Successful treatment algorithm for evaluation of early pregnancy after in vitro fertilization

Cookingham, L.M.; Goossen, R.P.; Voorhis, Bradley J. Van; Duran, Eyup Hakan

doi:10.1016/j.fertnstert.2015.07.1133

Cited by 11 publications

(12 citation statements)

References 10 publications

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“…[ 3 , 5 ] A recent study found that abdominal pain before HP was diagnosed was an independent risk factor for miscarriage in those with an HP. [ 7 ] However, we found that the symptoms of abdominal pain and hemoperitoneum due to rupture of the EP site did not affect the prognosis of patients with an IUP. Additionally, our study showed that the GA at treatment was earlier in the miscarriage group than it was in the nonmiscarriage group.…”

Section: Discussionmentioning

confidence: 83%

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The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management

Jung

Choi

et al. 2018

Medicine

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To investigate the clinical characteristics and risk factors for miscarriage of intrauterine normal pregnancy of patients with a heterotopic pregnancy (HP) after treatment.This was a retrospective study of medical records from CHA Bundang Medical Center. Sixty-four patients who were diagnosed with a HP between February 2006 and July 2017 were included in this study. All analyses were performed using SAS software, version 9.4 (SAS Institute, Inc., Cary, NC). P values < .05 were considered statistically significant.Forty-eight patients had tubal ectopic pregnancies (EP), 10 patients had cornual EPs, 1 patient had a cesarean section scar EP, 4 patients had an ovarian EP, and 1 patient had bilateral tubal EP. Among the 64 patients, 14.1% (9/64) miscarried before 10 weeks of gestation after management. Mean gestational age (GA) at treatment was 5.97 ± 0.50 weeks and 6.80 ± 1.04 weeks for miscarriage and nonmiscarriage group, respectively (P = .008). Significant differences were observed between 2 groups in terms of ultrasonographic features at the time HP was diagnosed (P = .040) Logistic regression models indicated that gestational age at treatment showed significant differences between 2 groups (OR: 0.003, 95% CI: 0.001–0.604).Immediate management after diagnosis could expect favorable prognosis of HP. GA at treatment was the only independent risk factor for miscarriage in patients with HP regardless of treatment methods.

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Section: Discussionmentioning

confidence: 83%

“…Several previous studies proved that laparoscopic surgery is now as safe as open surgery during pregnancy, with no deleterious effects on either the mother or child. [ 7 , 12 ]…”

Section: Discussionmentioning

confidence: 99%

The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management

Jung

Choi

et al. 2018

Medicine

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“…This marker is substantially helpful in devoting resources to pregnancies at risk of developing an EP 4,6,10 . In their cohort of ART‐conceived pregnancies, Cookingham et al 10 . observed a β‐hCG concentration < 50 IU/L in 7.1% of studied pregnancies.…”

Section: Discussionmentioning

confidence: 99%

“…has an area under the receiver‐operating‐characteristics (ROC) curve (AUC) of 0.900 for predicting an EP and has been validated in a clinical setting in three UK hospitals 9 . Within the field of ART, Cookingham et al 10 . developed an algorithm for the evaluation of early pregnancy after IVF, which identified 96.7% and 83.3% of EPs and heterotopic pregnancies, respectively.…”

Section: Introductionmentioning

confidence: 99%

Management of early gestations with low beta‐human chorionic gonadotropin conceived by assisted reproductive technologies: performance of M4 predictive model

Simbrón

Rodríguez

Jimenez

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives To assess the safety and performance of the M4 model for classifying as high risk or low risk for ectopic pregnancy (EP) pregnancies conceived by assisted reproductive technologies (ART) that present with low beta‐human chorionic gonadotropin (β‐hCG) concentration in early gestation. Methods This was a prospective cohort study of 243 pregnancies conceived by ART with low β‐hCG levels (5–50 IU/L) at 4 + 0 to 4 + 2 weeks' gestation. After subsequent β‐hCG testing at 48 h, pregnancies were classified according to the M4 model into the following categories: (i) high risk, probable EP/persistent pregnancy of unknown location (PPUL), when the risk for EP was ≥ 5%; (ii) low risk, probable intrauterine pregnancy (IUP), when the risk of EP was < 5% and the likelihood of IUP was greater than that of a failed pregnancy of unknown location (FPUL); and (iii) low risk, probable FPUL, when the risk of EP was < 5% and the likelihood of a FPUL was greater than that of an IUP. The predictive performance of the M4 model for EP and its ability to discriminate between high‐ and low‐risk pregnancies was assessed using the final pregnancy outcome at 11 to 13 weeks of gestation as reference, which was classified as EP/PPUL, FPUL or IUP. Results The sensitivity and specificity of the M4 model in detecting a high‐risk pregnancy (EP/PPUL) were 60.0% (95% CI, 43.6–74.4%) and 79.8% (95% CI, 73.8–84.7%), respectively. The area under the receiver‐operating‐characteristics curve of the M4 model for discriminating between high‐risk and low‐risk (FPUL/IUI) pregnancies was 0.72 (95% CI, 0.62–0.81). The model had a positive likelihood ratio of 2.97 (95% CI, 2.03–4.36) and a negative likelihood ratio of 0.50 (95% CI, 0.33–0.76). The kappa index was 0.30 (95% CI, 0.16–0.43), indicating a low degree of agreement between the model classification and the final diagnosis. No serious adverse events related directly to the application of the M4 model were observed, although 14 pregnancies classified ultimately as high risk had been categorized initially as low risk by the M4 model. Of these, seven resolved with expectant management, five with methotrexate (MTX) and two required laparoscopic surgery (one after failure of medical treatment with MTX and one after deviation from the follow‐up protocol). There were no cases of EP/PPUL with additional complications or need for blood or other blood product transfusion. Of the 243 ART pregnancies with low β‐hCG concentration in early gestation, only 47 (19.3%) had an IUP, half (24/47) of which had an early miscarriage, resulting in only 9.5% (23/243) cases having an ongoing pregnancy. Conclusions Application of the M4 model in pregnancies conceived by ART with low β‐hCG concentration in early gestation showed limited capacity in classifying them as being at low or high risk for EP, therefore, its use in pregnancies of this type is not recommended. No serious adverse events or complications related to the use of the model were observed. These pregnancies have a low probability of ending in an IU...

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“…The initial β-human chorionic gonadotropin (hCG) level and hCG rise are less predictive of HP. [ 4 ] And EP lesion might be too small to be detected on transvaginal sonography (TVS) at early stage or be ignored by clinicians who found a visible intrauterine sac. It is worthy to be familiar with clinical characteristics and risk factors of HP after in vitro fertilization (IVF).…”

Section: Introductionmentioning

confidence: 99%

Tubal infertility and pelvic adhesion increase risk of heterotopic pregnancy after in vitro fertilization

Liu

Zhao

et al. 2020

Medicine

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To analyze risk factors associated with heterotopic pregnancy and the uterine pregnant outcome of those patients after surgery. We retrospectively analyzed 22 patients diagnosed as HP after in vitro fertilization (IVF) between January 2015 and December 2018. HP was diagnosed at gestation age of 55.4 ± 11.8 days. HP were presented as irregular vaginal bleeding, abdominal pain, and sometimes no symptoms. 81.8% of ectopic lesion in HP occurred at fallopian tubes, especially ampullary; cornual pregnancy takes up 13.6%. Compared with clinical intrauterine pregnancy (IUP), IVF with tubal infertility factors had higher risks of HP (OR 4.185, 95% CI 1.080– 16.217); IVF with pelvic adhesion also had higher risks of HP (OR 5.552 95% CI 1.677–18.382); IVF with more than 2 embryos transferred increased risks of HP (OR 23.253, 95% CI 1.804–299.767). The abortion rates of surgery-treated HP and IUP after IVF were 27.8% versus 10.3% ( P = .042). These results demonstrate IVF with tubal infertility, pelvic adhesion or multiembryos transfer are risk factors of HP. Furthermore, surgery could induce abortion.

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Successful treatment algorithm for evaluation of early pregnancy after in vitro fertilization

Abstract: Our clinical algorithm for early pregnancy evaluation after ART is effective for identification and prompt intervention of EP and HP without significant over- or misdiagnosis, and avoids the potential catastrophic morbidity associated with delayed diagnosis.

Cited by 11 publications

References 10 publications

The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management

The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management

Management of early gestations with low beta‐human chorionic gonadotropin conceived by assisted reproductive technologies: performance of M4 predictive model

Tubal infertility and pelvic adhesion increase risk of heterotopic pregnancy after in vitro fertilization

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