Diagnosis and management of ectopic pregnancy

Sivalingam, Vanitha N.; Duncan, W. Colin; Kirk, E.; Shephard, Lucy A; Horne, Andrew W

doi:10.1136/jfprhc-2011-0073

Cited by 195 publications

(184 citation statements)

References 70 publications

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“…This has now also been endorsed by the Royal College of Obstetricians and Gynaecologists (RCOG) as an integral component of assessment 1 . Identification of key structures including the gestational sac eccentrically placed within the endometrial cavity is key to determining pregnancy location, 2 while the presence of a fetal or embryonic pole with visible cardiac pulsations is key to determining pregnancy viability 3 . However determining non‐viability in the clinically stable woman poses a significant challenge when no cardiac activity can be visualised in the embryo, or when no embryo can be visualised inside the intra‐uterine gestational sac.…”

Section: Introductionmentioning

confidence: 99%

Rationalising the change in defining non‐viability in the first trimester

Infante

Casikar

Menakaya

et al. 2013

Australas J Ultrason Med

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Introduction: With the publication of four papers in late 2011, international cut‐offs for definitions of non‐viability in the first trimester of pregnancy were challenged. These definitions were inconsistent across different international guidelines. For example, a gestational sac with absent yolk sac or embryo and a mean diameter of ≥ 16 mm would be classified as a miscarriage in the USA, whereas the same sac would have to measure ≥ 20 mm in the UK or Australia to meet this definition. Likewise, an embryo with no detectable heartbeat and a CRL of ≥ 5 mm would also meet criteria for missed miscarriage in the USA, compared to a CRL ≥ 6 mm in the UK or Australia. Methods: Later in 2011 and then in 2012, guidelines across the three countries were updated and are now consistent, defining an empty gestational sac with a mean diameter of > 25 mm as a non‐viable pregnancy and/or an embryo with CRL > 7 mm and no detectable heartbeat. In this paper we explore the rationale that led to these changes in order to potentially avoid wrongly diagnosing miscarriage at the decision boundary measurements and in turn avoiding inadvertent termination of potentially viable pregnancies. Conclusion: Although reducing women's anxiety and making a definitive diagnosis as early as possible is desirable, the need for absolute certainty is paramount before diagnosis of the death of an early pregnancy is made.

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Section: Introductionmentioning

confidence: 99%

Rationalising the change in defining non‐viability in the first trimester

Infante

Casikar

Menakaya

et al. 2013

Australas J Ultrason Med

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“…Luteal color or PD flow may be used as a guide while searching for an ectopic pregnancy, and could be called the "lighthouse effect" of corpus luteum which directs the investigator to the color Doppler signals of the ectopic pregnancy (Table 1) (12)(13)(14)(15)(16).…”

Section: Imaging Signs In Ultrasound Scanmentioning

confidence: 99%

Diagnostic and Treatment Modalities for All Localizations of Ectopic Pregnancy

Alkatout¹,

Honemeyer²,

Noé³

et al. 2017

International Journal of Women’s Health and Reproduction Scienc

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“…Commonly used diagnostic modality is transvaginal ultrasound which allows a detailed assessment of uterus, adnexa and presence or absence of free peritoneal fluid. 2,3 Visualization of a complex adnexal mass in combination with an empty uterus has a sensitivity of 97%, specificity of 99% and a positive and negative predictive value of 98%, provided serum beta-hCG concentrations exceed 1,000 IU/L. Serum beta hCG assay aid the diagnosis and management of ectopic pregnancy.…”

mentioning

confidence: 99%

“…IUCD's although associated with very low failure rate, when pregnancy occurs with IUCD in situ, it is more often ectopic. [2][3][4] Other risk factors for tubal ectopic include previous history of tubal surgery (tubal ligation, tubal reconstrctive surgery), past history of tubal ectopic, increasing use of ART techniques (incidence of heterotopic pregnancy is also high), developmental anomaly of fallopian tube (intramural polyp, tubal diverticula etc) and women exposed to diethyl-stilbestrol in utero. Other causal factors include multiple sexual partners, early sexual debut, vaginal douching and cigarette smoking.…”

mentioning

confidence: 99%

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A clinical study of ectopic pregnancy: a five-year institutional experience

Malavika

Prabhudev

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONEctopic pregnancy is implantation of the fertilized ovum outside the uterine cavity. Depending on the location it can be tubal, ovarian, cervical, abdominal and can even occur on the caesarean scar.1 Although the total number of pregnancies are decreasing with time there is an increase in the incidence of ectopic gestation over the past few decades, owing to rise in sexually transmitted infections, increasing subfertility and its treatment with ART techniques, and many other risk factors. Tubal ectopics comprise the majority accounting for almost 95 to 97% of total ectopics. Tubal ectopics are usually associated with predisposing risk factors which are known to damage the tubal epithelium. 1,2Most common risk factor is sexually transmitted infections and PID resulting in salpingitis and partial occlusion of fallopian tube. With the advent of antibiotic treatment for PID and STI's, agglutination of cilia can occur and result in band formation and partial tubal occlusion. Sexually transmitted infections (particularly ABSTRACT Background: Ectopic pregnancy contributes significantly to maternal morbidity and mortality. There is a steady increase in the incidence of ectopic pregnancy over the past few decades, owing to rise in sexually transmitted infections, subfertility and its treatment with ART techniques. Objective of present work was to study the rate of ectopic pregnancy, associated risk factors, clinical course and management at SSIMS and RC. Methods: This is a retrospective study carried out at SSIMS and RC, Davangere from 01 st January 2012 to 30 th April 2017. A detailed analysis of case sheets done and all parameters analyzed. Institutional ectopic rate was calculated per 1000 deliveries. Results: Out of 43 women with ectopic gestation, 40 (93.02%) were tubal ectopic and 3 (6.98%) were ovarian ectopic. Institutional rate of ectopic is 11.54 per 1000 deliveries. STI's are the commonest risk factor followed by subfertility. Diagnostic aid commonly used was pelvic ultrasound. There were no maternal deaths due to ectopic pregnancy. One third of the women presented with shock. 52.5% tubal and 66.6% ovarian ectopics were ruptured. All women with tubal ectopic were managed by salpingectomy either by open or laparoscopic method and ovarian ectopics managed by ipsilateral oophorectomy. Two-thirds of the women received blood transfusion and 5-7 days were required for post-operative recovery. Conclusions: Ectopic pregnancy is one of the commonest gynecological emergency and there is a yearly increase in the rate of ectopic. STI's and subfertility are important risk factors. Prevention, early detection and treatment of STI's may play an important role in reducing the rate of ectopic pregnancy.

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Diagnosis and management of ectopic pregnancy

Cited by 195 publications

References 70 publications

Rationalising the change in defining non‐viability in the first trimester

Rationalising the change in defining non‐viability in the first trimester

Diagnostic and Treatment Modalities for All Localizations of Ectopic Pregnancy

A clinical study of ectopic pregnancy: a five-year institutional experience

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