The early diagnosis of ectopic pregnancy is essential in determining the appropriate therapeutic approach. This study demonstrates the important factors considered in the prediction of a successful medical treatment, which will, in turn, improve the quality of patient counseling and guidance prior to the initiation of the treatment. MethodsThis was a retrospective cohort study of 58 ectopic pregnancies that were treated medically with methotrexate in Bahrain Defense Force (BDF) Hospital from January 2016 to January 2021. All patients that were offered medical treatment of ectopic pregnancy and completed the follow-up were included in the study. StatsDirect software was used to analyze the baseline characteristics of the successful and failed medical treatment of ectopic groups. Simple linear regression was used to correlate initial beta-human chorionic gonadotropin (β-hCG) levels and the drop of β-hCG levels after one week of medical treatment. ResultsPatients were divided into two outcomes: the primary outcome represented in the successful treatment group, 68.9% (40/58), and the secondary outcome represented in the unsuccessful treatment group 31% (18/58). The mean β-hCG level in the successful group was significantly lower than that of the unsuccessful treatment group (1403.6±1421 IU/L versus 2845.1±1705 IU/L, p=0.001). There were no differences between the two groups with regards to the size of the adnexal mass, presence of gestational sac, or size of the gestational sac. The cut-off value of the initial β-hCG level for successful medical treatment was 2,141 IU/L, with 72% sensitivity, 75% specificity, and receiver operator curve (ROC) of 0.76 [95% confidence interval (CI) = 0.63 to 0.89)]. The cut-off value of β-hCG fell between day four and day seven and was 37.2%, with 78% sensitivity, 68% specificity, and a ROC curve of 0.72 (95% CI = 0.55 to 0.89). ConclusionThis study found that low initial β-hCG levels can be used to predict successful methotrexate treatment of ectopic pregnancy. In this cohort of patients, the cut-off level of initial β-hCG for successful treatment was 2141 IU/L.
Background: Assess the risk factors, clinical presentation and type of intervention indicated in ectopic pregnancies at American mission hospital in Bahrain. Methods: This is a retrospective cohort study conducted from August 2021 to April 2022 at American mission hospital in Bahrain. All patients (n=205) who attended the hospital from January 2017 to June 2021 with a presentation suggestive of ectopic pregnancy were extracted from the electronic medical record database and reviewed. Data was recorded on Microsoft Excel version 16.61.1 and numerical data was extrapolated into graphs and tables via IBM SPSS Statistics version 28.0.0.0 (190). Data was subjected to descriptive and stratification analysis. Results: The leading risk factor for ectopic pregnancy was previous pelvic surgery (40.4%). The most reported symptom was amenorrhea (65.9%). Risk of rupture was tripled when serum B-hCG level was elevated, rendering it the strongest predictor of rupture according to our data (95% CI=1.25, 7.19; p-value 0.0139). Majority of patients (56.4%) were treated with methotrexate with a success rate of 88.7% and 8.5% of cases were managed expectantly. Those who failed medical management or presented with rupture were treated surgically.Conclusions: Our study found B-hCG levels to be the most sensitive predictor of rupture and need for surgical intervention. Therefore, management was largely, but not exclusively, based on B-hCG levels. Majority of cases were treated medically and patients undergoing expectant management experienced no complications.
Background: Abnormal uterine bleeding is a common complaint in most women of different ages that prompts seeking gynecologic care. This study aimed to analyze and age-classify the prevalence of endometrial pathologies in women with abnormal uterine bleeding.Methods: This is a cross-sectional and a descriptive study, conducted at the obstetrics and gynecology department of the American Mission Hospital in the Kingdom of Bahrain on 88 patients who presented with abnormal uterine bleeding between January 2019 and January 2020.Results: Eighty-eight women with abnormal uterine bleeding demonstrated a fluctuating pattern of twenty endometrial pathologies distributed among five age groups in the range of 30-71. The mean age of the study cohort was 44.9±7.65 years; 55% of which were reported in the 41-50 age group. Benign endometrial polyp was reported as the most common pathology, accounting for 47.8% of the cohort. Although benign endometrial polyp was significantly the highest overall finding in all three age groups younger than 60, disordered proliferative endometrium was the highest reported single pathology in the age group 41-50, (N=10, p≤0.0001).Conclusions: This study demonstrated that benign endometrial polyp was the most common finding in women with abnormal uterine bleeding. This information could be essential for patient guidance and awareness of the benefits of endometrial biopsy. Eventually, the prediction of the potential endometrial pathology in women with abnormal uterine bleeding is vital for early disease management.
Monochorionic pregnancies are at high risk of developing severe complications leading to high perinatal morbidity and mortality. About 15% of these twins have unidirectional anastomosis of the placenta, which is responsible for the major complications specific to monochorionic pregnancies. An important first step in the management is the identification of the chorionicity. Once it is identified, a close follow-up every 2 weeks is vital to allow early detection of complications and their management. Approximately 1 in 10 monochorionic pregnancies develops twin-to-twin transfusion syndrome, congenital anomalies, anaemia polycythaemia sequence, selective intrauterine growth restriction and intrauterine death of a co-twin. Rare complications that can occur are twin reversed arterial perfusion syndrome. Timely screening and detection of all such complications can lead to appropriate intervention such as in utero foetoscopic laser treatment. These interventions can increase the survival rate of at least one or both twins with reduced neonatal morbidity. Besides, early detection can facilitate parents to have an informed choice to decide if the prognosis of the pregnancy is otherwise not good.
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