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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.
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
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.
Int J Gynaecol Obstet ; 146(3): 289-295, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172522

RESUMO

OBJECTIVE: To establish a risk scoring system to predict the successful treatment of cesarean scar pregnancy. METHODS: A prospective observational study was conducted between June 2016 and March 2018 in a tertiary care center. Patients received evacuation followed by uterine artery embolization and laparoscopic local resection/hysterectomy successively as salvage measures if necessary. Optimal scaling regression determined the extent of each potential prognostic factor predicted. RESULTS: Out of 228 women, 144 cases required evacuation before recovery, 73 women required uterine artery embolization, and 11 women eventually required laparoscopic surgery. Six variables were included in the predictive model: number of cesarean deliveries; maximal diameter of gestational sac; remnant myometrial thickness; grading of Doppler signals; presence of fetal heartbeat; and location of gestational sac. A 10-point scoring system was established by weighting their prediction of the method of successful treatment. In the risk score rank of 1-4, only 4 (2.8%) out of 142 women needed uterine artery embolization as a salvage treatment, while in the risk score rank of 8-10, 41 (80.4%) cases needed uterine artery embolization; laparoscopic operations were performed by physicians for the other 10 (19.6%) cases. CONCLUSION: The successful treatment of cesarean scar pregnancy was accurately predicted by a 10-point scoring system. CHINESE CLINICAL TRIALS REGISTRY: ChiCTR-OOC-16008467.


Assuntos
Histerectomia/efeitos adversos , Gravidez Ectópica/cirurgia , Embolização da Artéria Uterina/métodos , Hemorragia Uterina/cirurgia , Adulto , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , China , Cicatriz/complicações , Cicatriz/cirurgia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Gravidez , Gravidez Ectópica/etiologia , Estudos Prospectivos , Resultado do Tratamento , Hemorragia Uterina/etiologia
5.
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
6.
Med Arch ; 73(1): 58-60, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31097863

RESUMO

Introduction: Cesarean scar pregnancy is potentially life-threatening condition because of heavy complications and includes adherent placenta: accreta, increta or percreta as a result of deep placental invasion. Aim: To present a rare case of ectopic cesarean scar pregnancy combined with placenta percreta in 38-year old woman who undergone previous cesarean section delivery. Case report: A multiparous woman aged 38 years with prior cesarean section delivery, admitted first time to the Clinic in 7th week of gestation, due to her medical record (light bleeding). Diagnosis was: graviditas hbd 7, gemellar pregnancy, blighted ovum gemellus I, graviditas isthmico-cervicalis gemellus II. Due to diagnosis it was performed vacuum aspiration et curettage and woman leaved hospital same day. One month later same woman was admitted again to the Clinic due to bleeding and ultrasound finding suspicious to residual trophoblastic tissue. Beta human chorionic gonadotropin serum concentration at the day of admittance was 8,419 IU/ml. Ultrasound finding showed inhomogeneous supracervical formation with dimension 2,73x1,89 cm with increased vascularity and resistant index 0.36 and suspicious placenta increta. We made decision to surgery, and performed hysterectomy in view of heavy intraoperative haemorrhage. Woman was discharged at fifth day after surgery in good condition. Histological finding showed cervical pregnancy complicated with placenta percreta parietis isthmicocervicalis of the uterus. Conclusion: We showed the importance of early and opportune diagnosis of cervical pregnancy specially complicated with one of kind of throphoblastic disease, to prevent life-threatening complication.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Placenta Acreta/etiologia , Gravidez Ectópica/etiologia , Adulto , Feminino , Humanos , Histerectomia , Placenta Acreta/cirurgia , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/cirurgia
7.
Eur J Obstet Gynecol Reprod Biol ; 238: 138-142, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31132691

RESUMO

OBJECTIVE: To report the efficacy of combined systemic and local methotrexate treatment for cesarean scar pregnancy and review data from selected, similar case series. STUDY DESIGN: A retrospective case series of 12 patients with cesarean scar pregnancy treated in a university hospital between 2014 and 2018. The intervention was combined treatment of systemic and local methotrexate. RESULTS: Twelve patients were treated with combined systemic and local methotrexate. Clinical characteristics, clinical course and treatment efficacy were evaluated. Mean gestational age at diagnosis was 7.5 weeks (range 5.9-9.1). ßhCG levels at diagnosis ranged from 1581 to 345,427 U/L with a mean of 77,795 U/L. All 12 patients were successfully treated without surgical intervention and with no significant side-effects. Mean hospitalization duration was 9 days (5.8-12.6) and mean time to normalization of ßhCG levels was 98 days (63-132). CONCLUSIONS: Treatment of cesarean scar pregnancy with a combination of systemic and local methotrexate was effective and safe. Although the treatment course tends to be longer than with other modalities, this protocol offers excellent success rates, with fertility preservation and few complications.


Assuntos
Abortivos não Esteroides/administração & dosagem , Cicatriz/complicações , Metotrexato/administração & dosagem , Gravidez Ectópica/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos
8.
Eur J Obstet Gynecol Reprod Biol ; 237: 28-32, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30999082

RESUMO

OBJECTIVE: Incidence of caesarean scar pregnancy (CSP) is increasing due to rising caesarean section rate and advanced imaging modalities. At present, there is no consensus to recommend any specific intervention. In our centre, we have adopted the high dose intravenous methotrexate therapy followed by folinic acid for the management of CSP. In this retrospective study, we report the success rate and safety of this regimen. STUDY DESIGN: This was a 10-year retrospective study of women with CSP who received high dose methotrexate therapy with folinic acid at a tertiary centre from 1 st January 2008 to 31 st December 2017. Treatment regimen consisted of a bolus dose of intravenous methotrexate followed by methotrexate infusion over 12 h. Oral folinic acid rescues were given post treatment. Successful treatment was confirmed with either resolution of serum beta-human chorionic gonadotropin or subsequent intrauterine pregnancy. RESULTS: Of 28 women with CSP who were treated with the regimen, 24 women (85.7%) were treated successfully with methotrexate alone. 3 women (10.7%) required suction evacuation following initial treatment with methotrexate and folinic acid. There was no serious side effect from methotrexate. Advanced gestational age, higher serum ß-hCG, larger gestational sac diameter and crown-rump length, and the presence of embryonic cardiac activity were associated with methotrexate failure or need for additional therapy. CONCLUSIONS: Our high dose intravenous methotrexate infusion therapy with folinic acid is effective and well tolerated. Caution is needed with factors associated with failure. Ensuring follow up ultrasound for live CSP and follow up ß-hCG for all women with CSP is essential.


Assuntos
Abortivos não Esteroides/uso terapêutico , Cesárea/efeitos adversos , Cicatriz/etiologia , Metotrexato/uso terapêutico , Gravidez Ectópica/tratamento farmacológico , Adulto , Feminino , Humanos , Infusões Intravenosas , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Resultado do Tratamento
9.
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
10.
Int J Mol Sci ; 20(2)2019 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-30669479

RESUMO

Trophoblast expressing paternal HLA-C resembles a semiallograft, and could be rejected by maternal T cells. IL-22 seems to be involved in allograft rejection and thus could be responsible for miscarriages. We examined the role of decidual IL-22-producing CD4+ T on human pregnancy. In those experiencing successful pregnancy and those experiencing unexplained recurrent abortion (URA), the levels of IL-22 produced by decidual CD4+ T cells are higher than those of peripheral blood T cells. We found a correlation of IL-22 and IL-4 produced by decidual CD4+ T cells in those experiencing successful pregnancy, not in those experiencing URA. The correlation of IL-22 and IL-4 was also found in the serum of successful pregnancy. A prevalence of CD4+ T cells producing IL-22 and IL-4 (Th17/Th2/IL-22+, Th17/Th0/IL-22+, Th17/Th2/IL-22+, and Th0/IL-22+ cells) was observed in decidua of those experiencing successful pregnancy, whereas Th17/Th1/IL-22+ cells, which do not produce IL-4, are prevalent in those experiencing URA. Th17/Th2/IL-22+ and Th17/Th0/IL-22+ cells are exclusively present at the embryo implantation site where IL-4, GATA-3, IL-17A, ROR-C, IL-22, and AHR mRNA are expressed. T-bet and IFN-γ mRNA are found away from the implantation site. There is no pathogenic role of IL-22 when IL-4 is also produced by decidual CD4+ cells. Th17/Th2/IL-22+ and Th17/Th0/IL-22+ cells seem to be crucial for embryo implantation.


Assuntos
Linfócitos T CD4-Positivos/metabolismo , Decídua/fisiologia , Interleucina-4/biossíntese , Interleucinas/biossíntese , Subpopulações de Linfócitos T/metabolismo , Aborto Habitual/etiologia , Aborto Habitual/metabolismo , Biomarcadores , Linfócitos T CD4-Positivos/imunologia , Citocinas/biossíntese , Citocinas/sangue , Feminino , Humanos , Interleucina-4/sangue , Interleucinas/sangue , Modelos Biológicos , Gravidez , Resultado da Gravidez , Gravidez Ectópica/etiologia , Gravidez Ectópica/metabolismo , Subpopulações de Linfócitos T/imunologia
11.
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
12.
J Obstet Gynaecol ; 39(3): 365-371, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30634873

RESUMO

A retrospective study was conducted in women with history of a caesarean scar pregnancy (CSP) to explore the possible causative mechanisms. Over a period of 40 months, a total of 16,926 deliveries and 3554 caesarean sections (CS) occurred in our hospital. Nine cases of CSP were identified at an incidence of 1:1880 births and 0.25% of all CS. Analysis of the indications of the previous CS revealed that 88.8% of women with known indication had undergone CS without labour. Out of them, 75% underwent CS at preterm gestation and 25% had term elective procedure for breech presentation. Of the patients, 77.7% had multiple CS. Conservation of the uterus was possible in 77.7% of patients utilising non-radical forms of treatment. As most of the women underwent CS with a non-contractile uterus without labour, we believe that the risk of CSP may be related to the indications of the previous CS as the number of CS alone could not explain the occurrence of CSP. It is time to explore this area so that screening strategies can be developed to detect CSP at the earliest possible gestation and to prevent life-threatening complications such as uterine rupture and severe hemorrhage. Impact statement What is already known on this subject? A caesarean scar pregnancy (CSP) is a life-threatening condition that can result in uterine rupture and in severe haemorrhage. Although the diagnostic criteria for the CSP have been established, the risk factors that favour the condition are not well understood. We know that the incomplete healing of the lower uterine segment (LUS) from poor vascularisation can create a microscopic dehiscent tract through which the blastocyst enters the myometrium. Some have postulated that the healing processes following the elective procedures, such as for breech deliveries performed in a non-developed LUS, might facilitate this process. What do the results of this study add? In this study, analysis of the indications of the previous CS revealed that majority of women with a known indication had undergone CS without labour, either at preterm gestation or term elective procedure for breech presentation. We have postulated the possible causative mechanisms in relation to the physiology of LUS development. To the best of our knowledge, this is the first study that has looked specifically at the relationship between the indications of previous CS and CSP. What are the implications of these findings for clinical practice and/or further research? Further studies exploring the indications of the previous CS are recommended so that early first-trimester screening strategies can be generated towards this subgroup of patients to detect CSP at the earliest possible gestation.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Gravidez Ectópica/etiologia , Adulto , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia Pré-Natal
14.
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
15.
J Obstet Gynaecol ; 39(2): 259-264, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30372649

RESUMO

The management of a caesarean scar pregnancy ranges from conservative medical therapy to surgical treatment. The aim of this study is to present our experience of caesarean scar ectopic pregnancies treated with different modalities and to develop a management algorithm. This retrospective clinical analysis included 21 caesarean scar pregnancies. The clinical data, ultrasonographic characteristics, b-human chorionic gonadotropin concentrations, the treatment options and complications were noted. One patient was managed expectantly, six patients were treated with D and C, seven patients were treated with systemic methotrexate, eight patients underwent a caesarean scar pregnancy removal with a laparoscopy, three patients were treated with a hysteroscopy. Three patients who recieved a methotrexate required additional treatment methods including a laparoscopy, hysteroscopy and D and C. Surgery was successful in all cases. An intra-abdominal haemorrhage from the vessels in the scar area occured in the patient managed expectantly, and a laparatomy and removal was performed. A systemic methotrexate, dilatation and curettage, hysteroscopic resection and laparoscopic resection are feasible methods for scar pregnancy treatment depending on the gestational age, ß-hCG level, the type of scar pregnancy and the clinical status of the patient. IMPACT STATEMENT What is already known on this subject? CSP has increased gradually parallel to the increased rates of CS worldwide. There is no treatment consensus on that rare entity. What do the results of this study add? We aimed to present our cases and to discuss a proposal algorithm with further studies. What are the implications of these findings for clinical practice and/or further research? Our cases and proposal algorithm could help to determine the treatment options for CSP.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Gravidez Ectópica/terapia , Adulto , Algoritmos , Feminino , Humanos , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Adulto Jovem
16.
J Obstet Gynaecol Res ; 45(2): 473-476, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30246476

RESUMO

Levonorgestrel is used worldwide as an emergency oral contraceptive. There have been occasional reports of ectopic pregnancy after oral levonorgestrel use. We present a case of ectopic tubal pregnancy after the use of oral levonorgestrel as an emergency contraceptive in a 37-year-old woman with a history of treatment for Chlamydia trachomatis infection. She conceived after sexual intercourse on menstrual day 14 of the first menstrual cycle following a normal delivery. After salpingectomy for this right tubal pregnancy, her following pregnancy was an ectopic pregnancy in the contralateral tube, which was treated with laparoscopic salpingectomy. Histopathological examination revealed endometriosis. We should be aware of ectopic pregnancy even after emergency contraceptive use, especially in patients with risk factors, such as Chlamydia infection and endometriosis. Because the efficacy of levonorgestrel decreases after ovulation, we should check the stage of the cycle before prescription.


Assuntos
Anticoncepção Pós-Coito , Anticoncepcionais Femininos/administração & dosagem , Endometriose/complicações , Levanogestrel/administração & dosagem , Gravidez Ectópica/etiologia , Adulto , Feminino , Humanos , Gravidez
17.
J Minim Invasive Gynecol ; 26(3): 399-400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29890356

RESUMO

STUDY OBJECTIVE: To present a case of a cesarean scar ectopic pregnancy treated by laparoscopic resection followed by isthmocele repair. DESIGN: A case report. SETTINGS: The University Gynecology Clinic of the Emergency Clinical City Hospital Timișoara, Timișoara, România. BACKGROUND: Cesarean scar pregnancy is a rare form of ectopic pregnancy. In recent years, its prevalence has risen because of the increasing number of cesarean sections. An early diagnosis can lead to early management, decreasing the risk of life-threatening complications such as uterine rupture and massive hemorrhage. Many therapeutic options are available, medical and surgical, but the current literature suggests that the laparoscopic approach with ectopic pregnancy resection is the best option. CASE REPORT: We present the case of a 30-year-old woman with a previous cesarean section in 2012 who was diagnosed by transvaginal ultrasound with a 6-week live pregnancy implanted at the level of the cesarean scar. The initial management was the administration of a 2-dose methotrexate protocol, but after 72 hours the transvaginal ultrasound showed an embryo with cardiac activity still present associated with an increased beta human chorionic gonadotropin level. We decided on laparoscopic surgical treatment, aiming to extract the pregnancy and repair the scar defect. A similar case was presented by Mahgoub et al [1], but their case had a different evolution, with decreasing levels of hCG. INTERVENTIONS: In order to reduce the blood loss, the anterior trunks of the hypogastric arteries were clipped. The side wall peritoneum was cut bilaterally, and the ureters and the hypogastric arteries were dissected. Next, we performed the dissection of the vesicouterine space. Because of the previous cesarean section, the identification of the correct dissection plane was difficult. A uterine manipulator was used to facilitate the dissection. The exact location of the gestational sac was demonstrated using intraoperative transvaginal ultrasound. To reduce the bleeding, Glypressin (Ferring GmbH, Saint Prex, Switzerland) was injected at the level of the uterine scar. The cesarean scar was cut using a monopolar knife. The gestation sac was reached easily and then extracted from the abdominal cavity with the use of an endobag. In order to obtain proper healing, the margins of the scar were resected using cold scissors. The hysterotomy was closed using a double-layered suture with 2.0 Vicryl (Ethicon Inc., Cincinnati, OH). We used methylene blue to verify the tightness of the suture. The final step was the removal of the clips. MEASUREMENTS AND MAIN RESULTS: The operative time was 85 minutes with minimal blood loss of about 20 mL. The patient recovered well and was discharged 2 days after the procedure. A transvaginal ultrasound was performed 1 month after the surgery showing good healing of the anterior uterine wall. CONCLUSION: The laparoscopic approach with excision and repair of the uterine wall represents a safe and efficient therapeutic option for the treatment of the cesarean scar ectopic pregnancy.


Assuntos
Cicatriz/cirurgia , Laparoscopia/métodos , Metotrexato/uso terapêutico , Gravidez Ectópica/tratamento farmacológico , Gravidez Ectópica/cirurgia , Adulto , Cesárea/efeitos adversos , Cicatriz/etiologia , Feminino , Humanos , Histerotomia/métodos , Gravidez , Gravidez Ectópica/etiologia , Romênia , Falha de Tratamento
18.
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
19.
PLoS One ; 13(12): e0207699, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30540783

RESUMO

OBJECTIVE: To identify the risk factors for ectopic pregnancy (EP) in a population of Cameroonian women. SAMPLE AND METHODS: We performed a matched case-control study; 88 women with diagnosed EP (cases), and 176 women with first trimester intrauterine pregnancy (IUP) (controls), who underwent questionnaires. Odds Ratio (OR) and 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors via multivariate logistic regression analysis. RESULTS: Of the fifteen identified risk factors, 4 were independently associated with increased odds of EP: prior pelvic inflammatory disease (PID) (adjusted odds ratio [AOR] 13.18; 95% CI 6.19-27.42), followed by current use of levonorgestrel-only pills for emergency contraception (LNG-EC) (AOR 10.15; 95% CI 2.21-46.56), previous use of depot medroxyprogesterone acetate (DMPA) (AOR 3.01; 95% CI 1.04-8.69) and smoking at the time of conception (AOR 2.68; 95% CI 1.12-6.40). CONCLUSION: The present study confirms the wide variety of EP's risk factors. Moreover, some new findings including current use of LNG-EC, previous use of DMPA, smoking at the time of conception are noteworthy. Thus, in our limited resources country where prevention remains the cornerstone for reducing EP chances of occurrence, clinicians should do enough counselling, especially to women with known risk factors. The necessity to facilitate access to more equipment to enable early diagnosis of EP is very crucial and should be seriously considered, in order to reduce the burden of EP in Cameroonian women.


Assuntos
Gravidez Ectópica/etiologia , Gravidez Ectópica/fisiopatologia , Adolescente , Adulto , Camarões/epidemiologia , Estudos de Casos e Controles , Anticoncepção Pós-Coito , Feminino , Humanos , Levanogestrel , Acetato de Medroxiprogesterona , Pessoa de Meia-Idade , Razão de Chances , Doença Inflamatória Pélvica , Gravidez , Fatores de Risco , Adulto Jovem
20.
Medicine (Baltimore) ; 97(48): e13143, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30508891

RESUMO

To explore the effect of interventional embolization treatment for hydrosalpinx on the outcome of in vitro fertilization and embryo transfer (IVF-ET).During the period from January 2013 to January 2015, a total of 129 patients with unilateral or bilateral hydrosalpinx were treated with IVF-ET and selected for retrospective analysis. Seventy-three patients (intervention group) with unilateral or bilateral hydrosalpinx were treated with fallopian tube embolization, which was followed by IVF-ET. During the same period, 56 patients (control group) with unilateral or bilateral hydrosalpinx directly received IVF-ET without receiving any treatment for hydrosalpinx.The clinical pregnancy rate of the control group was significantly lower than that of the intervention group (P < .05), while the abortion rate and ectopic pregnancy rate of the control group were strikingly higher than that of the intervention group (P < .05).Hydrosalpinx can decrease the clinical pregnancy rate of IVF-ET, and increase the incidence of abortion and ectopic pregnancy. The interventional embolization treatment for hydrosalpinx before IVF-ET can improve the clinical pregnancy rate and reduce adverse pregnancy outcome and which, with the advantages of a high success rate, convenient use, low cost, less pain, no anesthetic risk and no effect on the ovarian function it may further be developed for use in the clinic.


Assuntos
Embolização Terapêutica/métodos , Transferência Embrionária/estatística & dados numéricos , Doenças das Tubas Uterinas/terapia , Fertilização In Vitro/estatística & dados numéricos , Aborto Espontâneo/etiologia , Adulto , Transferência Embrionária/métodos , Doenças das Tubas Uterinas/complicações , Feminino , Fertilização In Vitro/métodos , Humanos , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos
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