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Medical Treatment Ectopic Pregnancy

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https://www.readbyqxmd.com/read/29751791/a-cohort-of-women-with-ectopic-pregnancy-challenges-in-diagnosis-and-management-in-a-rural-hospital-in-a-low-income-country
#1
R Mooij, G C Mgalega, I H Mwampagatwa, J van Dillen, J Stekelenburg
BACKGROUND: Ectopic pregnancy (EP) is a serious complication of early pregnancy. In low-income countries diagnosis of EP is difficult and it is a major contributor to maternal mortality. We aimed to assess and improve the diagnostic process of women with EP. METHODS: We conducted a retrospective medical records study of all women with confirmed EP in Ndala Hospital from 2010 to 2012. We used data on demographics, symptoms, diagnostic procedures, surgical findings, treatment and post-operative status...
May 11, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29727784/a-risk-prediction-model-for-medical-treatment-failure-in-tubal-pregnancy
#2
Jae Hoon Lee, Sunghoon Kim, Inha Lee, Jisun Yun, Bo Hyon Yun, Young Sik Choi, Byung Seok Lee, Seok Kyo Seo
OBJECTIVE: Methotrexate is an alternative treatment for tubal pregnancy. However, despite initial treatment, ∼15% of women eventually require surgery. This study aimed to identify the risk factors for medical treatment failure in tubal pregnancy and apply them to a risk prediction model. STUDY DESIGN: This single-center retrospective cohort study included 123 participants initially treated medically for tubal pregnancy between January 2006 and December 2015. Logistic regression analysis was used to construct a risk prediction model (visually presented as a nomogram) for medical treatment failure...
April 20, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/29724428/acr-appropriateness-criteria-%C3%A2-first-trimester-vaginal-bleeding
#3
Douglas L Brown, Ann Packard, Katherine E Maturen, Sandeep Prakash Deshmukh, Kika M Dudiak, Tara L Henrichsen, Benjamin J Meyer, Liina Poder, Elizabeth A Sadowski, Thomas D Shipp, Lynn Simpson, Therese M Weber, Carolyn M Zelop, Phyllis Glanc
Vaginal bleeding is not uncommon in the first trimester of pregnancy. The majority of such patients will have a normal intrauterine pregnancy (IUP), a nonviable IUP, or an ectopic pregnancy. Ultrasound (US) is the primary imaging modality in evaluation of these patients. US, along with clinical observations and serum human chorionic gonadotropin levels, can usually distinguish these causes. Although it is important to diagnose ectopic pregnancies and nonviable IUPs, one should also guard against injury to normal pregnancies due to inappropriate treatment with methotrexate or surgical intervention...
May 2018: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29718845/secondary-pregnancy-by-an-implant-in-a-laparoscopic-trocar-site-a-case-report
#4
Zhihua Ma, Lanbo Zhao, Na Xu, Chao Sun, Qi Wang, Yueling Wang, Qiling Li, Qinrui Lu
RATIONALE: For nearly 20 years, laparoscopy has been generally regarded as the gold standard for the surgical treatment of ectopic pregnancy and its application is very widespread. According to our knowledge, secondary pregnancy at the laparoscopic trocar site has not yet been reported until now. PATIENT CONCERNS: A 24-year-old Chinese female patient is reported herein. Her left fallopian tube was removed via laparoscopy due to a first ectopic pregnancy. Her postoperative blood β-human chorionic gonadotropin (β-hCG) was increasing with irregular vaginal bleeding...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29675930/relationship-between-ultrasonographic-and-biochemical-markers-of-tubal-ectopic-pregnancy-and-success-of-subsequent-management
#5
Batool Nadim, Chuan Lu, Fernando Infante, Shannon Reid, George Condous
OBJECTIVES: To determine whether there is an association between morphologic types of tubal ectopic pregnancy (EP), 0-hour human chorionic gonadotropin (hCG) levels, and subsequent management success. METHODS: We conducted a prospective study (November 2006-December 2015). Women had a diagnosis of EP by transvaginal ultrasonography if they had an inhomogeneous mass adjacent to the ovary and moving separately from it ("blob" sign), a mass with a hyperechoic ring around the gestational sac ("bagel" sign), or a gestational sac with an embryonic pole with or without a yolk sac with or without cardiac activity...
April 20, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/29675485/comparison-of-the-pregnancy-outcomes-between-the-medical-and-surgical-treatments-in-tubal-ectopi-pregnancy
#6
Azadeh Yousefnezhad, Azar Pirdehghan, Mahboubeh Roshandel Rad, Aemeh Eskandari, Shahnaz Ahmadi
Background: Various treatments have been proposed to treat ectopic pregnancy, but their impact on future pregnancies is still the subject of controversy. Objective: The aim of this study is to compare the medical and surgical treatment methods and their impact on the subsequent fertility results and complications in women with a history of ectopic pregnancy. Materials and Methods: In this analytical, cross-sectional study, 370 women with the history of ectopic pregnancy, (treared with single dose of methotrexate or salpingectomy by laparotomy), that referred to Al-Zahra Hospital, Rasht, Guilan between 2009 to 2013 were enrolled...
January 2018: International Journal of Reproductive Biomedicine (Yazd, Iran)
https://www.readbyqxmd.com/read/29550756/case-of-hepatic-flexure-ectopic-pregnancy-medically-managed-with-methotrexate
#7
Charlotte Elizabeth Trail, Andrew Watson, Alice Martha Schofield
Abdominal pregnancies represent 1.4% of extrauterine pregnancies. A literature search of six cases involving bowel ectopic pregnancies provided anecdotal treatment options. This case involves a woman admitted at 6 weeks gestation with right iliac fossa and shoulder tip pain. An ultrasound scan revealed an empty uterus with free fluid in both adnexa and a 31×21 mm heterogenous mass adjacent to the right ovary. At laparoscopy, an ectopic pregnancy was identified at the hepatic flexure. The patient received two doses of methotrexate and monitored until the beta human chorionic gonadotropin reduced...
March 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29485731/systematic-review-and-meta-analysis-of-single-dose-and-non-single-dose-methotrexate-protocols-in-the-treatment-of-ectopic-pregnancy
#8
REVIEW
Jin-Sung Yuk, Jung Hun Lee, Won I Park, Hyeong Sik Ahn, Hyun Jung Kim
BACKGROUND: It remains unclear which methotrexate protocol for the treatment of ectopic pregnancy has a higher success rate or a higher adverse effect rate. OBJECTIVE: To compare the treatment success rates and adverse effect rates of single-dose and non-single-dose (two-dose and multi-dose) methotrexate protocols in the treatment of ectopic pregnancy. SEARCH STRATEGY: Various databases including Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched on July 1, 2017, using search terms including "methotrexate" and "pregnancy...
June 2018: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/29429891/vinorelbine-potently-induces-placental-cell-death-does-not-harm-fertility-and-is-a-potential-treatment-for-ectopic-pregnancy
#9
Roxanne Hastie, Elgene Lim, Pavel Sluka, Lisa Campbell, Andrew W Horne, Lenore Ellett, Natalie J Hannan, Fiona Brownfoot, Tu'uhevaha J Kaitu'u-Lino, Stephen Tong
Ectopic pregnancies complicate 1-2 pregnancies and are a leading cause of maternal death. An effective oral drug therapy that replaces surgery might make its treatment safer, cheaper, simpler and therefore more widely accessible. The only current medical treatment offered to women is intramuscular methotrexate, but this only reliably resolves smaller ectopic pregnancies. As such, many ectopic pregnancies require surgical excision. We show that vinorelbine, an orally available chemotherapeutic agent, potently induced placental cell death but did not harm fertility in mice...
March 2018: EBioMedicine
https://www.readbyqxmd.com/read/29372162/ultrasound-guided-local-injection-of-methotrexate-and-systemic-intramuscular-methotrexate-in-the-treatment-of-cesarean-scar-pregnancy
#10
Young Ran Kim, Myoung Jin Moon
Objective: To assess the efficacy and safety of ultrasound-guided intragestational injection of methotrexate (MTX) and systemic intramuscular MTX in the management of cesarean scar pregnancies. Methods: This was a retrospective case-control study that included women diagnosed with cesarean scar pregnancy at CHA Bundang Medical Center unit between 2009 and 2015. The 26 cases were managed with local injection of MTX under ultrasound guidance and 15 cases were treated with systemic intramuscular of MTX...
January 2018: Obstetrics & Gynecology Science
https://www.readbyqxmd.com/read/29272996/spontaneous-first-trimester-miscarriage-rates-per-woman-among-parous-women-with-1-or-more-pregnancies-of-24-weeks-or-more
#11
Judy Slome Cohain, Rina E Buxbaum, David Mankuta
BACKGROUND: The purpose of this study was to quantify spontaneous first trimester miscarriage rates per woman among parous women. A vast amount of data has accumulated regarding miscarriage rates per recognized pregnancy as well as about recurrent miscarriage. This is the second study of miscarriage rates per woman in a parous population and the first study of recurrent and non-recurrent, spontaneous first trimester miscarriage rates per woman in a large parous population. METHODS: Extraction of the following variables from all delivery room admissions from both Hadassah Medical Centers in Jerusalem Israel, 2004-2014: # of first trimester spontaneous miscarriages, # live births; # living children; age on admission, pre-pregnancy height and weight, any smoking this pregnancy, any alcohol or drug abuse this pregnancy, blood type, history of ectopic pregnancy, history of cesarean surgery (CS) and use of any fertility treatment(s)...
December 22, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29260596/transverse-myelitis-following-methotrexate-treatment-of-ectopic-pregnancy-a-case-report
#12
Gabriel Levin, Henry H Chill, Amihai Rottenstreich
OBJECTIVE: Ectopic pregnancy is a common condition in the field of gynaecology, often treated with methotrexate. Adverse effects are common and usually mild. Severe adverse events are rare amongst patients treated with MTX for this condition. CASE: A 26-year-old healthy woman was admitted and treated medically with MTX for an ectopic pregnancy. The patient was treated in the standard drug labelled protocol with an intramuscular injection of 78 mg of MTX according to body surface area...
December 2017: European Journal of Contraception & Reproductive Health Care
https://www.readbyqxmd.com/read/29241915/predictors-of-failure-of-the-commonly-used-single-dose-methotrexate-protocol-for-treating-tubal-ectopic-pregnancies
#13
Eser Sefik Ozyurek, Evren Akmut, Erdal Kaya, Aysu Akca, Ozgur Akbayır
OBJECTIVES: This study identified patients who would benefit from an earlier additional medical intervention and/or continuing close surveillance even if commonly used parameters indicated sufficient medical treatment to determine markers of treatment failure. MATERIALS AND METHODS: A retrospective analysis of patients with a preliminary diagnosis of ectopic pregnancy treated with the single-dose methotrexate protocol. Group 1: cases cured with a single dose of methotrexate; Group 2: cases who required more than one dose of methotrexate or surgery following the first dose...
December 2017: Taiwanese Journal of Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29208873/correlation-between-seropositivity-of-chlamydia-trachomatis-and-tubal-and-or-pelvic-pathology-detected-by-diagnostic-laparoscopy-in-subfertile-women
#14
N Begum, S A Anwary, M Alfazzaman, Z Mahzabin, F Deeba, M A Mostafa, M Akhter, M M Rahman
This prospective observational study was carried out in the Infertility Unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from February 2011 to December 2013. Sixty-nine (69) subfertile women who were seropositive for Chlamydia Trachomatis were included in this study. Inclusion criteria was patients with sub-fertility having age between 22 and 40 years, seeking infertility treatment, normal ovarian function, all normozoospermic male partner, duration of infertility ranged from 1...
October 2017: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/29170088/simplified-medical-abortion-screening-a-demonstration-project
#15
Elizabeth G Raymond, Yi-Ling Tan, Rodica Comendant, Irina Sagaidac, Stelian Hodorogea, Melissa Grant, Patricio Sanhueza, Emigdio Van Pratt, Ginger Gillespie, Christy Boraas, Mark A Weaver, Ingrida Platais, Manuel Bousieguez, Beverly Winikoff
OBJECTIVES: The objectives were to evaluate the safety and acceptability of outpatient medical abortion in selected women without a pretreatment ultrasound or pelvic examination. STUDY DESIGN: We conducted a prospective case-series study to estimate the incidence of serious adverse events (death, life-threatening event, hospitalization, transfusion or any other medical problem that we judged to be significant), surgical completion of the abortion and satisfaction in women provided with medical abortion without a pretreatment ultrasound or pelvic examination...
April 2018: Contraception
https://www.readbyqxmd.com/read/29073481/human-placental-growth-hormone-in-ectopic-pregnancy-detection-in-maternal-blood-immunohistochemistry-and-potential-clinical-implication
#16
Christoph Hübener, Martin Bidlingmaier, Zida Wu, Joachim Diebold, Christian J Strasburger, Sven Mahner, Uwe Hasbargen, Maria Delius
OBJECTIVE: To investigate human placental growth hormone (hGH-V) in ectopic pregnancy (EP): detection in maternal blood, correlation with immunohistochemistry and possible role as a marker for the course of EP. DESIGN: Women presenting in the outpatient or emergency department of a tertiary care university hospital with a positive pregnancy test and strong suspicion of EP by ultrasound and/or symptoms were eligible for the study (n=70). Tissue specimens from the surgically treated patients (n=50) were examined by histopathology as well as by a hGH-V specific immohistochemistry set-up...
December 2017: Growth Hormone & IGF Research
https://www.readbyqxmd.com/read/29067069/can-hematologic-parameters-predict-treatment-of-ectopic-pregnancy
#17
Hatice Akkaya, Gulsum Uysal
OBJECTIVE: Ectopic pregnancy (EP) is the major cause of maternal morbidity and mortalityinthe first trimester of pregnancy. EP can be treated either medical or surgical approches. The purpose of our study wasto predict the treatment choice of tubal EP by usinghematologic parameters which are routinely used in clinical practice. METHODS: After retrospectively data evaluation was done from Januaryu 2014 to Deceber 201. we had 153 patients with EP. Patientsadmitted to methotrexate (MTX) therapy was Group-1...
July 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/29061036/diagnosing-ectopic-pregnancy-in-the-emergency-setting
#18
Robert Lee, Carolyn Dupuis, Byron Chen, Andrew Smith, Young H Kim
Ectopic pregnancy is the implantation of a fertilized egg outside the uterine endometrial cavity. For women presenting to the emergency department with abdominal pain and/or vaginal bleeding, ectopic pregnancy is an important diagnostic consideration. The diagnosis is made based on laboratory values and ultrasound imaging findings. The ultrasound appearance of both normal early pregnancy and ectopic pregnancy are variable and often subtle, presenting diagnostic challenges for radiologists. This pictorial essay describes and illustrates the sonographic findings of ectopic pregnancy and reviews the differential diagnoses that can mimic ectopic pregnancy on ultrasound...
January 2018: Ultrasonography
https://www.readbyqxmd.com/read/29059454/new-evidence-to-guide-ectopic-pregnancy-diagnosis-and-management
#19
Paula C Brady
Importance: Ectopic pregnancy is a leading source of morbidity and mortality in pregnancy, accounting for 1% to 2% of all pregnancies. Timely diagnosis and management of these abnormal gestations are vital to patient safety. Objective: The objective of this study was to describe recent evidence in the risk factors, diagnosis, and management of ectopic pregnancy. Evidence Acquisition: Comprehensive review of the published literature. Results: Recent literature describes newly identified risk factors for ectopic pregnancy, particularly those specific to assisted reproduction...
October 2017: Obstetrical & Gynecological Survey
https://www.readbyqxmd.com/read/28951291/fertility-outcomes-after-laparoscopic-salpingectomy-or-salpingotomy-for-tubal-ectopic-pregnancy-a-retrospective-cohort-study-of-95-patients
#20
Lifeng Chen, Danpeng Zhu, Qing Wu, Yan Yu
OBJECTIVE: This study presents our experience with laparoscopic surgery for tubal ectopic pregnancy (EP), sums up the different features of two commonly utilized laparoscopic surgeries, and compares subsequent post-salpingectomy or -salpingotomy reproductive outcomes in women with tubal EPs. STUDY DESIGN: Medical history data of 95 patients diagnosed with tubal EP between January 2013 and December 2014 were analyzed in a retrospective, observational manner. All patients studied were offered two surgical management options: salpingectomy (removal of the entire fallopian tube), or salpingotomy (removal of products of gestation only, leaving the remainder of the tube intact)...
December 2017: International Journal of Surgery
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