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2.
Medicine (Baltimore) ; 99(43): e22845, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120815

RESUMO

The aim of the study was to compare the efficacy of laparoscopy and hysteroscopy for the treatment of cesarean scar pregnancy (CSP) and analyze the clinical factors associated with successful selection for hysteroscopic or laparoscopic treatment of CSP.We retrospectively studied 112 cases of CSP that were treated by laparoscopy and/or hysteroscopy in our hospital from December 2014 to December 2017. In total, 72 of these patients underwent ultrasound-guided curettage and hysteroscopic resection without uterine scar defect repair. Fourty of these patients underwent laparoscopic resection and repair of the uterine scar defect. We analyzed the different clinical variables between the 2 groups and identified the clinical factors which could predict the need for the laparoscopic repair of uterine scar defect. Results showed that laparoscopy and hysteroscopy were safe ways to treat CSP, and no patient underwent hysterectomy. The ß-hCG level in both of the 2 groups decreased to normal 4 to 8 weeks after surgery. There were significant differences between the hysteroscopy group and laparoscopy uterine scar repair group in terms of days of amenorrhea, gestational sac diameter, myometrial thickness, operation time, intraoperative blood loss, and hospitalization duration (P < .05). Logistic regression analysis showed that the days of amenorrhea, gestational sac diameter and myometrial thickness were independent risk factors for CSP treated by minimally invasive surgery, which were also shown by ROC curve analysis to be predictors of the need for the repair of the uterine scar defect, with optimal cutoffs of 52.50 days, 3.25 cm, and 2.05 mm, respectively; and the areas under their corresponding ROC were 0.721, 0.851, and 0.927, respectively.We conclude that laparoscopy and hysteroscopy are safe and efficient minimally invasive procedures for the treatment of CSP. The days of amenorrhea, gestational sac diameter and myometrial thickness may be key factors associated with successful selection for hysteroscopic or laparoscopic treatment of CSP.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Histeroscopia/métodos , Laparoscopia/métodos , Gravidez Ectópica/cirurgia , Adulto , Cicatriz/cirurgia , Feminino , Humanos , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Ultrassonografia de Intervenção
3.
Sci Rep ; 10(1): 15389, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32958779

RESUMO

Shift work, performed by approximately 21 million Americans, is irregular or unusual work schedule hours occurring after 6:00 pm. Shift work has been shown to disrupt circadian rhythms and is associated with several adverse health outcomes and chronic diseases such as cancer, gastrointestinal and psychiatric diseases and disorders. It is unclear if shift work influences the complications associated with certain infectious agents, such as pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility resulting from genital chlamydial infection. We used an Environmental circadian disruption (ECD) model mimicking circadian disruption occurring during shift work, where mice had a 6-h advance in the normal light/dark cycle (LD) every week for a month. Control group mice were housed under normal 12/12 LD cycle. Our hypothesis was that compared to controls, mice that had their circadian rhythms disrupted in this ECD model will have a higher Chlamydia load, more pathology and decreased fertility rate following Chlamydia infection. Results showed that, compared to controls, mice that had their circadian rhythms disrupted (ECD) had higher Chlamydia loads, more tissue alterations or lesions, and lower fertility rate associated with chlamydial infection. Also, infected ECD mice elicited higher proinflammatory cytokines compared to mice under normal 12/12 LD cycle. These results imply that there might be an association between shift work and the increased likelihood of developing more severe disease from Chlamydia infection.


Assuntos
Infecções por Chlamydia/etiologia , Ritmo Circadiano/fisiologia , Jornada de Trabalho em Turnos/efeitos adversos , Animais , Chlamydia/patogenicidade , Infecções por Chlamydia/metabolismo , Infecções por Chlamydia/patologia , Chlamydia muridarum/patogenicidade , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Doença Inflamatória Pélvica/etiologia , Fotoperíodo , Gravidez , Gravidez Ectópica/etiologia
4.
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
5.
Niger Postgrad Med J ; 27(3): 177-183, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687116

RESUMO

Background: There is uncertainty in the trend of ectopic pregnancy incidence in the Southwest region, though the region has a lower fertility rate and a higher contraceptive use than some other regions of Nigeria. The study objective was to determine the temporal trends, presentation and management outcome of ectopic pregnancy at the Lagos University Teaching Hospital (LUTH), Lagos, South-Western Nigeria over a decade. Subjects and Methods: This is a retrospective study of ectopic pregnancies at LUTH, Lagos, Nigeria, from January 2005 to December 2014. Participants' medical records were used to extract socio-demographic, clinical characteristics, management and outcome data. Joinpoint regression modelling (version 4.7.1) was used to evaluate the trends while descriptive statistics were conducted using Stata version 14 software. Results: There were 434 cases of ectopic pregnancies giving an overall incidence of 2.2/100 deliveries and 3.50/100 gynaecological admissions. Overall, there was a 59.7% increase in the ectopic pregnancy rate from 1.81/100 deliveries in 2005 to 2.89/100 deliveries in 2014. Join point regression revealed two trends. There was an initial non-significant decrease in incidence of ectopic pregnancy from 2005 to 2010 (annual percent change [APC] = -1.5%, 95% confidence interval [CI]: -8.1% to 5.6%, P = 0.6). However, there was a statistically significant increase in incidence of ectopic pregnancy at an average of 11.6% per annum from 8.6/100 deliveries in 2011 to 25.4/100 deliveries in 2014 (APC = 11.6%, 95% CI: 1.2% to 23.1% P < 0.001). About one-third (33.9%) of the patients with ectopic pregnancy were within the age range 25-29 years while the majority (68.0%) presented at 9-10 weeks of gestational age. The most common identifiable risk factor was previous pelvic infection (35.71%). Majority (96.5%) had tubal pregnancy and all the cases had laparotomy. There were six maternal deaths giving a case fatality rate of 1.4%. Conclusion: The hospital had an increased trend in the incidence of ectopic pregnancy from 2005 to 2014. Frontline health workers need high index of suspicion in the prompt diagnosis and intervention of ectopic pregnancy among women in the reproductive age.


Assuntos
Aborto Induzido/efeitos adversos , Doença Inflamatória Pélvica/complicações , Gravidez Ectópica/epidemiologia , Doenças Sexualmente Transmissíveis/complicações , Adulto , Feminino , Hospitais de Ensino , Humanos , Incidência , Mortalidade Materna , Nigéria/epidemiologia , Doença Inflamatória Pélvica/epidemiologia , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Fatores de Risco , Comportamento Sexual , Doenças Sexualmente Transmissíveis/epidemiologia , Fatores Socioeconômicos , Adulto Jovem
6.
Sci Rep ; 10(1): 5145, 2020 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-32198466

RESUMO

Some studies show that children born after ICSI with non-ejaculated sperm are at increased risk of birth defects, other studies hold the opposite view. Does neonatal outcome including congenital malformations in children born after ICSI with percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) differ from neonatal outcome in children born after ICSI with ejaculated sperm? In this study, we examined the data from our IVF center from 2006 to 2016, to compare neonatal outcomes and rates of congenital malformations in children born after ICSI with different sperm origin. The results showed the clinical pregnancy rate and implantation rate of non-ejaculated sperm group were significantly higher (P < 0.001) than ejaculated sperm group. There were 775 clinical pregnancies from non-ejaculated sperm group and 2,486 clinical pregnancies from ejaculated sperm group. Most of the clinical pregnancy outcomes were comparable between non-ejaculated sperm group and ejaculated sperm group (p > 0.05): the miscarriage rate per transfer, ectopic pregnancy rate per clinical pregnancy, induced abortion rate per clinical pregnancy and fetal deaths per clinical pregnancy. However, the live delivery rate per transfer of non-ejaculated sperm group was significantly higher than that of ejaculated sperm group (45.4% vs 36.7%, P < 0.001). Moreover, the comparison between the epididymal sperm, testicular sperm and ejaculated sperm groups showed there were no difference in the incidence of congenital malformations of babies live birth. Among singleton gestation live births, there were more girls than boys in both non-ejaculated sperm and ejaculated sperm group. In conclusion, the present study clearly showed no statistical increased risk in neonatal outcomes of newborns were found in the ICSI treatment with epididymal or testicular sperm. It may provide information for consultation for ICSI treatment in PESA or TESA patients.


Assuntos
Resultado da Gravidez/epidemiologia , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Injeções de Esperma Intracitoplásmicas/métodos , Aborto Espontâneo/etiologia , Adulto , Criança , Pré-Escolar , China/epidemiologia , Ejaculação , Feminino , Morte Fetal/etiologia , Humanos , Lactente , Recém-Nascido , Nascimento Vivo , Estudos Longitudinais , Masculino , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Recuperação Espermática , Espermatozoides , Testículo
7.
Taiwan J Obstet Gynecol ; 59(2): 237-242, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32127144

RESUMO

OBJECTIVES: To investigate the risk factors of persistent cesarean scar pregnancy (PCSP) after dilation and curettage (D&C). MATERIALS AND METHODS: A retrospective, age-matched case-control study including 45 cases of PCSP patients after D&C was conducted between January 2013 and April 2018. For each case, 4 women who had been diagnosed with CSP and had the same age and same hospitalization period as the case group but no residual CSP tissue after D&C were selected as the controls (Control group, n = 180). Conditional logistic regression analysis was used to assess the risk factors of PCSP after D&C. RESULTS: After conditional logistic regression, the 3 factors associated with PCSP after D&C were maximum diameter of CSP mass (or gestational sac) ≥4.5 cm (adjusted odds ratio [aOR] 6.51, 95% CI 1.39-30.47), myometrial thickness at the implantation site <2 mm (aOR 3.58, 95% CI 1.37-9.38) and a ≤66.42% decrease rate in ß-hCG levels on the first day after D&C (aOR 18.58, 95% CI 5.80-59.57). ROC analysis showed that the indicator [(hCG0-hCG1)/hCG0*100%] has a good predictive value for PCSP, and the area under the curve (AUC) is 0.745; when the cut-off value is equal to 66.42%, the indicator has the best predictive value, with a sensitivity of 82.2% and a specificity of 67.7%. CONCLUSIONS: For these high-risk patients with PCSP, choosing individualized treatment options and proper management could reduce the incidence of PCSP.


Assuntos
Cesárea/efeitos adversos , Cicatriz/etiologia , Dilatação e Curetagem/efeitos adversos , Complicações Pós-Operatórias/etiologia , Gravidez Ectópica/cirurgia , Adulto , Área Sob a Curva , Estudos de Casos e Controles , Gonadotropina Coriônica Humana Subunidade beta/sangue , Cicatriz/patologia , Feminino , Saco Gestacional/patologia , Humanos , Modelos Logísticos , Razão de Chances , Complicações Pós-Operatórias/cirurgia , Gravidez , Gravidez Ectópica/etiologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
8.
BMC Pregnancy Childbirth ; 20(1): 90, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041575

RESUMO

BACKGROUND: Intramyometrial pregnancy is a rare subtype of ectopic pregnancy. The cases following IVF-ET were few reported in recent years. The etiological factors include previous uterine trauma like myomectomy, salpingectomy, dilatation and curettage, assisted reproductive technologies and adenomyosis. Early diagnosis is difficult to make due to its various manifestation. The medical treatment includes conservative management with surgical excision, aortic balloon occlusion, uterine artery embolization, MTX etc. Sometimes hysterectomy was performed due to delayed diagnosis. CASE PRESENTATION: In this article, we presented a case of a 28 years old woman who had cryopreserved embryo transfer with a history of right side salpingectomy. We suspected it a right adnexa ectopic pregnancy at the first place, especially the right fallopian interstitial or right uterus cornu due to ultrasonography and medical history. The product of conception was discovered embedded in the myometrium and protruding out from the right side of the posterior uterine wall, with seemingly no connection with uterine cavity nor fallopian tubes. The diagnosis of intramural pregnancy was made intraoperatively and validated after pathological report. The interventions were made early enough that exploratory laparoscopy, hysteroscopy and conservative surgical excision were successfully performed at 7 weeks' gestation preserving the fertility. CONCLUSIONS: It is important for clinicians to be aware of risk factors of intramural pregnancy and maintain an index of suspicion in ART treatment. Ultrasound and laparoscopy are essential managements for early diagnose which make conservative treatment possible and prevent life-threatening consequences.


Assuntos
Transferência Embrionária/efeitos adversos , Gravidez Ectópica/etiologia , Técnicas de Reprodução Assistida/efeitos adversos , Adulto , Criopreservação , Feminino , Humanos , Miométrio/patologia , Gravidez
9.
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
10.
Aust N Z J Obstet Gynaecol ; 60(3): 330-335, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31944267

RESUMO

BACKGROUND: Despite the rising incidence of caesarean scar pregnancy (CSP), as yet there are no consensus or evidence-based guidelines for management. AIMS: To review diagnosis, treatment and management of all women with CSP over a 5 year period at Mater Mothers' Hospital, Brisbane, Australia. MATERIALS AND METHODS: Retrospective cohort study of CSP between 2013-2018. Data reviewed included demographics, presenting symptoms, gestational age, ultrasound findings, human chorionic gonadotrophin levels, treatment success, complications, and if available, subsequent pregnancy outcomes. RESULTS: Twenty-eight women were treated for CSP during the study period. Initial diagnosis was delayed in ten (36%). Overall success rates of initial treatment were 22/28 (79%). Of the six cases of failed treatment, five had been treated with systemic methotrexate alone. All women requiring further intervention had fetal pole present, and 50% had fetal cardiac activity. Failure rate of systemic methotrexate alone was 5/11 (45%). Eleven women deemed appropriate for conservative management did not require further treatment or experience complications. Nine women had data available for subsequent pregnancies, of whom two developed placenta accreta. CONCLUSION: This study provides data that may assist in guideline development and decision-making for management of CSP. Conservative management in carefully selected women appeared to be safe. Nearly half of women treated with systemic methotrexate alone required another treatment modality, suggesting a role for intralesional treatment, particularly in the presence of fetal pole ± fetal cardiac activity. More than one in five women with documented subsequent pregnancies were diagnosed with placenta accreta.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Gravidez Ectópica/terapia , Abortivos não Esteroides/uso terapêutico , Adulto , Austrália , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Metotrexato/uso terapêutico , Placenta Acreta , Gravidez , Resultado da Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Centros de Atenção Terciária
11.
J Obstet Gynaecol Res ; 46(2): 272-278, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31943529

RESUMO

AIM: Cesarean scar pregnancy (CSP) is a rare but life-threatening type of ectopic pregnancy. This study's aim is to investigate the clinical characteristics and possible risk factors for cesarean scar pregnancy. METHODS: A clinically randomized, unpaired and retrospective case-control study was implemented. A study group of 291 CSP patients and a control group of 317 full-term pregnant women with a history of cesarean section (CS) were recruited in our hospital from May 2013 to October 2018. Their demographic characteristics and medical and obstetric history were collected. RESULTS: Only symptoms suggestive of an impending abortion, such as vaginal bleeding with or without abdominal pain, were identified as the clinical characteristics of CSP. Maternal age older than 35 years, gravidity higher than 3 (especially gravidity higher than 5), more than two induced abortions (especially more than five abortions), an interval of less than 5 years (especially less than 2 years) between the current pregnancy and the last CS, history of CS performed in a rural hospital, history of induced abortions after CS and retroposition of the uterus were possible independent risk factors for CSP. CONCLUSION: CSP is a result of a combination of multiple factors associated with CS. There are no unique early clinical features of CSP. As a unique type of ectopic pregnancy, early diagnosis, early termination and early clearance should be the treatment principles. Further research is needed to evaluate the relationship between the cesarean scar defect and CSP in the future.


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
12.
J Minim Invasive Gynecol ; 27(1): 94-99, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31212071

RESUMO

STUDY OBJECTIVE: Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, and a significant concern in the management of this condition is the control and prevention of bleeding. We aimed to determine the efficacy and value of an indwelling, intrauterine Foley balloon catheter in controlling and preventing intraoperative and postoperative bleeding in patients with CSP. DESIGN: Retrospective case series. SETTING: University-affiliated hospital. PATIENTS: Between January 1, 2015 and May 31, 2017, 70 patients presented with CSP. INTERVENTIONS: All patients underwent uterine curettage under hysteroscopic guidance and ultrasound monitoring. Patients were then assigned to 2 groups: the study group, with an indwelling Foley balloon catheter placed in the uterine cavity during surgery and retained for 24 to 48 hours, and the control group, without catheter placement. Data were collected to compare the 2 groups in terms of intraoperative and postoperative complications, surgical time, and status of menstruation resumption. MEASUREMENTS AND MAIN RESULTS: The average daily volume of postoperative blood loss during the first 3 postoperative days in the study group was 23.1 mL compared with 31.5 mL observed in the control group (p = .041). Moreover, the study group had significantly shorter average duration of bleeding (p = .027) and fewer menstruation abnormalities than the control group. Uterine ultrasonography performed after resumption of menstruation showed that none of the enrolled patients had any intrauterine abnormalities. CONCLUSIONS: The use of an indwelling, intrauterine Foley balloon catheter has positive results in the management of CSP.


Assuntos
Oclusão com Balão , Cesárea/efeitos adversos , Cicatriz/cirurgia , Hemorragia Pós-Operatória/terapia , Gravidez Ectópica/terapia , Cateterismo Urinário , Adulto , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Oclusão com Balão/métodos , Estudos de Casos e Controles , Cateteres de Demora/efeitos adversos , Cicatriz/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Hemorragia Pós-Operatória/etiologia , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Útero/cirurgia
13.
J Minim Invasive Gynecol ; 27(2): 352-361.e2, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31546066

RESUMO

OBJECTIVE: To systematically review and perform a meta-analysis of the risk of ectopic pregnancy in endometriosis. DATA SOURCES: MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), and Cochrane Library to April 1, 2019. Inclusion criteria were cohort or case-control studies from 1990 onward. Exclusion criteria were cohort studies without controls, case reports or series, or no English full-text. METHODS OF STUDY SELECTION: A total of 1361 titles/abstracts were screened after removal of duplicates, 39 full-texts were requested, and, after 24 studies were excluded, there were 15 studies in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: Data were extracted using standardized spreadsheets with 2 independent reviewers, and conflicts were resolved by a third reviewer. We performed random effects calculation of weighted estimated average odds ratio (OR). Heterogeneity and publication bias were assessed with the I2 metric and funnel plots/Egger's test, respectively. The Ottawa-Newcastle Quality Assessment Scale was used with a cutoff of ≥7 for higher quality. There were 10 case-control studies (17 972 ectopic pregnancy cases and 485 266 nonectopic pregnancy controls) and 5 cohort studies (30 609 women with endometriosis and 107 321 women without endometriosis). For case-control studies, endometriosis was associated with increased risk of ectopic pregnancy with an OR of 2.66 (95% confidence interval [CI] = 1.14-6.21, p = .02). For cohort studies, the OR was 0.95 (95% CI = 0.29-3.11, p = .94), but after post hoc analysis of the studies with a Ottawa-Newcastle score ≥7, the OR was 2.16 (95% CI = 1.67-2.79, p <.001). For both case-control and cohort studies, there was high heterogeneity among studies (I2 = 93.9% and I2 = 96.6%, Q test p <.001) but no obvious evidence of systematic bias in the funnel plot, and Egger's test results were not significant (p = .35, p = .70), suggesting no strong publication bias. There were insufficient data to make any conclusions with respect to anatomic characteristics of endometriosis (e.g., stage) or mode of conception (e.g., assisted reproductive technology vs spontaneous). CONCLUSION: Possible evidence of an association between endometriosis and ectopic pregnancy was observed (OR = 2.16-2.66). However, these results should be considered with caution, owing to high heterogeneity among studies. Continued research is needed to delineate the pregnancy implications of endometriosis.


Assuntos
Endometriose/complicações , Endometriose/epidemiologia , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Estudos de Casos e Controles , Estudos de Coortes , Endometriose/terapia , Feminino , Humanos , Gravidez , Gravidez Ectópica/terapia , Técnicas de Reprodução Assistida , Fatores de Risco
14.
Fertil Steril ; 113(1): 131-139, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31727414

RESUMO

OBJECTIVE: To investigate whether endometrial thickness (EMT) influences the incidence of ectopic pregnancy (EP) in frozen embryo transfer (FET) cycles. DESIGN: Retrospective cohort study. SETTING: Academic tertiary-care medical center. PATIENT(S): A total of 16,556 patients were enrolled between January 2010 and December 2017, comprising 16,701 intrauterine, 488 ectopic, and 45 heterotopic pregnancy cycles after FET. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): EP was the primary outcome. EMT was the main measured variable. Data were analyzed with the binary logistic general estimating equations model to calculate the adjusted odds ratio (aOR) for EP. RESULT(S): After adjusting for confounders, EMT remained statistically significant as an independent risk factor for EP. Compared with women with an EMT of ≥14 mm, the aORs for women with EMT in the ranges 7-7.9, 8-9.9, and 10-11.9 mm were 2.70 (95% confidence interval [CI], 1.65-4.40), 2.06 (95% CI, 1.33-3.20), and 1.66 (95% CI, 1.07-2.58), respectively. Hormone replacement treatment for endometrial preparation during FET increased the risk of EP after adjustment for confounding variables. CONCLUSION(S): EMT is inversely proportional to EP rate in FET cycles and is therefore a potential quantitative marker of endometrial receptivity and uterine contractibility in an FET cycle. The predictive validity of EMT value must be evaluated in further studies.


Assuntos
Criopreservação/métodos , Transferência Embrionária/métodos , Endométrio/diagnóstico por imagem , Taxa de Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/etiologia , Adulto , Estudos de Coortes , Criopreservação/tendências , Transferência Embrionária/tendências , Feminino , Humanos , Indução da Ovulação/métodos , Indução da Ovulação/tendências , Gravidez , Taxa de Gravidez/tendências , Estudos Retrospectivos
15.
BMC Pregnancy Childbirth ; 19(1): 502, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842804

RESUMO

BACKGROUND: The aim of this study was to assess the feasibility, safety and outcome of the embolization of non-gonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP). METHODS: A retrospective study was undertaken from January 2012 to September 2018 in 24 CSP patients in whom non-gonadal collaterals supplying GS were identified by arterial angiography performed immediately after UAE. These patients underwent attempt collateral embolization in addition to UAE, followed by hysteroscopic curettage for the management of CSP. The 24 patients were divided into two groups based on whether they underwent technically successful collateral embolization (UAE-SCE group) or failed collateral embolization (UAE-FCE group) in addition to UAE. The baseline characteristics and clinical outcomes including time for serum ß-human chorionic gonadotropin (ß-hCG) levels normalization, blood loss, secondary anemia, and pelvic pain were compared between the two groups. The paired t test and Man Whitney test were used for comparisons of discrete and numerical variables, respectively. RESULTS: Collateral embolization was techinically successful in 16 (66.7%, 16/24) patients and failed in the other 8 (33.3%, 8/24) patients. There were no significant differences between the two groups in baseline characteristics. The mean blood loss and secondary anemia in the UAE-SCE group were significantly less than UAE-FCE group. No significant difference was found between the two groups in the mean time for ß-hCG levels normalization and pelvic pain. CONCLUSIONS: During the management of UAE combined with hysteroscopic curettage for CSP, additional embolization of non-gonadal collateral supplying GS during UAE is feasible and safe in patients with non-gonadal collateral supplying GS, and the additional embolization of the collateral may reduce blood bloss related to hysteroscopic curettage.


Assuntos
Curetagem/métodos , Saco Gestacional/irrigação sanguínea , Histeroscopia/métodos , Gravidez Ectópica/cirurgia , Embolização da Artéria Uterina/métodos , Adulto , Cesárea/efeitos adversos , Cicatriz/complicações , Circulação Colateral , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(44): e17741, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689823

RESUMO

OBJECTIVES: We compared the clinical efficacy of contrast-enhanced ultrasound (CEUS) to transvaginal ultrasound (TVS) for diagnosing cesarean scar pregnancy (CSP). METHODS: A total of 485 cases of suspected CSP were recruited from January 2017 to March 2018. All received TVS and CEUS by two sonologists blinded to diagnosis by the other. Diagnostic features of CSP that significantly differed between modalities by univariate analysis (P < .05) were included in a logistic regression model. The sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), and accuracy (ACC) of CSP diagnosis by TVS and CEUS were compared according to operational and pathological outcomes as the reference standard. RESULTS: There were 220 CSP cases (including 85 cases of type I, 93 of type II, and 42 of type III). The sensitivities of CEUS for detection of types I - III CSP were 94.1%, 92.5%, and 97.6%, respectively, and corresponding sensitivities of TVS were 82.4%, 80.6%, and 95.2%. Compared to TVS, CEUS yielded significantly better overall sensitivity (97.27% vs 88.18%), specificity (96.60% vs 75.47%), +LR (28.60 vs 3.59), -LR (0.03 vs 0.16), and diagnostic ACC (96.9% vs 81.23%) (all P < .001). CONCLUSIONS: CEUS is superior to TVS for detecting cesarean scar pregnancy and distinguishing among CSP types.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Meios de Contraste , Complicações Pós-Operatórias/diagnóstico por imagem , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Gravidez , Gravidez Ectópica/etiologia , Estudos Prospectivos , Sensibilidade e Especificidade , Vagina/diagnóstico por imagem
17.
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
18.
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
19.
Arch Gynecol Obstet ; 300(6): 1797-1803, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31720777

RESUMO

PURPOSE: The ectopic pregnancy (EP) rate after in vitro fertilization-embryo transfer (IVF-ET) is higher than after spontaneous conception. The reason for the increased risk of EP is not clear. We aimed to determine the risk factors associated with EP in patients undergoing IVF-ET. METHODS: This was a 1:4 matched case-control study that enrolled 225 EP patients and 900 matched intrauterine pregnancy patients from the ART center of Northwest Women's and Children's Hospital from January 2014 to April 2018. Conditional logistic regression was used to analyze the association between risk factors and EP, and a receiver-operating characteristic (ROC) curve was generated for the predictors of EP. RESULTS: Our findings showed that tubal factor (OR 1.61; 95% CI 1.12-2.31) and pelvic surgery other than cesarean section (OR 2.04; 95% CI 1.26-3.29) were associated with a higher risk of EP (p = 0.001). An endometrial thickness > 12 mm prior to embryo transfer (OR 0.27; 95% CI 0.13-0.56) and the number of transferable embryos (OR 0.71; 95% CI 0.65-0.78) were protective factors against EP (p < 0.001). The other factors did not have a significant effect on the probability of developing ectopic pregnancy. The area under the curve of the endometrial thickness and the number of transferable embryos for EP prediction were higher than those for tubal factor and pelvic surgery other than cesarean section. CONCLUSIONS: An endometrial thickness > 12 mm is a strong protective factor against ectopic pregnancy. Attention should be paid to women with specific characteristics who have undergone IVF-ET.


Assuntos
Transferência Embrionária , Endométrio/patologia , Fertilização In Vitro , Gravidez Ectópica/etiologia , Adulto , Estudos de Casos e Controles , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Modelos Logísticos , Gravidez , Gravidez Ectópica/epidemiologia , Estudos Retrospectivos
20.
Folia Med Cracov ; 59(2): 5-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31659344

RESUMO

Ectopic pregnancy constitutes 2% of all pregnancies. In the last decades, due to the rising amount of caesarean sections, new localization of ectopic pregnancy has been observed - caesarean scar pregnancy (CSP). Cesarean scar pregnancy is an iatrogenic disease and a life-threatening condition which frequency will systematically rise. Because of possible serious complications, CSP should be swiftly diagnosed and treated. The purpose of this retrospective study was to demonstrate different methods of CSP treatment performed between 2015-2018 in the Clinic of Endocrinological Gynaecology and Gynaecology Jagiellonian University Medical College in Cracow. The clinical characteristics, diagnosis, various methods of treatment and clinical outcomes were analysed. Definitive algorithm of CSP treatment is still not established. Pharmacological and operative methods are approved while expectant observation is considered unsafe due to possible risk of complications for the patient, including death.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Laparoscopia/métodos , Complicações na Gravidez/terapia , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/etiologia , Gravidez Ectópica/terapia , Adulto , Feminino , Humanos , Polônia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia
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