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1.
Medicine (Baltimore) ; 99(1): e18489, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895782

RESUMO

BACKGROUND: In a multitude of previous studies, Chlamydia trachomatis (CT) plays an important role in the occurrence of ectopic pregnancy (EP). However, the predictive value of CT infections in the occurrence of EP has not been estimated worldwide. We thus evaluated, by means of a meta-analysis, the current status of the association between CT infections with EP and the potential predictive value of CT infections in EP. METHODS: We evaluated studies performed between the database construction time and August 2018 published in PubMed, the Cochrane Library, EMBASE, and the Web of Science (SCI). The relationship between CT and EP was calculated based upon the predetermined entry criteria for control group selection and the original data. The related articles were analyzed using a random-effects model, and the heterogeneity of the studies was assessed using the I index. Data were analyzed with the STATA 12.0 software. RESULTS: Twenty-five studies that recruited 11960 patients were included in the present meta-analysis, and the relation of CT infections with EP were assessed. The association between CT infections and EP risk showed an odds ratio (OR) of 3.03, with a 95% confidence interval (CI) of 2.37 to 3.89. Our results showed that there was a statistically significant difference between the intervention and control groups. The prevalence of CT infections in EP was then calculated by a subgroup analysis: African (OR, 2.22; 95% CI, 1.14-4.31), European (OR, 3.16; 95% CI, 2.10-4.47), North American (OR, 3.07; 95% CI, 1.78-5.31), and Asian (OR, 3.39; 95% CI, 1.95-5.90). CONCLUSIONS: From the results of numerous studies conducted on different continents, this meta-analysis showed a clear association between EP and prior CT infections, that is, CT infections increase the risk of EP occurrence.


Assuntos
Infecções por Chlamydia/epidemiologia , Gravidez Ectópica/epidemiologia , Adulto , Chlamydia trachomatis , Feminino , Humanos , Razão de Chances , Gravidez , Gravidez Ectópica/etiologia , Prevalência , Fatores de Risco , Sensibilidade e Especificidade
2.
Niger Postgrad Med J ; 26(4): 235-238, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621664

RESUMO

Context: Ectopic pregnancy is a common life-threatening emergency and a notable cause of maternal morbidity and mortality. Aims: This study aims to determine the prevalence of ectopic gestation, the associated risk factors, the pattern of presentation and management of ectopic pregnancy in Dalhatu Araf Specialist Hospital (DASH) Lafia. Patients and Methods: This was a retrospective study of all cases of ectopic pregnancy managed at the gynaecological unit of the DASH Lafia, North-central Nigeria from 1st January, 2013 to 31st December, 2017. The data were analysed with simple descriptive statistics and were reported as frequencies and percentages. Results: During the 5-year period, there were a total of 93 ectopic pregnancies, 10,401 deliveries and 3399 gynaecological admissions in the hospital. The prevalence of ectopic pregnancy was 0.89% of all deliveries and 2.74% of all the gynaecological admissions. The majority of the patients were in the age group of 26-30 years, and significant number of the affected them were nulliparous, 30 (32.3%). Furthermore, majority of the patients had past history of sexually transmitted diseases 48 (51.6%), multiple sexual partners 40 (43.0%) and induced abortions. Abdominal pains, amenorrhoea and vaginal bleeding were the most common presenting complaints. Unilateral salpingectomy was done for majority of the patients. Conclusions: Ectopic pregnancy is an important gynaecological challenge associated with notable morbidity. Past history of sexually transmitted diseases, multiple sexual partners and induced abortions were the associated risk factors identified, and nulliparous women were mostly affected. This can limit their future reproductive accomplishments. Targeted health education campaigns should be embarked on to enlighten this group of women and the public at large.


Assuntos
Dor Abdominal/etiologia , Gravidez Ectópica/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Incidência , Nigéria/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Doenças Sexualmente Transmissíveis , Fatores Socioeconômicos , Adulto Jovem
3.
Int J Gynaecol Obstet ; 147(1): 120-125, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31344263

RESUMO

OBJECTIVE: To investigate risk factors for ectopic pregnancy among pregnant women attending the Korle-Bu Teaching Hospital, Accra, Ghana. METHODS: In an unmatched case-control study from September to November 2015, 104 women with ectopic pregnancy (cases) were compared with 208 women with intrauterine pregnancy (controls). Data were collected by interviewer-administered questionnaire and record review. Bivariable analysis was used to compare characteristics. Multivariate logistic regression was used to assess associations between risk factors and ectopic pregnancy. Adjusted odds ratios (aORs) and 95% confidence interval (CIs) were reported. RESULTS: Risk factors for ectopic pregnancy were being single (aOR, 5.5; 95% CI, 2.15-14.65), sexual debut at younger than 15 years (aOR, 36.4; 95% CI, 2.49-532.49), multiple sexual partners (aOR, 4.8; 95% CI, 1.76-13.36), previous instrumental evacuation of uterus (aOR, 5.8; 95% CI, 1.20-27.99); previous diagnosis of infertility (aOR, 6.1; 95% CI, 1.36-27.28), being uninsured (aOR, 11.8; 95% CI, 4.23-32.74), and condom use (aOR, 6.1; 95% CI, 1.36-27.28). CONCLUSION: Women who were single with early sexual intercourse, multiple partners, instrumental evacuation of the uterus, and diagnosis of infertility were at risk of ectopic pregnancy. Identification of these factors should facilitate early diagnosis and treatment of ectopic pregnancy.


Assuntos
Gravidez Ectópica/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Gana/epidemiologia , Humanos , Modelos Logísticos , Razão de Chances , Gravidez , Gravidez Ectópica/epidemiologia , Fatores de Risco , Atenção Terciária à Saúde/estatística & dados numéricos
4.
Eur J Contracept Reprod Health Care ; 24(4): 294-298, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31204856

RESUMO

Objective: Our study aimed to investigate the predisposing factors for recurrence of an ectopic pregnancy (EP) following single-dose methotrexate (MTX) treatment for a primary EP. Methods: This was a retrospective cohort study performed in a tertiary care medical centre including all patients diagnosed with primary EP and treated with a single-dose regimen of intramuscular MTX. EPs with future recurrence were compared with first time only EPs, to identify risk factors for recurrent EP. Forward stepwise multivariate logistic regression analyses were subsequently carried out. Results: The study included 272 women. Of those, 22 (8.1%) had a recurrent EP. Women in the recurrent EP group had a higher rate of abortions (45.5% vs 32.7%; p = 0.02), previous pelvic surgery (45.5% vs 6.5%; p < 0.001) and both pelvic and uterine surgery (4.5% vs 1.6%; p < 0.001). Conception by assisted reproductive technology (ART) was more common among the non-recurrent EP group (23.0% vs 4.5%; p = 0.04). Success of single-dose MTX treatment was lower in the recurrent EP group compared with the non-recurrent EP group (36.4% vs 65.7%; p = 0.006). A history of pelvic surgery was independently associated with recurrent EP (adjusted odds ratio [OR] 17.6; 95% confidence interval [CI] 4.9, 63.2; p = 0.001). Treatment success of single-dose MTX was independently protective for recurrent EP (adjusted OR 0.25; 95% CI 0.08, 0.76; p = 0.02). Conclusions: Among women with an EP, attention should be paid to those with previous pelvic surgery. Efforts should be made to achieve medical treatment success to prevent recurrent EP.


Assuntos
Abortivos não Esteroides/uso terapêutico , Metotrexato/uso terapêutico , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Adulto , Feminino , Genitália/cirurgia , Humanos , Israel/epidemiologia , Modelos Logísticos , Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
5.
Fertil Steril ; 112(1): 112-119, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31056305

RESUMO

OBJECTIVE: To provide information on the birth outcomes of future intrauterine pregnancies in women whose first pregnancy was ectopic. DESIGN: Population-based longitudinal cohort study. SETTING: All hospitals in Quebec, Canada, 1989-2013. PATIENT(S): Group surgically treated for an ectopic first pregnancy: 15,823 women; comparison group with an intrauterine first pregnancy: 1,101,748 women. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Repeat ectopic pregnancy, future delivery of a live infant, stillbirth, cesarean delivery, preterm birth, low birth weight, preeclampsia, gestational diabetes, and postpartum hemorrhage as well as other outcomes of pregnancy. RESULT(S): The overall prevalence of ectopic first pregnancy was 14.2 per 1,000 women, of whom 10% of women with an ectopic first pregnancy had a future ectopic. Regardless of age, women with ectopic first pregnancies had an increased risk of adverse birth outcomes at future intrauterine pregnancies, including 1.27 times the risk of preterm birth (95% confidence interval [CI], 1.18-1.37), 1.20 times the risk of low birth weight (95% CI, 1.10-1.31), 1.21 times the risk of placental abruption (95% CI, 1.04-1.41), and 1.45 times the risk of placenta previa (95% CI, 1.10-1.91). Older women with a prior ectopic pregnancy had particularly elevated risks of placental abruption (risk ratio 1.42; 95% CI, 1.16-1.69). CONCLUSION(S): Women with ectopic first pregnancies have an increased risk of adverse birth outcomes during subsequent intrauterine pregnancies. These women may benefit from closer clinical management in pregnancy to prevent adverse birth outcomes.


Assuntos
Fertilidade , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gravidez Ectópica/epidemiologia , Adulto , Cesárea , Feminino , Humanos , Nascimento Vivo , Estudos Longitudinais , Gravidez , Complicações na Gravidez/diagnóstico , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/fisiopatologia , Prevalência , Quebeque/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
6.
Medicine (Baltimore) ; 98(20): e15491, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096449

RESUMO

RATIONALE: Uterine rupture is a rare incidence but can lead to catastrophic maternal and fetal consequences. We still need to place a high premium on these cases. PATIENT CONCERNS: The patients all showed hemodynamic shock with complaints of serious pain in the abdomen. They all had a history of laparoscopy or hysteroscopy procedures. DIAGNOSES: Case 1 and 2 were diagnosed during surgery. Case 3 was diagnosed by an urgent abdominal ultrasonogram before surgery. INTERVENTIONS: We performed emergency surgeries for the 3 cases. OUTCOMES: Three patients all recovered well. But only the child in case 2 survived. LESSONS: It must be emphasized that pregnant women with a history of such surgeries should be aware of uterine rupture during pregnancy.


Assuntos
Histeroscopia/efeitos adversos , Laparoscopia/efeitos adversos , Choque/etiologia , Ruptura Uterina/etiologia , Útero/patologia , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Placenta Acreta/patologia , Gravidez , Gravidez Ectópica/epidemiologia , Choque/diagnóstico , Resultado do Tratamento , Ultrassonografia/métodos , Ruptura Uterina/diagnóstico por imagem , Ruptura Uterina/patologia , Útero/diagnóstico por imagem , Útero/cirurgia
7.
Medicine (Baltimore) ; 98(13): e14952, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921195

RESUMO

Built on 2 existing classification systems, this study was to develop a new classification system to better predict the pregnancy prognosis after laparoscopic surgery in patients with tubal factor infertility and accordingly propose a management strategy.We followed up 423 patients suffering from tubal factor infertility who had undergone hysteroscopic-laparoscopic surgery for 2 years without in vitro fertilization and embryo transfer (IVF/ET). Based on the operative reports, a new, modified classification of fallopian tube status (hereafter referred to as the modified classification) was developed with reference to the 2 existing classification systems (the r-AFS classification of pelvic adhesions and the scoring system of distal tubal obstruction). A score of 0 to 3 was assigned to each of the 4 factors (tubal wall consistency, hydrosalpinx, pelvic adhesions, and tubal patency) for each of the tubes with a total bilateral score of 0 to 24. The patients were classified for the abnormalities of the fallopian tubes into 3 groups: mild (<8), moderate (8-15) and severe (>15). By utilizing SPSS 20.0 Statistic Analysis Software, the data were analyzed with t test, Chi-Square test, ANOVA or ROC as appropriate.Each of the 4 factors of the modified classification was independently and closely associated with post-surgical prognosis (P < .05). There was a statistically significant difference in postoperative pregnancy prognosis among the 3 groups of patients (P < .05). Patients with a score of <8 (mild) had the highest intrauterine pregnancy rate, reaching 60.1%. In contrast, patients with a score of 8 to 15 (moderate) had a significant increase in ectopic pregnancy (21.5%), while patients with a score of >15 (severe) had a significantly increased infertility rate of 89.5%. When the pregnancy outcomes were divided into intrauterine pregnancy and other outcomes, the modified classification had the largest area under the ROC curve (0.569) (P < .05). With the optimum cutoff of 4.5, the sensitivity was 88.6%, specificity was 74.5% and accuracy was 63.1%.The modified classification of fallopian tube status is a simple and practical scoring system which can comprehensively and effectively evaluate the function of the fallopian tube and thus is more accurate than the other 2 systems in predicting the postoperative pregnancy outcomes.


Assuntos
Tubas Uterinas/patologia , Tubas Uterinas/cirurgia , Infertilidade Feminina/patologia , Infertilidade Feminina/cirurgia , Taxa de Gravidez , Índice de Gravidade de Doença , Feminino , Humanos , Histeroscopia , Valor Preditivo dos Testes , Gravidez , Gravidez Ectópica/epidemiologia , Prognóstico , Curva ROC , Estudos Retrospectivos
8.
Yonsei Med J ; 60(3): 285-290, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30799591

RESUMO

PURPOSE: To elucidate the correlation between ovarian reserve and the incidence of ectopic pregnancy (EP) following in vitro fertilization and embryo transfer (IVF/ET) cycles. MATERIALS AND METHODS: In this observational study, 430 fresh IVF/ET cycles were examined from patient data of two university hospital infertility clinics. All included patients were positive for ß-human chorionic gonadotropin (hCG) at 2 weeks after oocyte retrieval via controlled ovarian stimulation. For each cycle, information on age, duration of infertility, basal follicle stimulating hormone (FSH), anti-Müllerian hormone (AMH), days of ovarian stimulation, numbers of retrieved oocytes and transferred embryos, and pregnancy outcomes was collected. Patients with AMH lower than 1.0 ng/dL or basal FSH higher than 10 mIU/mL were classified into the decreased ovarian reserve (DOR) group, and the remaining patients were classified into the normal ovarian reserve (NOR) group. RESULTS: In total, 355 cycles showed NOR, and 75 cycles DOR. There were no significant differences between the DOR and NOR groups regarding intrauterine (74.7% vs. 83.4%, respectively) or chemical (14.7% vs. 14.1%, respectively) pregnancies. The DOR group had a higher EP than that of NOR group [10.7% (8/75) vs. 2.5% (9/355), p=0.004]. In both univariate [odds ratio (OR) 5.6, 95% confidence interval (CI) 1.4-9.6, p=0.011] and multivariate (adjusted OR 5.1, 95 % CI 1.1-18.7, p=0.012) analysis, DOR was associated with a higher risk of EP. CONCLUSION: DOR may be associated with a higher risk of EP in IVF/ET cycles with controlled ovarian stimulation. More careful monitoring may be necessary for pregnant women with DOR.


Assuntos
Transferência Embrionária/efeitos adversos , Fertilização In Vitro/efeitos adversos , Reserva Ovariana/fisiologia , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Adulto , Feminino , Humanos , Incidência , Modelos Logísticos , Análise Multivariada , Razão de Chances , Gravidez , Resultado da Gravidez , Taxa de Gravidez
9.
Fertil Steril ; 111(4): 734-746.e2, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30683590

RESUMO

OBJECTIVE: To investigate endometrial scratch injury (ESI) as an intervention to improve IVF outcome in women undergoing a first ET. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Infertile women undergoing a first fresh/frozen embryo transfer. INTERVENTION(S): We included published and unpublished data from randomized controlled trials in which the intervention group received ESI and controls received placebo or no intervention. Pooled results were expressed as relative risk (RR) with 95% confidence interval (CI). The review protocol was registered in PROSPERO to start the data extraction (CRD42018087786). MAIN OUTCOME MEASURE(S): Ongoing pregnancy/live birth rate (OPR/LBR), clinical pregnancy rate (CPR), multiple pregnancy rate (MPR), miscarriage rate (MR), and ectopic pregnancy rate (EPR). RESULT(S): Seven studies were included (1,354 participants). We found a nonsignificant difference between groups in terms of OPR/LBR, CPR, MR, MPR, and EPR. Subgroup analysis found that ESI on the day of oocyte retrieval (achieved by a Novak curette) reduced OPR/LBR (RR 0.31, 95% CI 0.14-0.69) and CPR (RR 0.36, 95% CI 0.18-0.71), whereas ESI during the cycle preceding ET (performed through soft devices) had no effect on OPR/LBR and CPR. No difference in the impact of ESI was observed between fresh and frozen embryo transfer. CONCLUSION(S): Current evidence does not support performing ESI with the purpose of improving the success of a first ET attempt.


Assuntos
Implantação do Embrião/fisiologia , Transferência Embrionária/métodos , Endométrio/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Infertilidade Feminina/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Adulto , Transferência Embrionária/estatística & dados numéricos , Endométrio/lesões , Endométrio/patologia , Feminino , Humanos , Infertilidade Feminina/epidemiologia , Gravidez , Taxa de Gravidez , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Editoração/estatística & dados numéricos , Resultado do Tratamento
10.
Sex Transm Infect ; 95(4): 300-306, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30606817

RESUMO

OBJECTIVES: A better understanding of Chlamydia trachomatis infection (chlamydia)-related sequelae can provide a framework for effective chlamydia control strategies. The objective of this study was to estimate risks and risk factors of pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility (TFI) with a follow-up time of up until 8 years in women previously tested for chlamydia in the Chlamydia Screening Implementation study (CSI) and participating in the Netherlands Chlamydia Cohort Study (NECCST). METHODS: Women who participated in the CSI 2008-2011 (n=13 498) were invited in 2015-2016 for NECCST. Chlamydia positive was defined as a positive CSI-PCR test, positive chlamydia serology and/or self-reported infection (time dependent). Data on PID, ectopic pregnancy and TFI were collected by self-completed questionnaires. Incidence rates and HRs were compared between chlamydia-positive and chlamydia-negative women corrected for confounders. RESULTS: Of 5704 women included, 29.5% (95% CI 28.3 to 30.7) were chlamydia positive. The incidence rate of PID was 1.8 per 1000 person-years (py) (1.6 to 2.2) overall, 4.4 per 1000 py (3.3 to 5.7) among chlamydia positives compared with 1.4 per 1000 py (1.1 to 1.7) for chlamydia negatives. For TFI, this was 0.4 per 1000 py (0.3 to 0.5) overall, 1.3 per 1000 py (0.8 to 2.1) and 0.2 per 1000 py (0.1 to 0.4) among chlamydia positives and negatives, respectively. And for ectopic pregnancy, this was 0.6 per 1000 py (0.5 to 0.8) overall, 0.8 per 1000 py (0.4 to 1.5) and 0.6 per 1000 py (0.4 to 0.8) for chlamydia negatives. Among chlamydia-positive women, the strongest risk factor for PID was symptomatic versus asymptomatic infection (adjusted HR 2.88, 1.4 to 4.5) and for TFI age <20 versus >24 years at first infection (HR 4.35, 1.1 to 16.8). CONCLUSION: We found a considerably higher risk for PID and TFI in chlamydia-positive women, but the incidence for ectopic pregnancy was comparable between chlamydia-positive and chlamydia-negative women. Overall, the incidence rates of sequelae remained low. TRIAL REGISTRATION: NTR-5597.


Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Infertilidade/epidemiologia , Doença Inflamatória Pélvica/epidemiologia , Gravidez Ectópica/epidemiologia , Adulto , Infecções por Chlamydia/complicações , Estudos de Coortes , Feminino , Humanos , Infertilidade/complicações , Programas de Rastreamento , Países Baixos/epidemiologia , Doença Inflamatória Pélvica/complicações , Gravidez , Prevalência , Fatores de Risco
11.
J Evid Based Med ; 12(1): 56-62, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30426707

RESUMO

OBJECTIVE: There are some studies on the prevalence of ectopic pregnancy (EP) in a different population of Iranian women. This study aimed to estimate the ectopic pregnancy prevalence in obstetrical clients and infertile patients treated by assisted reproductive technologies in Iran. METHODS: International and national databases including PubMed, Web of Science, Ovid, Scopus, ScienceDirect, Magiran, Iran doc, and Iran Medex were searched up to January 2016. Also, conference databases were searched. All studies in which, the ectopic pregnancy prevalence in Iranian obstetrical clients and infertile patients treated by assisted reproductive technologies were reported, included and reviewed. Data of studies were extracted into a standard data sheet. Meta-analysis was conducted by a random-effects model with 95% confidence interval. RESULTS: Eight studies were included, involving overall 571 826 women of whom 1446 had an ectopic pregnancy. The overall prevalence of ectopic pregnancy in obstetrical units of the hospitals and assisted reproductive technologies patients was 2.9 (95% CI: 2.1, 3.7) and 53 (95% CI: 20.4, 85.6) per 1000 clients, respectively. CONCLUSION: There is limited evidence on the ectopic pregnancy prevalence in Iranian obstetrical clients and assisted reproductive technologies patients. Furthermore, a significant heterogeneity existed between the results. So, more population-based studies on national data are needed for the exact estimation of the ectopic pregnancy prevalence in Iran.


Assuntos
Infertilidade Feminina/terapia , Tocologia/estatística & dados numéricos , Gravidez Ectópica/epidemiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Feminino , Unidades Hospitalares/estatística & dados numéricos , Humanos , Irã (Geográfico)/epidemiologia , Obstetrícia/estatística & dados numéricos , Gravidez , Prevalência
12.
Gynecol Endocrinol ; 35(4): 337-341, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30430877

RESUMO

The aim of this study was to investigate early clinical features and risk factors for cesarean scar pregnancy (CSP). Study group of 206 CSP patients out of 6853 women with early pregnancies, diagnosed from 2014 to 2016 was compared with a randomly selected control group of 412 patients. Early clinical features for CSP were vaginal bleeding (OR: 9.65; 95% CI: 5.67-16.41), lower abdominal pain (OR: 3.8; 95% CI: 1.52-9.54) and increased white blood cells (OR: 1.30; 95% CI: 1.12-1.50). Important risk factors for CSP were artificial abortion within the last pregnancy (OR: 4.13; 95% CI: 2.23-7.66), 0 ∼ 1 year and 2 ∼ 3 year interval between present and last pregnancy (OR: 2.27; 95% CI: 1.11-4.67 and OR: 2.15; 95% CI: 1.15-4.03). Pregnancy problems are important issues within the scope of 'Gynecological Endocrinology'. Vaginal bleeding and lower abdominal pain, although unspecific, could be early clinical symptoms of CSP, especially if main risk factors exist such as abortion within the last pregnancy and short interval to the last pregnancy. Knowing this can help for prevention and early diagnosis CSP which can reduce life-threatening complications such as massive hemorrhage and can avoid hysterectomy. Consequence also must be to avoid unwanted pregnancies by using effective contraception, especially in risk patients.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Gravidez Ectópica/etiologia , Adulto , China/epidemiologia , Feminino , Humanos , Modelos Logísticos , Gravidez , Gravidez Ectópica/epidemiologia , Estudos Retrospectivos , Fatores de Risco
13.
Gynecol Endocrinol ; 35(2): 93-99, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30129787

RESUMO

BACKGROUND: Ectopic pregnancy (EP) is the main cause of maternal death during early pregnancy. Blastocyst transfer (BT) reduces EP rates compared with cleavage stage embryo transfer (ET), and frozen ET reduces EP rates compared with fresh ET. However, data comparing the EP rate of fresh BT and frozen BT are limited. The objective of this meta-analysis was to determine whether frozen BT decreases the EP rate compared with fresh BT. MATERIALS AND METHODS: PUBMED, EMBASE, and Cochrane Library databases were searched for papers with no limitation on language and publication year. A systemic literature search identified 14 studies which met the inclusion criteria for further analysis. EP rate is our only outcome measure. All statistical analyses were carried out using RevMan software [version 5.3]. Random effects models were chosen to calculate the odds ratio (OR). RESULTS: Fourteen retrospective studies (n = 251,762 cycles) were finally analyzed, including 154,214 and 97,548 cycles undergoing fresh and frozen BT, respectively. Compared with fresh BT, the frozen BT was associated with an decrease in EP rate [OR = 1.79; 95% confidence interval (CI) = 1.37-2.34, heterogeneity was 71%], the EP rate was 1.74% (2683/154,214 pregnancies) for fresh BT and 0.97% (949/97,548 pregnancies) for frozen BT. The number of embryos transferred in subgroup analysis found that the incidence of EP in frozen BT is lower than fresh BT (OR = 1.62; 95% CI = 1.38-1.91), the EP rate was 1.2% (206/16,610 pregnancies) for one fresh BT and 0.8% (153/19,569 pregnancies) for one frozen BT, also the EP rate was 1.9% (78/4043 pregnancies) for two fresh BT and 1.1% (19/1790 pregnancies) for two frozen BT. CONCLUSIONS: Our meta-analysis found that frozen BT was associated with an decrease in EP rate compared with fresh BT in IVF/ICSI patients. We also found that a single frozen BT is the better choice as a method to reduce the incidence of EP.


Assuntos
Transferência Embrionária/métodos , Gravidez Ectópica/epidemiologia , Blastocisto , Criopreservação , Feminino , Humanos , Incidência , Razão de Chances , Gravidez
14.
J Minim Invasive Gynecol ; 26(5): 919-927, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30243684

RESUMO

STUDY OBJECTIVE: To describe the incidence, management, and complications of cesarean scar pregnancy (CSP) and define risk factors for conversion from medical to surgical treatment of CSP. DESIGN: Retrospective clinical study (Canadian Task Force classification II-3). SETTING: Tertiary medical center. PATIENTS: All patients who were admitted and treated for CSP between 2008 and 2016. INTERVENTIONS: The cohort was divided according to management, and demographic, clinical, and sonographic data were collected. Rates of conversion were compared between groups, and risk factors necessitating conversion were sought. MEASUREMENTS AND MAIN RESULTS: Forty-six cases of CSP were identified. The incidence of CSP has increased from 0.05% to 0.09% of all deliveries. A regression model for absolute numbers of CSP predicted an additional 0.47 CSP each year (p = .03). The most common treatment modalities were systemic treatment with methotrexate (28.2%) and ultrasound-guided intrasac injection of KCl with systemic treatment of methotrexate (58.7%). The mean sac diameter (MSD) of cases that were converted was 11.2 mm larger than in cases that were not converted (p < .001). No patients with an MSD <10 mm or a trophoblastic mass <20 mm3 were converted to surgical management. Maximal levels of beta human chorionic gonadotropin (ß-hCG) were significantly associated with the risk of conversion. Only 6.3% of patients with a ß-hCG level <10,000 IU at presentation were converted from medical to surgical management. There was no significant association between fetal cardiac activity and conversion from medical to surgical management. CONCLUSIONS: CSP has emerged as an important phenomenon in modern obstetrics and gynecology, and its frequency appears to be on the rise. The preferred method of treatment remains unclear; however, it is possible that a large MSD and trophoblastic mass at presentation should prompt surgical treatment.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Gravidez Ectópica/cirurgia , Adulto , Austrália/epidemiologia , Cesárea/estatística & dados numéricos , Cicatriz/epidemiologia , Cicatriz/patologia , Cicatriz/cirurgia , Feminino , Humanos , Incidência , Metotrexato/uso terapêutico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/cirurgia , Gravidez Ectópica/tratamento farmacológico , Retratamento , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Ultrassonografia
15.
Fertil Steril ; 110(7): 1328-1337, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30503132

RESUMO

OBJECTIVE: To evaluate the relationship between demographic, lifestyle, and reproductive factors and the risk of ectopic pregnancy (EP). DESIGN: Prospective cohort. SETTING: United States. PATIENT(S): Nurses' Health Study II cohort comprising 41,440 pregnancies from 22,356 women. INTERVENTION(S): Demographic, lifestyle, and reproductive factors self-reported in 1989 then updated every 2 years. Multivariable log-binomial regression models with generalized estimating equations were used to estimate adjusted risk ratios (aRR). MAIN OUTCOME MEASURE(S): Ectopic pregnancy. RESULT(S): Incident EP was reported in 411 (1.0%) pregnancies. Former and current smokers had 1.22 (95% confidence interval [CI], 0.97-1.55) and 1.73 (95% CI, 1.28-2.32) times, respectively, the risk of EP compared with never smokers. The risk of EP 10 years after quitting was similar to never smokers (aRR 0.90; 95% CI, 0.60-1.33). Women consuming ≥10 g/day of alcohol had 1.50 (95% CI, 1.08-2.09) times the risk of EP compared with never consumers. In utero exposure to diethylstilbestrol (aRR 3.55; 95% CI, 2.51-5.01), earlier initiation of oral contraceptives (aRR 2.64; 95% CI, 1.70-4.09 for <16 years vs. never), intrauterine device use (aRR 3.99; 95% CI, 2.06-7.72), or history of infertility (aRR 3.03; 95% CI, 2.48-3.71) or tubal ligation (aRR 16.27; 95% CI, 11.76-22.53) also were associated with a higher risk of EP. CONCLUSION(S): Women who were current or former smokers, consumed ≥10 g/day of alcohol, were exposed to diethylstilbestrol in utero, initiated oral contraceptives at earlier than age 16 years (which may be a marker of riskier sexual behaviors), and who had a history of infertility, intrauterine device use, or tubal ligation had a higher risk of EP.


Assuntos
Estilo de Vida , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , História Reprodutiva , Adulto , Demografia , Feminino , Humanos , Dispositivos Intrauterinos/estatística & dados numéricos , Razão de Chances , Gravidez , Fatores de Risco , Esterilização Tubária/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
16.
Sci Rep ; 8(1): 17308, 2018 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-30470815

RESUMO

We estimated the incidence of ectopic pregnancy (EP) and the success rate of expectant management of EP in South Korea. We analyzed data from 2009 to 2015 using the Health Insurance Review and Assessment Service National Inpatient Sample (HIRA-NIS) database. EP was identified by diagnostic codes, and strict EP was identified by both diagnostic codes and treatment codes. From 2009 to 2015, 369,701 cases of EP, abortion, or delivery were extracted from a total of 4,476,495 women. Of the total pregnancies, 8,556 cases were EPs. The incidence of EP was 34.1 ± 0.7 per 1,000 pregnancies and the incidence of strict EP was 17.3 ± 0.3 per 1,000 pregnancies. Among women aged 25-44 years, age was associated with a higher incidence of EP (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.06, 1.19; P < 0.01). The incidence rates of EP (OR: 0.99; 95% CI: 0.97, 1.01; P = 0.51) did not significantly differ by year. The incidence of EP in Korea was 17.3 ± 0.3 per 1,000 pregnancies, and almost did not change over 7 years. About 50% of EPs were treated without surgery or methotrexate. This study provides an important reference for the treatment of EP.


Assuntos
Aborto Induzido/tendências , Gravidez Ectópica/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Gravidez , Prognóstico , República da Coreia/epidemiologia
17.
Eur J Obstet Gynecol Reprod Biol ; 231: 174-179, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30391866

RESUMO

OBJECTIVE: To determine whether there were changes in the incidence, management and outcomes of ectopic pregnancy hospitalisations in Ireland during 2005-2016. STUDY DESIGN: Population-based study was carried out from January 2005 to December 2016. A total of 12,098 women hospitalised due to ectopic pregnancy. All acute maternity hospital settings in the Republic of Ireland. Electronic health records were retrieved using the Hospital In-Patient Enquiry database. Rates ratios were calculated to estimate trends, risk of blood transfusion and risk of extended stay at the hospital. RESULTS: The rate of hospitalisation for ectopic pregnancy increased over the 12-year study period from 12.8/1,000 deliveries in 2005 to 17.7/1,000 deliveries in 2016. Risk of blood transfusion reduced over time (aIRR 0.8; 95%CI 0.6-0.9). Women aged at least 40 years had double the risk of hospitalisation and double the risk of blood transfusion. Women undergoing open surgical procedures were more likely to need a blood transfusion than those undergoing laparoscopic salpingectomy. Similar results were found for length of stay over two days. Blood transfusion was rare for patients who underwent medical management (aIRR 0.1; 95%CI 0.05-0.2). CONCLUSION: Advanced maternal age increased risk of hospitalisation for ectopic pregnancy. While the overall rate of hospitalisations increased over time, there was a reduction in the risk of blood transfusion and length of stay over two days. Type of management significantly affected the risk of blood transfusion and length of stay over two days at the hospital.


Assuntos
Parto Obstétrico , Hospitalização/estatística & dados numéricos , Gravidez Ectópica/terapia , Adulto , Gerenciamento Clínico , Feminino , Humanos , Incidência , Irlanda/epidemiologia , Tempo de Internação/estatística & dados numéricos , Idade Materna , Pessoa de Meia-Idade , Gravidez , Gravidez Ectópica/epidemiologia , Estudos Retrospectivos , Adulto Jovem
18.
Afr J Prim Health Care Fam Med ; 10(1): e1-e8, 2018 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-30456972

RESUMO

BACKGROUND:  Ectopic pregnancy (EP) is a life-threatening condition; at Odi Hospital, approximately 7-10 EPs are managed weekly. Our study is the first to assess the management of this life-threatening condition at Odi Hospital. AIM:  This study aimed to determine the incidence of EP and to assess the profile of women who presented with EP at Odi District Hospital from 01 January 2010 to 31 December 2014. SETTING:  The study was conducted at Odi District Hospital, located in Mabopane, a township in Gauteng province, 45 km north of Tshwane, South Africa (SA). METHODS:  This was a cross-sectional study. RESULTS:  We analysed 263 completed patient records. The incidence rate was 22 per 1000 live births. The mean age was 28.9 years (SD ± 6.09), 57% were within the age group of 25-34 years, 90.9% were single and 85.2% were unemployed. Abdominal pain was the most common presenting complaint (81.1%). Ninety-nine (37.8%) were in a state of haemorrhagic shock. Possible risk factors were not documented in the patient files for 95%. A third (34.2%) were operated on within 4 hours of consultation. Early management was associated with poor record-keeping (p = 0.02). There was a delay in confirming the diagnosis in 48.7%. It was associated with gestational age (p = 0.0017), previous abdominal surgery (p = 0.0026), normal haemoglobin level at the time of consultation (p = 0.0024), considerable haemoperitoneum at operation (p < 0.00001) and per vaginal bleeding (p = 0.003). CONCLUSION:  The study highlighted the need to emphasise the importance of good record-keeping and documentation in patients, as well as the urgent need for ultrasound skills training among clinicians to implement the Essential Steps in Managing Obstetric Emergencies programme at this hospital to improve the management of EP and other obstetric emergencies.


Assuntos
Hospitais de Distrito , Gravidez Ectópica/terapia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Auditoria Médica , Pessoa de Meia-Idade , Gravidez , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/cirurgia , Estudos Retrospectivos , África do Sul/epidemiologia , Adulto Jovem
19.
Rev. inf. cient ; 97(6): 1100-1110, nov.-dic. 2018. tab
Artigo em Espanhol | CUMED | ID: cum-74031

RESUMO

Introducción: durante los últimos 20 años la incidencia del embarazo ectópico se ha duplicado o triplicado, principalmente en los países desarrollados. Este incremento se comporta de forma diferente en países, regiones o áreas poblacionales. Objetivo: caracterizar el comportamiento del embarazo ectópico en el Hospital General Docente de Guantánamo Dr Agostinho Neto durante el año 2006. Método: el universo estuvo constituido por 763 pacientes con embarazo ectópico en el período 2002-2006. La muestra fue de 175, todas del año 2006. Las variables estudiadas fueron: grupo de edades, síntomas al ingreso, medios diagnóstico, formas clínicas y operaciones realizadas. Resultados: se obtuvo discreto crecimiento en el número de embarazos ectópicos durante los años de estudio. El grupo de edades de 20-24 obtuvo el 31,4 por ciento en frecuencia y el de 25-29 el 34,9 por ciento. El 85,7 por ciento de las pacientes acudió con los síntomas de dolor bajo vientre y sangramiento vaginal anormal, seguidas por las que presentaron dolor bajo vientre y amenorrea (78,3 por ciento). En 73 pacientes fue diagnosticado por la clínica más culdocentesis en el 41,8 por ciento de los casos y solo en 9 por clínica más laparoscopia. Conclusiones: hubo incremento de los embarazos ectópicos. El año de mayor frecuencia fue 2006. Predominó el grupo de edades de 25 a 29 años y las pacientes primíparas. El síntoma al ingreso predominante fue el dolor bajo vientre y el sangramiento vaginal anormal. El diagnóstico con más frecuencia fue la clínica más culdocentesis. El embarazo ectópico complicado inestable, el sitio de implantación tubárica y la localización ampular con salpingectomía total como operación fueron las más frecuentes.(AU)


Introduction: during the last 20 years the incidence of ectopic pregnancy has doubled or tripled, mainly in developed countries. This increase behaves differently in countries, regions or population areas. Objective: to characterize the behavior of ectopic pregnancy in the Guantánamo General Teaching Hospital Dr Agostinho Neto during the year 2006. Method: the universe consisted of 763 patients with ectopic pregnancy in the period 2002-2006. The sample was 175, all of the year 2006. The variables studied were: age group, symptoms on admission, means of diagnosis, clinical forms and operations performed. Results: discrete growth was obtained in the number of ectopic pregnancies during the years of study. The age group of 20-24 obtained 31.4 percent in frequency and that of 25-29 and 34.9 percen. 85.7 percent of the patients presented with symptoms of abdominal pain and abnormal vaginal bleeding, followed by those with lower abdominal pain and amenorrhea (78.3%). In 73 patients it was diagnosed by the clinic plus culdocentesis in 41.8% of the cases and only in 9 by clinical plus laparoscopy. Conclusions: there was an increase in ectopic pregnancies. The year of greatest frequency was 2006. The age group of 25 to 29 years and the primiparous patients predominated. The predominant symptom of admission was lower abdominal pain and abnormal vaginal bleeding. The diagnosis with more frequency was the clinic plus culdocentesis. The complicated unstable ectopic pregnancy, the tubal implantation site and the ampullary location with total salpingectomy as the operation were the most frequent(AU)


Introdução: nos últimos 20 anos, a incidência de gravidez ectópica dobrou ou triplicou, principalmente nos países desenvolvidos. Esse aumento se comporta de maneira diferente em países, regiões ou áreas de população. Objetivo: caracterizar o comportamento da gravidez ectópica no Hospital Geral de Ensino de Guantánamo Dr Agostinho Neto durante o ano de 2006. Método: o universo consistiu em 763 pacientes com gravidez ectópica no período 2002-2006. A amostra foi de 175, durante todo o ano de 2006. As variáveis estudadas foram: faixa etária, sintomas na admissão, meios de diagnóstico, formas clínicas e operações realizadas. Resultados: crescimento discreto foi obtido no número de gestações ectópicas durante os anos de estudo. A faixa etária de 20 a 24 anos obteve 31,4% de frequência e a de 25 a 29 e 34,9%. 85,7% dos pacientes apresentavam sintomas de dor abdominal e sangramento vaginal anormal, seguidos por dor abdominal baixa e amenorreia (78,3%). Em 73 pacientes foi diagnosticada pela clínica mais culdocentese em 41,8% dos casos e somente em 9 pela clínica mais laparoscopia. Conclusões: houve aumento de gravidez ectópica. O ano de maior frequência foi 2006. A faixa etária de 25 a 29 anos e as primíparas predominaram. O sintoma predominante da admissão foi dor no baixo ventre e sangramento vaginal anormal. O diagnóstico com maior frequência foi a clínica e culdocentese. A gestação ectópica complicada e instável, o local de implantação das trompas e a localização ampular com salpingectomia total como operação foram os mais frequentes(AU)


Assuntos
Humanos , Feminino , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/cirurgia , Salpingectomia
20.
J Obstet Gynaecol Can ; 40(8): 1017-1023, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30103874

RESUMO

OBJECTIVE: This study sought to evaluate the sustained value of an early pregnancy assessment clinic (EPAC) in the management of early pregnancy complications and its effect on the incidence emergency room (ER) visits. METHODS: A 10-year retrospective study (January 2006 to December 2015) was conducted. The number of patients assessed, sources and reasons for referral, and treatments provided were reviewed. The numbers of ER assessments and reassessments for abortion, hemorrhage, and ectopic pregnancy from January 2004 to December 2005 (pre-EPAC) and January 2006 to December 2015 (post-EPAC) were also reviewed. RESULTS: There were 11 349 new referrals and 10 764 follow-up visits. The reasons for referral were threatened miscarriage (n = 3568, 31.4%), missed miscarriage (n = 3056, 26.9%), incomplete miscarriage (n = 1064, 9.4%), complete miscarriage (n = 991, 8.7%), ectopic pregnancy (n = 857, 7.6%), hyperemesis gravidarum (n = 139, 1.2%), and others (n = 1674, 14.8%). There has been a significant decreasing trend (tau = -0.60, P = 0.0127) and a significant decrease in the post-EPAC rate of ER reassessments (P = 0.0396) for hemorrhage, with a concomitant decrease in EPAC visits for hemorrhage. In addition, there has been a significant increasing trend (tau = 0.64, P = 0.0081) and a significant increase in the post-EPAC rate of ER assessments (P = 0.00001) for ectopic pregnancies. CONCLUSION: Over the 10-year period, the EPAC has remained a vital service for managing early pregnancy complications for women. However, the clinic has not yet had a sustained impact on ER visits for miscarriage, ectopic pregnancy, and hemorrhage. It is possible that a reduction in ER assessments and reassessments for early pregnancy complications can be achieved through a clinic with daily access.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/prevenção & controle , Adolescente , Adulto , Emergências , Feminino , Humanos , Pessoa de Meia-Idade , Ontário/epidemiologia , Gravidez , Complicações na Gravidez/prevenção & controle , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/prevenção & controle , Encaminhamento e Consulta , Estudos Retrospectivos , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/prevenção & controle , Adulto Jovem
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