , Reações Falso-Negativas , Feminino , Fertilização in vitro/efeitos adversos , Hemoperitônio/sangue , Hemoperitônio/diagnóstico , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Inseminação Artificial Heteróloga/efeitos adversos , Laparoscopia/métodos , Metotrexato/uso terapêutico , Gravidez , Testes de Gravidez/efeitos adversos , Gravidez Tubária/sangue , Gravidez Tubária/tratamento farmacológico , Gravidez Tubária/cirurgia , Salpingectomia/métodosRESUMO
RESEARCH QUESTION: What is the time required for complete physical resolution of tubal ectopic pregnancies diagnosed on ultrasound imaging in women undergoing successful expectant management? DESIGN: A prospective observational cohort study of 177 women who had successful expectant management of tubal ectopic pregnancy, who attended a single Early Pregnancy Unit between January 2014 and December 2018. All participants were monitored until their serum beta-human chorionic gonadotrophin (beta-HCG) dropped to non-pregnant concentrations and with 2-weekly follow-up ultrasound scans until resolution of the pregnancy. RESULTS: A total of 112/177 (63.3%, 95% confidence interval [CI] 55.7-70.4) of tubal ectopic pregnancies were indiscernible on ultrasound 2 weeks after serum beta-HCG had returned to non-pregnant concentrations. In 8/177 (4.5%, 95% CI 2.0-8.7), physical resolution took longer than 78 days. There was a positive correlation between biochemical and physical resolution of tubal ectopic pregnancy (râ¯=â¯0.21, Pâ¯=â¯0.006). CONCLUSIONS: Physical resolution of tubal ectopic pregnancy is often prolonged and is positively correlated with initial and maximum beta-HCG concentrations. Results of this study indicate that beta-HCG resolution cannot be used as the end-point of expectant management of tubal ectopic pregnancy, which should be considered when counselling women and planning for future pregnancies.
Assuntos
Gonadotropina Coriônica Humana Subunidade beta/sangue , Gravidez Tubária/sangue , Conduta Expectante , Adulto , Feminino , Humanos , Gravidez , Gravidez Tubária/diagnóstico por imagem , Estudos Prospectivos , UltrassonografiaRESUMO
BACKGROUND: Blood flow in the corpus luteum is associated with luteal function. However, the impact of luteal blood flow on methotrexate (MTX) treatment in women with unruptured tubal pregnancy has not been reported. The aim of the present study was to observe the impact of luteal blood flow on the therapeutic effect of MTX in women with unruptured tubal pregnancy. METHODS: A prospective observational study recruited 129 women with unruptured tubal pregnancy in the First Affiliated Hospital of Xi'an Jiaotong University from September 2016 to June 2018. One hundred and fifteen women were treated successfully with MTX, and women were divided into 2 groups according to luteal blood flow: the poor luteal blood flow group and the abundant luteal blood flow group. The therapeutic effects were compared between the two groups. RESULTS: Women in the abundant luteal blood flow group had a significantly higher serum ß-human chorionic gonadotropin (ß-hCG) level 4 days, 1 week and 2 weeks after MTX treatment compared with women in the poor luteal blood flow group (P < 0.05). The average diameter of the ectopic mass 1 week, 2 weeks and 3 weeks after MTX treatment in women with abundant luteal blood flow was significantly larger (P < 0.05), and the time of serum ß-hCG clearance and ectopic mass disappearance were significantly longer compared with those in women in the poor luteal blood flow group (P < 0.05). CONCLUSIONS: Luteal blood flow might be a predictive factor for MTX treatment outcomes in women with unruptured tubal pregnancy, and those with abundant luteal blood flow need a longer recovery time.
Assuntos
Abortivos não Esteroides/administração & dosagem , Gonadotropina Coriônica Humana Subunidade beta/sangue , Corpo Lúteo/irrigação sanguínea , Metotrexato/administração & dosagem , Gravidez Tubária/sangue , Adulto , China/epidemiologia , Gonadotropina Coriônica Humana Subunidade beta/efeitos dos fármacos , Corpo Lúteo/diagnóstico por imagem , Corpo Lúteo/efeitos dos fármacos , Feminino , Humanos , Gravidez , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Bilateral tubal ectopic pregnancy is a very rare form of ectopic pregnancy. The incidence is higher in women undergoing assisted reproductive techniques or ovulation induction. We report the case of bilateral tubal ectopic pregnancy. The patient was 30 years old and had a 3-year history of infertility; she was referred to the in-vitro fertilization (IVF) program because of tubal factor infertility. A pregnancy resulted from the transfer of two embryos during an artificial cycle. Despite the increase in ß-hCG values during the follow-up, 22 days after the embryo transfer, the ß-hCG levels were 2,408 U/L and the serum progesterone (P4) level was 10.53 ng/ml. After application with methotrexate, ß-hCG levels did not decrease effectively. Moreover, the sonographic screening revealed a suspicious bilateral tubal focus for ectopic pregnancy. A mini-laparotomy was performed and a bilateral tubal pregnancy was found. In the case of unilateral tubal pregnancy after the transfer of two embryos, the situation of the other tube should be systematically checked and ß-hCG levels should be monitored.
Assuntos
Transferência Embrionária , Gravidez Tubária/diagnóstico , Diagnóstico Pré-Natal , Injeções de Esperma Intracitoplásmicas , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Gravidez Tubária/sangue , Gravidez Tubária/diagnóstico por imagem , Ultrassonografia Pré-NatalRESUMO
OBJECTIVE: To evaluate if a decreasing human chorionic gonadotropin (hCG) between day (D) 1 and D7 is an equal or better predictor of tubal ectopic pregnancy (EP) resolution following methotrexate (MTX) treatment than the current standard of care. STUDY DESIGN: This was a retrospective cohort prognostic accuracy study of women with a transvaginal ultrasound (TVS)-confirmed tubal EP (November 2006-December 2015). After single-dose MTX treatment, D4/7 hCG ratios were compared with that of D1/D7 in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to predict EP resolution. RESULTS: Tubal EP was diagnosed in 301/7350 (4.1%) women who underwent TVS for early pregnancy-related complaints. The patients were managed accordingly: expectant, 84/301 (27.9%); MTX, 65/301 (21.6%); surgery, 152/301 (50.5%). A D1/D7 hCG ratio ≤0.85 predicted successful resolution of tubal EPs (P < 0.001) treated with MTX with sensitivity 0.84 [95% confidence interval (CI), 0.69-0.94]), specificity 0.71 [95%CI, 0.48-0.89], PPV 0.84 [95%CI, 0.69-0.94], NPV 0.84 [95%CI, 0.69-0.94], which is comparable to the prognostic performance of the D4/7 protocol. CONCLUSION: In patients with tubal EP carefully selected for and treated with MTX, it may be reasonable to eliminate the D4 hCG in the follow-up algorithm.
Assuntos
Abortivos não Esteroides/administração & dosagem , Gonadotropina Coriônica/sangue , Metotrexato/administração & dosagem , Gravidez Tubária/tratamento farmacológico , Conduta Expectante/estatística & dados numéricos , Adulto , Feminino , Humanos , New South Wales/etnologia , Gravidez , Gravidez Tubária/sangue , Gravidez Tubária/epidemiologia , Estudos Retrospectivos , Adulto JovemRESUMO
Abstract Bilateral tubal ectopic pregnancy is a very rare form of ectopic pregnancy. The incidence is higher in women undergoing assisted reproductive techniques or ovulation induction. We report the case of bilateral tubal ectopic pregnancy. The patient was 30 years old and had a 3-year history of infertility; she was referred to the in-vitro fertilization (IVF) program because of tubal factor infertility. A pregnancy resulted from the transfer of two embryos during an artificial cycle. Despite the increase in β-hCG values during the follow-up, 22 days after the embryo transfer, the β-hCG levels were 2,408 U/L and the serum progesterone (P4) level was 10.53 ng/ml. After application with methotrexate, β-hCG levels did not decrease effectively. Moreover, the sonographic screening revealed a suspicious bilateral tubal focus for ectopic pregnancy. A mini-laparotomy was performed and a bilateral tubal pregnancy was found. In the case of unilateral tubal pregnancy after the transfer of two embryos, the situation of the other tube should be systematically checked and β-hCG levels should be monitored.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Gravidez Tubária/diagnóstico , Diagnóstico Pré-Natal , Injeções de Esperma Intracitoplásmicas , Transferência Embrionária , Gravidez Tubária/sangue , Gravidez Tubária/diagnóstico por imagem , Ultrassonografia Pré-Natal , Diagnóstico DiferencialRESUMO
The aim of this study was to compare the success rate of methotrexate (MTX) treatment in patients with recurrent ectopic pregnancy (REP) and primary EP (PEP). A retrospective cohort study. The study cohort comprised all patients diagnosed with an EP and treated by intention with single-dose regimen of intramuscular MTX in a tertiary medical centre during 2010-2018. Cases (REP) and controls (PEP) were compared.262 patients had PEP and 32 had a REP. Women with REP had significantly higher gravidity order and higher incidence of previous abortions (5 vs. 3, median, p < .001, 59.3% vs. 32.8%, p < .001, respectively). Women with REP had a higher proportion of a history of previous surgery in general, and specifically pelvic surgery (46.8% vs. 20.6%, p < .001, 24.4% vs. 7.2%, p < .001, respectively). Treatment success was lower in the REP group (40.6% vs. 66.4%, p = .006, Odds ratio 0.34, 95% confidence interval 0.16, 0.73). In a logistic regression analysis, the only factor found to be independently associated with treatment failure was REP (adjusted odds ratio 0.30, 95% confidence interval 0.12, 0.77, p = .01). Our study suggests that medical treatment success with a single-dose regimen of MTX is lower than expected among REP cases, suggesting that different treatment approach should be considered in this setting.Impact statementWhat is already known on this subject ? There is paucity of data regarding success rate of methotrexate treatment for a recurrent ectopic pregnancy (REP).What do the results of this study add? Medical treatment success with a single-dose regimen of MTX in patients with a REP is lower than expectedWhat are the implications of these findings for future clinical practice and/or further research? As medical treatment success with a single-dose regimen of MTX for women with a REP is lower than expected, different treatment approach should be considered. Further and prospective studies with a larger sample size are needed to confirm our findings.
Assuntos
Gonadotropina Coriônica/sangue , Metotrexato , Gravidez Tubária , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Adulto , Estudos de Casos e Controles , Cálculos da Dosagem de Medicamento , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Israel/epidemiologia , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Gravidez , Gravidez Tubária/sangue , Gravidez Tubária/diagnóstico , Gravidez Tubária/tratamento farmacológico , Gravidez Tubária/epidemiologia , Recidiva , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Tubal pregnancy is recognized as one of the most common ectopic pregnancy types. Salpingitis may result in tubal pregnancy by causing fallopian tube occlusion and hydrosalpinx. B cell activation factor (BAFF) is a proinflammatory cytokine that helps regulate both innate and adaptive immune responses. Our previous study firstly showed that BAFF immunostaining appeared on the cellular membrane and in the cytoplasm of tubal epithelial cells, and both BAFF protein and mRNA in human inflamed fallopian tubes had higher expression levels than those in normal fallopian tubes. This study aimed to elucidate the association between the expression of BAFF gene and the inflammation in the human fallopian tube leading to tubal pregnancy. METHODS: We examined 70 patients undergoing salpingectomy for salpingitis (n = 35) and tubal pregnancy (n = 35). Twenty patients with benign uterine diseases undergoing complete hysterectomy and salpingectomy were recruited into control group. BAFF mRNA and protein in tissue samples were detected by qPCR and Western blotting methods. Furthermore, serum levels of BAFF, tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 were measured using ELISA kits. RESULTS: We found statistically significantly elevated expressions of BAFF mRNA or protein in whole tissue samples, and serum levels of BAFF, TNF-α and IL-6 in whole blood samples from patients with salpingitis and tubal pregnancy, in comparison to the control group. CONCLUSION: Based on the results, high expression of BAFF gene might induce inflammation in the human fallopian tube, suggesting its possible role in the tubal pregnancy process.
Assuntos
Fator Ativador de Células B/genética , Fator Ativador de Células B/metabolismo , Gravidez Tubária/metabolismo , Salpingite/genética , Salpingite/metabolismo , Adulto , Fator Ativador de Células B/sangue , Estudos de Casos e Controles , Tubas Uterinas , Feminino , Expressão Gênica , Humanos , Interleucina-6/sangue , Gravidez , Gravidez Tubária/sangue , Gravidez Tubária/etiologia , RNA Mensageiro/metabolismo , Salpingite/complicações , Fator de Necrose Tumoral alfa/sangueAssuntos
Gonadotropina Coriônica Humana Subunidade beta/sangue , Gravidez Heterotópica/sangue , Gravidez Tubária/sangue , Gravidez de Gêmeos/sangue , Feminino , Humanos , Gravidez , Gravidez Heterotópica/diagnóstico , Gravidez Heterotópica/terapia , Gravidez Tubária/diagnóstico , Gravidez Tubária/cirurgia , Conduta ExpectanteRESUMO
BACKGROUND: Consecutive measurements of ß-hCG levels and sonographic evaluation of adnexae are critical for choosing the optimal management in ampullar tubal ectopic pregnancies (EP). To select suitable patients for conservative approach, there is a need for an affordable and reliable marker for determining rupture risk. Evaluation of systemic inflammatory markers in combination with serum ß-hCG levels and ultrasound might help to decide the appropriate treatment option. OBJECTIVE: The purpose of the present study was to evaluate the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the rupture risk in ampullar tubal EPs and to compare with intraoperative findings. METHODS: A total of 142 patients who underwent surgery for tubal EP were included. Seventy-two patients were in the intraoperatively diagnosed tubal rupture group and 70 patients without rupture findings were included in the control group. Both groups were compared for inflammation markers, ß-hCG levels, and sonographic findings. RESULTS: Both NLR and PLR levels were found to be significantly higher in the tubal rupture group (4.62 ± 3.13 vs. 2.67 ± 1.43, 162.94 ± 63.61 vs. 115.84 ± 41.15, p < 0.01, respectively). According to the receiver operating characteristic analysis performed for the diagnostic performance of tubal diameter measurement, ß-hCG, NLR, and PLR levels were significantly associated with histopathologically confirmed tubal rupture (p < 0.01). CONCLUSION: Systemic inflammatory markers are feasible and affordable tools for predicting tubal rupture risk in ampullar EPs and might be useful for determining surgery decision especially in low resource settings.
Assuntos
Plaquetas/metabolismo , Linfócitos/metabolismo , Neutrófilos/metabolismo , Gravidez Tubária/sangue , Ruptura Espontânea/etiologia , Adulto , Biomarcadores/sangue , Gonadotropina Coriônica Humana Subunidade beta/sangue , Feminino , Humanos , Inflamação , Contagem de Linfócitos , Pessoa de Meia-Idade , Seleção de Pacientes , Contagem de Plaquetas , Gravidez , Gravidez Tubária/terapia , Período Pré-Operatório , Curva ROC , Medição de Risco , Fatores de Risco , Ruptura Espontânea/terapiaRESUMO
OBJECTIVE: To investigate the clinical results and prognostic factors of multiple dose methotrexate (Mtx) treatment of ectopic pregnancy patients with high initial serum (human chorionic gonadotropin [hCG]). DESIGN: Retrospective cohort study. PATIENTS: Twenty-six ectopic pregnancy patients with serum (ßhCG) > 5,000 mIU/mL who received multiple doses of Mtx (1 mg/kg) with folinic acid rescue on the alternating days. RESULTS: Success rate was 88.5%. All failures were tubal ruptures in those who underwent surgery. Median initial hCG values of the success and the failure patients were 8,582 (5,058-31,114) and 5,280 (5,042-13,563) mIU/mL respectively (p > 0.05). Side effects were seen in 18 patients (69.2%, one bone marrow suppression and 17 minor side effects). The number of Mtx injections (7.04 ± 1.71), Mtx dose (71.35 ± 13.16 mg) and follow-up period (42.04 ± 23.77 days) did not differ between groups. Body mass index (BMI), Mtx dose, number of Mtx and change in ßhCG levels between the initials and the levels measured 2 days after the 3rd, 4th, and 5th Mtx injections were found to be highly predictive for tubal rupture. CONCLUSIONS: Multiple-dose Mtx treatment of ectopic pregnancies with high initial hCG is safe and effective. BMI, Mtx dose, number of Mtx injections and the decrement of ßhCG levels were found as highly predictive for the success of the treatment.