Relationship Between Ultrasonographic and Biochemical Markers of Tubal Ectopic Pregnancy and Success of Subsequent Management

Nadim, B.; Lü, Chuan; Infante, F.; Reid, S.; Condous, G.

doi:10.1002/jum.14652

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…It is interesting that 16/31 (51.6%) women with EP and a hCG ratio of >1 had surgical management. This is in agreement with previously published studies highlighting the association between higher incremental rises in hCG level at 48 hours and increased likelihood of failure of non‐surgical EP management . Healthcare professionals should be more vigilant in these cases, with early referral to specialized units.…”

Section: Discussionsupporting

confidence: 92%

“…This is in agreement with previously published studies highlighting the association between higher incremental rises in hCG level at 48 hours and increased likelihood of failure of non-surgical EP management. 17,18 Healthcare professionals should be more vigilant in these cases, with early referral to specialized units. There are several other limitations to the current study.…”

Section: Discussionmentioning

confidence: 99%

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Rationalizing the management of pregnancies of unknown location: Diagnostic accuracy of human chorionic gonadotropin ratio‐based decision tree compared with the risk prediction model M4

Nadim

Leonardi

Infante³

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The objective was to compare the diagnostic accuracy of the decision tree analysis prediction model P1, which incorporates the human chorionic gonadotropin (hCG) ratio (hCG 48 hours/hCG 0 hour), and risk prediction model M4 in the management of women with pregnancy of unknown location (PUL). Material and methods A retrospective diagnostic accuracy study was performed on PUL data collected between August 2011 and September 2018. Women with a PUL were prospectively managed according to the P1 prediction model, which utilizes the hCG ratio and, if necessary, a day (D) 7 hCG. We compared the performance of P1 with the M4 model, a logistic regression mathematical model using initial hCG and hCG ratio, to classify PULs as low risk (failed PUL [failed] or intrauterine pregnancy) or high risk (ectopic pregnancy or persistent PUL). The reference standard was defined as the final PUL outcome. Results Transvaginal ultrasound was done in 3847 consecutive women for early pregnancy complications, 437 (11.3%) of whom were classified as PUL. Final analysis comprised 413 cases with complete data. Final PUL clinical outcomes were: 247 (59.8%) failed PUL, 94 (22.7%) intrauterine pregnancy, 49 (11.8%) ectopic pregnancy and 23 (5.5%) persistent PUL. The sensitivity of P1 and M4 in predicting high‐risk PUL were 81.9% (95% confidence interval [CI] 71.1‐90.0) and 80.6% (95% CI 69.5‐88.9), respectively. The specificities were 74.5% (95% CI 69.5‐79.1) and 75.6% (95% CI 70.7‐80.1), respectively. Conclusions P1 and M4 performed similarly with respect to diagnostic accuracy in predicting PUL outcome. P1 needs to be externally validated.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Rationalizing the management of pregnancies of unknown location: Diagnostic accuracy of human chorionic gonadotropin ratio‐based decision tree compared with the risk prediction model M4

Nadim

Leonardi

Infante³

et al. 2019

Acta Obstet Gynecol Scand

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“…Early prediction of medical treatment success in ectopic pregnancy is important in terms of preventing morbidity and mortality due to ectopic pregnancy. There are publications suggesting that ultrasonography can be used to predict medical treatment success [17,18]. In our study, although the results were not statistically significant, they determined that the EP mass size and the side in which EP was determined differed in the surgical group.…”

Section: Discussioncontrasting

confidence: 62%

The effect of ultrasonography in predicting medical treatment success in ectopic pregnancy

Balıkoğlu

Bayraktar

Akar

2019

Aegean J Obstet Gynecol

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Ectopic pregnancy(EP) treatment success in a single dose methotrexate(MTX) regimen is decided by more than 15% β chorionic gonadotropin reduction in the 4th and 7th days after administration of 50mg/m² of medication. In our study , it was aimed whether the EP mass size less than 40mm detected by ultrasonography and the adnexal side on which it was located had an effect on the success of medical treatment. 82 patients who treated with MTX included in the study were divided into two groups as those with a single dose of methotrexate success and those without (n:67 vs n:15). The groups were compared in terms of age, parity, size of adnexal mass detected on ultrasonography, and the side of ectopic pregnancy. The parity rates and the age of patients were similar in both groups(p = 0.615, p = 0.742). Although the average adnexal mass size was found to be higher in the patient group those single dose MTX treatment was not successful, there was no statistically significant difference(p = 0.098). Ectopic pregnancy was frequently observed on the right side in the group in which the medical treatment was successful(66 % vs 33%). The effect of ectopic pregnancy mass size on medical treatment prediction was investigated in cases with mass size less than 40mm. Ectopic pregnancy mass size, even if it is below 40 mm, may not indicate the medical treatment success.

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“…With regard to the prediction of EP MTX-treatment outcome, there has been no consistent demonstrated value of hCG (or serial hCGs) or sonographic size (i.e. MaxDia) to predict this [10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Ectopic Pregnancy: Vascularity Index as a Novel Diagnostic Criterion

2022

Archives of Obstetrics and Gynaecology

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Background and aims:To determine the value of using Three-Dimensional Ultrasound with Power Doppler Angiography for the diagnosis and management of Ectopic Pregnancy.Methods: Three-dimensional ultrasound was used at the time of presentation to the Emergency Department of a facility for patients who were ultimately diagnosed with having a tubal Ectopic Pregnancy. This prospective observational investigation compared the results of offline analysis with outcomes after treatment (e.g. tubal rupture), suggesting its potential for predicting that outcome. Results:Of the 64 consecutive confirmed cases of Ectopic Pregnancy presenting to the Emergency Department of a single hospital, 39 patients were intact and 26 of them were medically treated with methotrexate. There were 9 subsequent failures of this treatment, resulting in 8 ruptures and one case with a continued rise of human Chorionic Gonadotropin. The Power Doppler Angiography quantification of the Vascularity Index correlated with those failed outcomes. STARD standards were applied to this investigation.Conclusions: Use of Three-Dimensional Ultrasound with Power Doppler Angiography with measurement of the Vascularity Index for patients presenting with an Ectopic Pregnancy may have value for determining which patients are best treated with surgical intervention rather than the use of medical treatment.

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Relationship Between Ultrasonographic and Biochemical Markers of Tubal Ectopic Pregnancy and Success of Subsequent Management

Abstract: There is no significant correlation between the morphologic type and size of EP with a nonsurgical management outcome. A likely successful outcome is related to a lower level of serum hCG at presentation.

Cited by 7 publications

References 19 publications

Rationalizing the management of pregnancies of unknown location: Diagnostic accuracy of human chorionic gonadotropin ratio‐based decision tree compared with the risk prediction model M4

Rationalizing the management of pregnancies of unknown location: Diagnostic accuracy of human chorionic gonadotropin ratio‐based decision tree compared with the risk prediction model M4

The effect of ultrasonography in predicting medical treatment success in ectopic pregnancy

Ectopic Pregnancy: Vascularity Index as a Novel Diagnostic Criterion

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