The Importance of Ectopic Mindedness: Scar Ectopic Pregnancy, a Diagnostic Dilemma

Kumari, Vina; Himanshu, Kumar; Datta, Mamta R

doi:10.7759/cureus.13089

Cited by 5 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…About 2.5% occur in the cornua of the uterus, and the abdominal cavity, cervix, and ovaries account for 1.5% of ectopic pregnancies [ 18 ]. Further, with rates of cesarean sections increasing, it has been reported that the scar left behind from the hysterotomy can serve as a possible implantation site, accounting for 1% of ectopic pregnancies [ 19 ].…”

Section: Reviewmentioning

confidence: 99%

The Utility of Monitoring Beta-Human Chorionic Gonadotropin Levels in an Ectopic Pregnancy

Hirschler¹,

Soti²

2023

Cureus

View full text Add to dashboard Cite

Ectopic pregnancy, a rare complication involving embryo nidation outside the uterus, significantly impacts women's lives worldwide. About 95% of ectopic pregnancies occur in the Fallopian tubes. If not diagnosed early, the patient may suffer from tubal rupture, resulting in hemorrhage and lethal consequences. Transvaginal ultrasound (TVUS) is typically used to diagnose an ectopic pregnancy. However, over the last decade, monitoring beta-human chorionic gonadotropin (β-hCG) levels in ectopic pregnancy have evolved to detect ectopic pregnancy. But there are inconsistencies in its utility in monitoring or diagnosing ectopic pregnancy in clinical practice. This systematic review highlights the potential of monitoring β-hCG levels to accurately diagnose ectopic pregnancy. Furthermore, it showcases if β-hCG levels can determine effective treatment options to successfully resolve an ectopic pregnancy. We performed a literature search between January 2022 through December 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The clinical evidence demonstrated that monitoring β-hCG levels, combined with TVUS, accurately diagnosed an ectopic pregnancy. Moreover, pre-treatment β-hCG levels higher than 5000 international units per liter (IU/L), statistically significant, indicated surgical management for a successful resolution of an ectopic pregnancy. Whereas lower β-hCG levels showed successful management through expectant and methotrexate treatment. Interestingly, patients who failed non-surgical treatment developed increased β-hCG levels and required surgical intervention. However, there was conflicting evidence on whether β-hCG levels could indicate tubal rupture. Nevertheless, as highlighted in this review, monitoring β-hCG levels could be crucial in the early diagnosis of ectopic pregnancy. Besides, it might significantly aid in monitoring and deciding on effective treatment options for patients with ectopic pregnancy, which could be vital to saving their lives and preserving fertility.

show abstract

Section: Reviewmentioning

confidence: 99%

The Utility of Monitoring Beta-Human Chorionic Gonadotropin Levels in an Ectopic Pregnancy

Hirschler¹,

Soti²

2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Older maternal age may also increase the risk of scar ectopic pregnancy due to the higher prevalence of uterine fibroids and other conditions that can cause uterine scarring [13]. It is important to note that, while these factors increase the risk of scar ectopic pregnancy, the condition can still occur in women without any known risk factors [14]. Therefore, a high index of suspicion is necessary in any woman with a previous uterine surgery who presents with symptoms of ectopic pregnancy [15].…”

Section: Introductionmentioning

confidence: 99%

Scar Ectopic Pregnancy as an Uncommon Site of Ectopic Pregnancy: A Case Report and Literature Review

Elawad,

Alyousef,

Alkhaldi

et al. 2023

Life

View full text Add to dashboard Cite

A cesarean scar pregnancy is a rare type of ectopic pregnancy that occurs when a fertilized egg implants in the scar from a previous cesarean section. It is a serious condition that can lead to significant morbidity and mortality if not managed promptly and appropriately. In this literature review and case report, we discuss the etiology, diagnosis, and management of cesarean scar pregnancy. We conducted a comprehensive search of relevant literature using electronic databases and included studies that reported on the diagnosis and management of cesarean scar pregnancy. We also present a case report of a patient with cesarean scar pregnancy who was managed surgically. The diagnosis of cesarean scar pregnancy is primarily done via transvaginal or transabdominal ultrasound, and medical or surgical management can be used depending on the gestational age, hemodynamic status, and patient preferences. The surgical approach, which involves hysteroscopy, laparoscopy, or laparotomy, is usually preferred, since it is associated with fast recovery and lower recurrence rates. However, it is crucial to consider the patient’s plans for future fertility when selecting the management approach. In conclusion, cesarean scar pregnancy is a rare but potentially life-threatening condition that requires prompt and appropriate management. Early diagnosis and treatment can prevent significant morbidity and mortality, and surgical management is usually preferred due to its higher success rates and lower recurrence rates.

show abstract

Ectopic pregnancy: a single-center experience over ten years

Naimi

Moore²,

Brüggmann

et al. 2021

Reprod Biol Endocrinol

View full text Add to dashboard Cite

Purpose The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality. Methods This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, β-human chorionic gonadotropin (β-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA). Results The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10− 5) that was diagnosed in the 7th gestational week. The only association found was between the β-HCG level and LOS, with a linear regression β coefficient of 0.01 and a P-value of 0.04. Conclusion EP is a relatively common condition affecting approximately 1% of all pregnancies. β-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.

show abstract

The Importance of Ectopic Mindedness: Scar Ectopic Pregnancy, a Diagnostic Dilemma

Cited by 5 publications

References 8 publications

The Utility of Monitoring Beta-Human Chorionic Gonadotropin Levels in an Ectopic Pregnancy

The Utility of Monitoring Beta-Human Chorionic Gonadotropin Levels in an Ectopic Pregnancy

Scar Ectopic Pregnancy as an Uncommon Site of Ectopic Pregnancy: A Case Report and Literature Review

Ectopic pregnancy: a single-center experience over ten years

Contact Info

Product

Resources

About