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1.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431533

RESUMO

The definition of a chronic ectopic pregnancy (CEP) is poorly defined in the literature and making a timely diagnosis can be incredibly challenging. This is primarily due to its broad range of clinical presentations and conflicting biochemical and sonographic results. Often, CEPs are mistaken for ovarian malignancies, pelvic inflammatory disease (PID), uterine fibroids or endometriosis, therefore, leading to a delayed diagnosis. We present a case report of a woman who was initially misdiagnosed with PID and then later preoperatively diagnosed with a CEP. This case particularly highlights the diagnostic dilemma posed by CEPs and raises awareness of the key clinical symptoms, biochemical and sonographic investigations which in combination can contribute towards making a timely preoperative diagnosis.


Assuntos
Dor Abdominal/etiologia , Tubas Uterinas/cirurgia , Doença Inflamatória Pélvica/diagnóstico , Gravidez Ectópica/diagnóstico , Hemorragia Uterina/etiologia , Adulto , Erros de Diagnóstico , Tubas Uterinas/diagnóstico por imagem , Feminino , Humanos , Laparoscopia , Gravidez , Gravidez Ectópica/cirurgia , Salpingectomia , Ultrassonografia
3.
Obstet Gynecol ; 136(5): 1001-1005, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030869

RESUMO

Patient-centered care is one of the six aims for improvement in health care quality outlined by the National Academy of Medicine (previously known as the Institute of Medicine). We propose an algorithm for patients who are presenting with a pregnancy of unknown location that emphasizes pregnancy desiredness to improve patient-centered care. Health care professionals should assess pregnancy desiredness at a patient's initial consultation for evaluation of pregnancy of unknown location; desiredness, along with other clinical criteria, should guide management. For women with an undesired pregnancy, health care professionals should offer expedient active management. Uterine aspiration will allow for quick clinical diagnosis and resolution of the pregnancy. Alternatively, for women with a desired pregnancy or for those who are ambivalent, we recommend careful conservative management. Adopting this algorithm will recenter the patient in the complex management of pregnancy of unknown location.


Assuntos
Assistência Centrada no Paciente/normas , Gravidez Ectópica/diagnóstico , Gravidez não Desejada/psicologia , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde/normas , Algoritmos , Feminino , Humanos , Gravidez , Gravidez Ectópica/psicologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia
4.
Rev. habanera cienc. méd ; 19(4): e3006, tab, ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139179

RESUMO

RESUMEN Introducción: el embarazo ectópico se produce cuando el embrión se implanta fuera de la cavidad uterina, y se ubica mayormente en las trompas de Falopio. Objetivo: presentar un caso clínico en el que la paciente desarrolló un embarazo ectópico en la cicatriz de una histerorrafia previa, fue diagnosticada cuando cursaba la sexta semana de gestación y se resistió ante la idea de perderlo irremediablemente, aunque su cuadro clínico es muy doloroso y se complica rápidamente. Presentación del caso: paciente de 27 años de edad, de color de piel negra, con antecedente de cesárea previa 9 meses atrás. Según reporte ecográfico se diagnostica embarazo de 8,6 semanas de gestación localizado en la zona de cicatriz de cesárea previa. Recibe tratamiento inicial con metotrexate y cloruro de potasio, para luego ser intervenida quirúrgicamente a través de legrado instrumental, se corrobora diagnóstico ecográfico y se logra extraer el embrión exitosamente. Conclusión: el manejo atendió a las características clínicas e individuales de la gestante y se respetó el principio de autonomía de la embarazada. La paciente pudo ser dada de alta con un estado de salud satisfactorio, conservó su capacidad de fecundidad(AU)


ABSTRACT Introduction: Ectopic pregnancy occurs when the embryo is implanted outside the uterine cavity, mostly located in the fallopian tubes. Objective: To present a clinical case in which the patient developed an ectopic pregnancy over a previous cesarean section scar; the diagnosis was made when she was in the sixth week of her pregnancy and she could not withstand the idea of losing the baby, but the clinical picture worsened, she was very painful and became complicated quickly. Case report: Twenty-seven-year-old black patient with previous history of a cesarean section 9 months ago. According to ultrasound criteria, 8.6 weeks of pregnancy located in the area of a previous cesarean section scar is diagnosed. The patient receives initial treatment with methotrexate and potassium chloride to undergo a surgical procedure through instrumental intervention (curettage), confirming the diagnosis of the ultrasound and removing the embryo successfully. Conclusions: The management was based on the clinical and individual characteristics of the pregnant woman respecting the principle of autonomy. The patient was in good health at the moment of discharge, preserving her fertility capacity(AU)


Assuntos
Humanos , Gravidez , Adulto , Gravidez Ectópica/cirurgia , Gravidez Ectópica/diagnóstico , Cicatriz/complicações , Curetagem a Vácuo
5.
Medicine (Baltimore) ; 99(28): e21105, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664132

RESUMO

RATIONALE: The incidence of a unicornuate uterus is 0.2% to 0.3% of the whole population. A unicornuate uterus is closely associated with obstetrical complications such as early miscarriages, ectopic pregnancy, and malpresentation. PATIENT CONCERNS: A 32-year-old patient developed a rare ectopic pregnancy arising at a distal, fimbriated end of the undescended fallopian tube. DIAGNOSES: A transvaginal ultrasound scan revealed hemoperitoneum and no gestational sac in the uterine endometrium. A laparoscopic finding showed that high up in the right abdomen, just below the liver, an ectopic mass could be seen arising at a distal, fimbriated end of the fallopian tube, which was developed adjacent to the undescended right ectopic ovary. INTERVENTIONS: After laparoscopic removal of the right salpinx, we removed it with a bag. OUTCOMES: One day after the operation, she was discharged without problems. Postoperative hysterosalpingography showed the unicornuate uterus with patent left and some right salpinx. Magnetic resonance imaging revealed a unicornuate uterus, right ovary at the right inferior hepatic area, a bilateral normal kidney, and double inferior vena cava. LESSONS: This is the first reported case of its type. It demonstrated that ectopic pregnancy may occur in the upper abdomen, not in the pelvic cavity, in uterine anomaly, and double inferior vena cava; hence, we must thoroughly check the whole abdominal cavity. Additional imaging tests are needed after treatment to see if there are any abnormalities.


Assuntos
Tubas Uterinas/anormalidades , Ovário/anormalidades , Gravidez Ectópica/etiologia , Anormalidades Urogenitais/diagnóstico , Útero/anormalidades , Malformações Vasculares/diagnóstico , Veia Cava Inferior/anormalidades , Adulto , Endossonografia/métodos , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Histerossalpingografia , Laparoscopia/métodos , Imagem por Ressonância Magnética , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/cirurgia , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/cirurgia , Útero/cirurgia , Vagina
6.
Am Fam Physician ; 101(10): 599-606, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32412215

RESUMO

Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity. In the United States, the estimated prevalence of ectopic pregnancy is 1% to 2%, and ruptured ectopic pregnancy accounts for 2.7% of pregnancy-related deaths. Risk factors include a history of pelvic inflammatory disease, cigarette smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility. Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa. However, most ectopic pregnancies do not reach this stage. More often, patient symptoms combined with serial ultrasonography and trends in beta human chorionic gonadotropin levels are used to make the diagnosis. Pregnancy of unknown location refers to a transient state in which a pregnancy test is positive but ultrasonography shows neither intrauterine nor ectopic pregnancy. Serial beta human chorionic gonadotropin levels, serial ultrasonography, and, at times, uterine aspiration can be used to arrive at a definitive diagnosis. Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management. A patient with diagnosed ectopic pregnancy should be immediately transferred for surgery if she has peritoneal signs or hemodynamic instability, if the initial beta human chorionic gonadotropin level is high, if fetal cardiac activity is detected outside of the uterus on ultrasonography, or if there is a contraindication to medical management.


Assuntos
Gravidez Ectópica/diagnóstico , Gravidez Ectópica/terapia , Gonadotropina Coriônica Humana Subunidade beta/sangue , Diagnóstico Diferencial , Feminino , Humanos , Metotrexato/administração & dosagem , Gravidez , Fatores de Risco , Salpingostomia , Ultrassonografia Pré-Natal
7.
Ceska Gynekol ; 85(1): 15-17, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32414280

RESUMO

OBJECTIVE: We present a rare case of peroperatively diagnosed bilateral tubular pregnancy. DESIGN: Case report. SETTING: Department of Obstetrics and Gynekology, Novy Jicin Hospital. CONCLUSION: In the case of ectopic pregnancy always think about the possibility of contralateral pathology and during the surgical revision remember a thorough inspection of both fallopian tubes.


Assuntos
Tubas Uterinas/cirurgia , Gravidez Ectópica/cirurgia , Gravidez Tubária/cirurgia , Feminino , Humanos , Obstetrícia , Gravidez , Complicações na Gravidez/cirurgia , Gravidez Ectópica/diagnóstico , Gravidez Tubária/diagnóstico , Salpingectomia , Resultado do Tratamento
8.
Lakartidningen ; 1172020 05 18.
Artigo em Sueco | MEDLINE | ID: mdl-32430904

RESUMO

An ectopic pregnancy occurs when a blastocyst implants outside the uterus cavity. It is a condition with increased morbidity and mortality for women in reproductive age. Most of the ectopic pregnancies (95.5%) are located in the fallopian tube. We report a case of an ectopic pregnancy that progressed unruptured and with fetus in situ up to 17 gestational weeks. This case is rare, especially in developed countries where patients have access to healthcare. With this case report we would like to emphasize that ectopic pregnancy should be among the differential diagnoses of abdominal pain even in the second trimester of pregnancy but also the importance of an early vaginal ultrasound examination in its diagnosis.


Assuntos
Gravidez Ectópica , Gravidez Tubária , Dor Abdominal/etiologia , Tubas Uterinas , Feminino , Feto , Humanos , Gravidez , Segundo Trimestre da Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Tubária/diagnóstico
9.
Clin Imaging ; 66: 26-34, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32442857

RESUMO

PURPOSE: The aim of the study is to evaluate our 5 years experience in diagnosis and treatment of ectopic pregnancy developing in a Caesarean section scar. SUBJECTS & METHODS: The study included twenty-one women, diagnosed with a Caesarean scar ectopic pregnancy (CSEP) in the first trimester, which was confirmed by ultrasound and treated in our hospital during 5 years between 2012 and 2016. The clinical presentations, imaging findings, and treatment outcomes of all these pregnancies were recorded. RESULTS: The main complaints of the patients were vaginal bleeding in 7 (33.3%) of cases and abdominal pain in association with vaginal bleeding in 4 (19.1%) of cases. However, the remaining 10 cases (47.6%) were asymptomatic. The number of previous Caesarean sections ranged from 1 to 4 with an average of 2.14, 24% (5/21) of our patients had only one prior Caesarean section, 43% (9/21) had 2 prior Caesarean sections, 28% (6/21) had 3 prior Caesarean sections and only 5%, (1/21) had 4 prior Caesarean sections. All our 21 cases underwent successful early first trimester diagnosis with trans-vaginal color Doppler ultrasonography. All our 21 cases showed empty uterus and empty cervical canal with visualization of gestational sac at the presumed site of the Caesarean scar; however, 13 cases showed thinned myometrium (<5 mm) between the gestational sac and bladder. The mean thickness of Caesarean section incision scar was 0.3 ±â€¯0.15 cm. 7 cases (33.3%) showed no embryo in the gestational sac while 14 cases (66.7%) showed embryonic gestational sac, 9 cases from the 14 showed heart activity. MRI studies were done in 7 patients with Caesarean scar ectopic pregnancy to confirm the diagnosis and to follow up 2 complicated cases. In all 7 cases, the diagnosis of Caesarean scar ectopic pregnancy using MRI included empty uterine and cervical cavities, and a gestational sac seen embedded within the site of caesarean scar, with thin myometrium adjacent to the sac. No bulging of the sac through the myometrium or bladder invasion was detected. Termination of pregnancy was done by systemic methotrexate administration in 14 cases, and with trans-cervical aspiration of the gestational sac in 7 cases. Intra-operative bleeding occurred in all 7 cases treated with aspiration of the gestational sac, one of the 7 cases complicated with hysterectomy, while one patient complicated with uterine rupture and was treated conservatively. The cases treated with systemic methotrexate injection showed no complication. The Caesarean scar mass was followed with trans-vaginal ultrasound and regressed within 2 months to about 1 year post treatment. CONCLUSION: Early imaging diagnosis and effective treatment of CSEP are critically important not only to improve outcomes, minimize maternal complications and the need for emergency extended surgery, but also to maintain treatment options, and potentially preserve future fertility.


Assuntos
Cicatriz/diagnóstico por imagem , Gravidez Ectópica/diagnóstico por imagem , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia/efeitos adversos , Metotrexato/uso terapêutico , Miométrio , Gravidez , Primeiro Trimestre da Gravidez , Gravidez Ectópica/diagnóstico , Resultado do Tratamento , Ultrassonografia , Ultrassonografia Doppler em Cores , Útero
10.
J Med Virol ; 92(7): 731-739, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32219871

RESUMO

Coronavirus disease 2019 (COVID-19) is a novel type of highly contagious pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the strong efforts taken to control the epidemic, hundreds of thousands of people were infected worldwide by 11 March, and the situation was characterized as a pandemic by the World Health Organization. Pregnant women are more susceptible to viral infection due to immune and anatomic alteration, though hospital visits may increase the chance of infection, the lack of medical care during pregnancy may do more harm. Hence, a well-managed system that allows pregnant women to access maternal health care with minimum exposure risk is desired during the outbreak. Here, we present the managing processes of three pregnant women who had fever during hospitalization in the gynecology or obstetrics department, and then, we further summarize and demonstrate our maternal health care management strategies including antenatal care planning, patient triage based on the risk level, admission control, and measures counteracting emergencies and newly discovered high-risk cases at in-patient department. In the meantime, we will explain the alterations we have done throughout different stages of the epidemic and also review relative articles in both Chinese and English to compare our strategies with those of other areas. Although tens of COVID-19 cases were confirmed in our hospital, no nosocomial infection has occurred and none of the pregnant women registered in our hospital was reported to be infected.


Assuntos
Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Febre/diagnóstico , Acesso aos Serviços de Saúde/organização & administração , Pneumonia Viral/diagnóstico , Gravidez Ectópica/diagnóstico , Adulto , Betacoronavirus/genética , Biomarcadores/sangue , China/epidemiologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diagnóstico Diferencial , Feminino , Febre/sangue , Febre/epidemiologia , Febre/virologia , Hospitalização/estatística & dados numéricos , Humanos , Saúde Materna , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez , Gravidez Ectópica/sangue , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/virologia , Tomografia Computadorizada por Raios X , Triagem/organização & administração
11.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(1): 22-24, ene.-mar. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-187069

RESUMO

El embarazo abdominal es una modalidad extremadamente rara de embarazo ectópico (EE) extratubárico, con muy pocos casos documentados en la literatura. La mortalidad materna es mayor que en los EE tubáricos por la demora en el diagnóstico y las complicaciones. Presentamos un caso de EE abdominal que se complicó con la aparición de hemoperitoneo severo en el primer trimestre de gestación. En nuestro caso, fueron necesarias 2 laparoscopias de urgencia en menos de 24 h hasta poder dar con el diagnóstico definitivo, lo cual demuestra lo dificultoso que puede llegar a ser la identificación de esta enfermedad en estadios precoces


Abdominal ectopic pregnancy is an extremely rare type of extratubal ectopic (EE) pregnancy, with very few cases documented in the literature. Maternal mortality is higher than in tubal EE because of the delay in diagnosis and complications. The case is presented of a patient with an abdominal EE that was complicated by the appearance of severe haemoperitoneum in the first trimester of pregnancy. In this case, two emergency laparoscopies were needed in less than 24 hours, until the definitive diagnosis could be found. This demonstrates how difficult it can be to identify this pathology in its early stages


Assuntos
Humanos , Feminino , Gravidez , Adulto , Hemoperitônio/etiologia , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/cirurgia , Laparoscopia , Dor Abdominal/etiologia , Ultrassonografia , Cavidade Abdominal/fisiopatologia , Escavação Retouterina/lesões , Escavação Retouterina/cirurgia
12.
Acta Obstet Gynecol Scand ; 99(3): 381-390, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31628674

RESUMO

INTRODUCTION: The objective was to compare the diagnostic accuracy of the decision tree analysis prediction model P1, which incorporates the human chorionic gonadotropin (hCG) ratio (hCG 48 hours/hCG 0 hour), and risk prediction model M4 in the management of women with pregnancy of unknown location (PUL). MATERIAL AND METHODS: A retrospective diagnostic accuracy study was performed on PUL data collected between August 2011 and September 2018. Women with a PUL were prospectively managed according to the P1 prediction model, which utilizes the hCG ratio and, if necessary, a day (D) 7 hCG. We compared the performance of P1 with the M4 model, a logistic regression mathematical model using initial hCG and hCG ratio, to classify PULs as low risk (failed PUL [failed] or intrauterine pregnancy) or high risk (ectopic pregnancy or persistent PUL). The reference standard was defined as the final PUL outcome. RESULTS: Transvaginal ultrasound was done in 3847 consecutive women for early pregnancy complications, 437 (11.3%) of whom were classified as PUL. Final analysis comprised 413 cases with complete data. Final PUL clinical outcomes were: 247 (59.8%) failed PUL, 94 (22.7%) intrauterine pregnancy, 49 (11.8%) ectopic pregnancy and 23 (5.5%) persistent PUL. The sensitivity of P1 and M4 in predicting high-risk PUL were 81.9% (95% confidence interval [CI] 71.1-90.0) and 80.6% (95% CI 69.5-88.9), respectively. The specificities were 74.5% (95% CI 69.5-79.1) and 75.6% (95% CI 70.7-80.1), respectively. CONCLUSIONS: P1 and M4 performed similarly with respect to diagnostic accuracy in predicting PUL outcome. P1 needs to be externally validated.


Assuntos
Gonadotropina Coriônica/sangue , Árvores de Decisões , Gravidez Ectópica/diagnóstico , Diagnóstico Pré-Natal , Adulto , Austrália , Feminino , Humanos , Modelos Teóricos , Gravidez , Resultado da Gravidez , Gravidez Ectópica/sangue , Gravidez Ectópica/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade
13.
Matern Child Health J ; 24(2): 213-221, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31848926

RESUMO

OBJECTIVES: Ectopic pregnancy is an important adverse pregnancy outcome that is under-surveilled. Emergency department (ED) data can help provide insight on the trends of ectopic pregnancy incidence in the United States (US). METHODS: Data from the largest US all-payer ED database, the Healthcare Cost and Utilization Project Nationwide ED Sample, were used to identify trends in the annual ratio of ED ectopic pregnancy diagnoses to live births during 2006-2013, and the annual rate of diagnoses among all pregnancies during 2006-2010. Diagnoses were identified through International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes and CPT codes. RESULTS: The overall ratio of weighted ED visits with an ectopic pregnancy diagnosis during 2006-2013 was 12.3 per 1000 live births. This ratio increased significantly from 2006 to 2013, from 11.0 to 13.7 ectopic pregnancies per 1000 live births, with no inflections in trend. The rate of ectopic pregnancy diagnoses per 1000 pregnancies increased during 2006-2010, from 7.0 to 8.3, with no inflections in trend. Females of all age groups experienced increases, though increases were less pronounced with increasing age. All geographic regions experienced increases, with increases being most pronounced in the Northeast. CONCLUSIONS: Our study suggests that ED ectopic pregnancy diagnoses may be increasing in the US, although the drivers of these increases are not clear. Our results highlight the need for national measures of total pregnancies, stratified by pertinent demographic variables, to evaluate trends in pregnancy-related conditions among key populations.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Gravidez Ectópica/diagnóstico , Adolescente , Adulto , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Gravidez , Gravidez Ectópica/epidemiologia , Prevalência , Estados Unidos/epidemiologia
14.
Clin Chim Acta ; 500: 69-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31647905

RESUMO

BACKGROUND: The diagnosis of ectopic pregnancy (EP) is challenging and 40-50% of patients are initially misdiagnosed. METHODS: This prospective case-control study measured activin-A, activin-B, activin-AB and follistatin for the diagnosis of EP, spontaneous abortion (SAB) and normal intrauterine pregnancy (IUP). Sera were collected from 120 women with symptoms suggesting early pregnancy failure and who were clinically diagnosed as IUP, SAB or EP (n = 40/group). The markers were measured by ELISA and their area under the curve (AUC), cut-off value, sensitivity and specificity were determined by receiver-operating characteristic curve. The results were compared with serum ß-human chorionic gonadotropin and progesterone. RESULTS: Activin-A and activin-B decreased significantly, while activin-AB and follistatin increased, in the EP and SAB groups than the IUP group. Activin-AB (AUC = 0.961) and progesterone (AUC = 0.973) were the best markers for EP and SAB, respectively. Activin-AB (≥61.5 pg/mL) showed 92.5% sensitivity, 85% specificity, 75.5% positive predictive value (PPV) and 95.8% negative predictive value (NPV) for EP. Progesterone (≤6.3 ng/mL) had 100% sensitivity, 86.2% specificity, 78.4% PPV and 100% NPV for SAB. CONCLUSIONS: Serum activins and follistatin were significantly altered with EP and activin-AB could be a promising marker for the diagnosis of EP.


Assuntos
Ativinas/sangue , Folistatina/sangue , Gravidez Ectópica/sangue , Gravidez Ectópica/diagnóstico , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Resultado da Gravidez , Gravidez Ectópica/fisiopatologia , Estudos Prospectivos , Adulto Jovem
15.
Adv Emerg Nurs J ; 41(4): 282-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687992

RESUMO

This article, "Is the pelvic examination still crucial in patients presenting to the emergency department (ED) with vaginal bleeding or abdominal pain when an intrauterine pregnancy is identified on ultrasonography? A randomized controlled trial," by J. A. ) seeks to determine whether excluding a pelvic examination among patients presenting to the ED with first-trimester vaginal bleeding or lower abdominal pain, and indication of intrauterine pregnancy recorded on ultrasound increases morbidity. The findings are discussed in the context of changing practice and patient preference. Emergency nurse practitioners should remain informed about changing practices to ensure that patients receive safe care. Although pelvic examination does provide additional information for specific clinical conditions, the current practice to always include it in the evaluation of a pregnant patient with vaginal bleeding or pelvic pain may no longer be relevant given the improved diagnostic capabilities available within the ED setting.


Assuntos
Exame Ginecológico , Adulto , Medicina de Emergência , Serviço Hospitalar de Emergência , Feminino , Humanos , Profissionais de Enfermagem , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Gravidez , Gravidez Ectópica/diagnóstico , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/etiologia
17.
Obstet Gynecol Clin North Am ; 46(4): 783-795, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677754

RESUMO

Ultrasound is essential in the evaluation and management of pregnancies of unknown location. Differential diagnoses include early pregnancy loss, pregnancy of unknown location, and ectopic pregnancies. Both transabdominal and transvaginal routes should be available, in addition to physical examination, for complete evaluation. Diagnostic criteria for early pregnancy loss have expanded in recent years to ensure false positive results do not lead to inappropriate evacuation of desired pregnancies.


Assuntos
Complicações na Gravidez/diagnóstico por imagem , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Feminino , Humanos , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/fisiopatologia , Fatores de Risco
18.
Obstet Gynecol Clin North Am ; 46(4): 797-811, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677755

RESUMO

Cesarean scar pregnancy is a potentially dangerous consequence of a previous cesarean delivery. If unrecognized and inadequately managed, it can lead to untoward complications throughout all three trimesters of the pregnancy. The rate of occurrence parallels the mounting rate of cesarean sections. The late consequences of cesarean delivery, such as placenta previa and placenta accrete, were known for a long time. However, it took more than a decade for the obstetric community to make the connection between the cesarean scar pregnancy and the placenta accreta spectrum. This article discusses the pathogenesis and diagnosis of cesarean scar pregnancy.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico por imagem , Placenta Acreta/diagnóstico por imagem , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia Pré-Natal , Cicatriz/etiologia , Feminino , Humanos , Placenta Acreta/etiologia , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/etiologia , Fatores de Risco
19.
Obstet Gynecol Clin North Am ; 46(4): 813-828, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677756

RESUMO

There is no universally agreed upon and adopted management protocol supported by professional societies in the United States or around the world for the treatment of cesarean scar pregnancy. There is a wide range of management options in the literature, and many of them can to lead to severe bleeding complications, which can result in loss of fertility or even maternal death. If inadequately managed, it can lead to untoward complications throughout all 3 trimesters of the pregnancy. Early detection of CSP has a paramount clinical importance.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico por imagem , Aconselhamento , Placenta Acreta/diagnóstico por imagem , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia Pré-Natal , Cicatriz/etiologia , Feminino , Humanos , Placenta Acreta/etiologia , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/etiologia , Gravidez Ectópica/terapia , Fatores de Risco
20.
Metabolomics ; 15(11): 143, 2019 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-31630278

RESUMO

INTRODUCTION: Ectopic pregnancy (EP) is a potentially life-threatening condition and early diagnosis still remains a challenge, causing a delay in management leading to tubal rupture. OBJECTIVES: To identify putative plasma biomarkers for the detection of tubal EP and elucidate altered biochemical pathways in EP compared to intrauterine pregnancies. METHODS: This case-control study included prospective recruitment of 39 tubal EP cases and 89 early intrauterine pregnancy controls. Plasma samples were biochemically profiled using proton nuclear magnetic resonance spectroscopy (1H NMR). To avoid over-fitting, datasets were randomly divided into a discovery group (26 cases vs 60 controls) and a test group (13 cases and 29 controls). Logistic regression models were developed in the discovery group and validated in the independent test group. Area under the receiver operating characteristics curve (AUC), 95% confidence interval (CI), sensitivity, and specificity values were calculated. RESULTS: In total 13 of 43 (30.3%) metabolite concentrations were significantly altered in EP plasma (p < 0.05). Metabolomic profiling yielded significant separation between EP and controls (p < 0.05). Independent validation of a two-metabolite model consisting of lactate and acetate, achieved an AUC (95% CI) = 0.935 (0.843-1.000) with a sensitivity of 92.3% and specificity of 96.6%. The second metabolite model (D-glucose, pyruvate, acetoacetate) performed well with an AUC (95% CI) = 0.822 (0.657-0.988) and a sensitivity of 84.6% and specificity of 86.2%. CONCLUSION: We report novel metabolomic biomarkers with a high accuracy for the detection of EP. Accurate biomarkers could potentially result in improved early diagnosis of tubal EP cases.


Assuntos
Metabolômica , Gravidez Ectópica/diagnóstico , Adulto , Biomarcadores/análise , Biomarcadores/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Gravidez Ectópica/metabolismo , Estudos Prospectivos , Espectroscopia de Prótons por Ressonância Magnética , Turquia
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