Retrospective evaluation of patients treated for ectopic pregnancy: Experience of a tertiary center

Abstract Objective In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. Methods In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. Results Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. Conclusion The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.

O papel da ressonância magnética na distinção das gestações intersticial, cornual e angular / The role of magnetic resonance imaging in distinguishing interstitial, cornual and angular pregnancies

Apesar da melhora no diagnóstico e tratamento, a gravidez ectópica ainda é a principal causa de mortalidade materna no primeiro trimestre da gravidez. Formas raras podem apresentar um desafio diagnóstico e, sem um diagnóstico adequado, a incidência de complicações e a mortalidade materna estão relacionadas a aumento de seus índices. Os termos "gravidez cornual" e "gravidez intersticial" têm sido utilizados de forma inconsistente na literatura, sendo frequentemente usados como sinônimos do termo "gravidez angular". Uma distinção estrita entre essas entidades pode ter implicações clínicas importantes, porque o curso natural, a propedêutica e os resultados diferem entre eles. A ressonância magnética não é o padrão-ouro para o diagnóstico de gravidez ectópica, no entanto possui relevância significativa no diagnóstico de possíveis complicações decorrentes dessa afecção. Nesse contexto, esta revisão aborda a importância da ressonância magnética na distinção dos tipos de gravidez mencionados, ilustrados por meio de casos do nosso serviço.(AU)

Despite the improvement in diagnostics and treatment, ectopic pregnancies are still the main cause of maternal mortality in the first trimester of pregnancy. Rare forms may present a diagnostic challenge and without adequate diagnosis, the incidence of complications and maternal mortality is greatly increased. The terms "cornual pregnancy" and "interstitial pregnancy" have been used inconsistently in the literature, frequently been used as synonyms and even used interchangeably with the term "angular pregnancy". A strict distinction among these entities can have important clinical implications because the natural course, management and outcomes differ among them. Magnetic resonance imaging is not the gold standard for the diagnosis of ectopic pregnancy, however, it can be useful in the diagnosis of complicated presentations of such ailment. In this context, this review highlights the importance of MRI in distinguishing the aforementioned types of pregnancies, illustrated with few cases from our service.(AU)

Embarazo ectópico ovárico / Ovarian Ectopic Pregnancy

El embarazo ectópico es en la actualidad un problema de salud a nivel mundial atribuido al aumento de su incidencia y la morbimortalidad que crea. La localización ovárica del embarazo ectópico es un evento raro pero posible y también en ascenso. Presentamos el caso de una paciente que acude al cuerpo de guardia con escasa sintomatología. Se le realizó el diagnóstico ultrasonográfico de la entidad y apoyado en una prueba de embarazo positiva. Luego le practicaron laparotomía de urgencia en la que se comprobó el embarazo ovárico derecho no complicado. También se efectuó una salpingooforectomía y la paciente tiene una evolución satisfactoria trans-posoperatoria(AU)

Ectopic pregnancy is currently a global health problem due to the increase in its incidence and morbidity and mortality. The ovarian location of ectopic pregnancy is a rare but possible event and on the rise. We present the case of a patient who comes in with little symptoms. The ultrasound diagnosis of the entity was made and supported by a positive pregnancy test. Then emergency laparotomy was performed, which proved that the right ovarian pregnancy was not complicated. Salpingo-oophorectomy was also performed and the patient has a satisfactory trans and postoperative evolution(AU)

Embarazo ectópico cervical / Cervical Ectopic Pregnancy

El embarazo ectópico cervical representa alrededor de 0,1 por ciento de todos los embarazos ectópicos. La incidencia se estima en 1: 2500 a 1: 98,000 embarazos. Es un fenómeno extraño; sin embargo, la morbilidad y la mortalidad por esta causa son elevadas, pero pueden disminuirse con el diagnóstico temprano. Es extremadamente peligroso porque el trofoblasto puede alcanzar los vasos uterinos a través de la delgada pared cervical y provocar una hemorragia grave e incoercible que aun en la actualidad suele terminar en cirugías mutilantes que limitarán la reproducción futura. En la actualidad, no existen criterios claros en la bibliografía que ayuden a la toma de decisiones. Se reporta un caso de embarazo cervical tratado exitosamente mediante histerectomía total abdominal y posterior seguimiento en la Unidad de Cuidados Intensivos. Se exponen algunos criterios que en el futuro podrían ayudar a diagnosticar esta entidad devastadora de forma oportuna para disminuir la morbimortalidad por esta causa y mejorar las posteriores posibilidades reproductivas de la mujer(AU)

Cervical ectopic pregnancy accounts for about 0.1 percent of all ectopic pregnancies. The incidence is estimated at 1: 2500 to 1: 98,000 pregnancies. It is a strange phenomenon; however, morbidity and mortality from this cause are high, but early diagnosis can help reducing. It is extremely dangerous because the trophoblast can reach the uterine vessels through the thin cervical wall and cause a severe and incoercible hemorrhage that, even today, usually ends in mutilating surgeries that will limit future reproduction. At present, no clear criteria in the literature help decision-making. We report a case of cervical pregnancy successfully treated by total abdominal hysterectomy and subsequent follow-up in the Intensive Care Unit. We present some criteria that could help timely diagnosing this devastating entity to reduce morbidity and mortality and improve the later reproductive possibilities of women(AU)

Embarazo ectópico tubárico con feto vivo en una adulta joven / Ectopic tubal pregnancy with alive fetus in a young adult woman

Se describe el caso clínico de una paciente de 21 años de edad quien acudió al Cuerpo de Guardia del Hospital Ginecobstétrico Docente Tamara Bunke Bider de Santiago de Cuba por presentar dolor leve en bajo vientre y sangrado en forma de manchas luego de que le fuera realizado un legrado uterino por aspiración 8 días atrás. Se efectuó una ecografía ginecológica que mostró un embarazo ectópico tubárico de 11 semanas en el lado derecho, con el feto vivo, por lo cual se indicó laparotomía exploratoria de urgencia y salpingectomía parcial en la trompa derecha. La paciente evolucionó de manera satisfactoria

The case report of a 21 years patient who went to the emergency room of Tamara Bunke Bider Teaching Gynecological-Obstetrics Hospital in Santiago de Cuba is described. She presented a slight pain in low stomach and bledding in form of stains after a suction curettage 8 days earlier. A gynecological echography that showed an ectopic tubaric pregnancy of 11 weeks in the right side, with alive fetus was carried out, reason why an exploratory emergency laparotomy and partial salpingectomy in the right tube were indicated. The patient had a satisfactory clinical course

Embarazo ectópico cervical: diagnóstico preciso y enfoque de manejo médico. Reporte de caso / Ectopic Cervical Pregnancy ­ Precise Diagnosis and Medical Management Approach. Case Report

El embarazo ectópico cervical es una condición exótica. Su diagnóstico y manejo plantean un desafío importante, dada su asociación con desenlaces maternos graves. La sospecha clínica y la juiciosa aplicación de los criterios diagnósticos permiten establecer modalidades de terapia conservativa. Este artículo reporta un caso de embarazo ectópico cervical con diagnóstico de imágenes de ultrasonido y resonancia nuclear magnética en el que se administró tratamiento con metotrexato. El seguimiento clínico, de los exámenes paraclínicos y de ultrasonido mostraron la resolución completa de la condición. Se revisan aspectos relacionados con el diagnóstico y tratamiento.

Cervical ectopic pregnancy is an exotic condition. Its diagnosis and management pose a major challenge given its association with serious maternal outcomes. The clinical suspicion and the judicious application of the diagnostic criteria allow for conservative therapy modalities. In this article, a case of cervical ectopic pregnancy is reported to diagnostic ultrasound imaging and nuclear magnetic resonance in which treatment with Methotrexate was administered. Clinical follow-up of the laboratory test and ultrasound showed complete resolution of the condition. Aspects related to the diagnosis and treatment are reviewed.

Caso clínico: embarazo ectópico cervical, presentación de un caso clínico / Clinical case: cervical ectopic pregnancy, presentation of a clinical case

RESUMEN Antecedentes: El embarazo cervical es una forma rara del embarazo ectópico y representa < 1% de todos los embarazos ectópicos. Objetivo: Se presenta el caso de un embarazo ectópico cervical. Se realiza una revisión literaria sobre las diferentes opciones de manejo y tratamiento. Caso clínico: Mujer de 32 años en la semana 7+4 de embarazo en la que se objetiva un saco gestacional ístmico vascularizado, que ofrece dudas diagnósticas. Se establece el diagnóstico de embarazo ectópico cervical y se realiza un cerclaje por metrorragia. Conclusión: El embarazo ectópico cervical sigue siendo un reto importante en el campo del embarazo. El éxito del tratamiento conservador depende principalmente del diagnóstico precoz, lo que puede reducir las posibilidades de hemorragia grave y de histerectomía.

ABSTRACT Background: Cervical pregnancy is a rare type of ectopic pregnancy and it represents <1% of all ectopic pregnancies. Objetive: The case of a cervical ectopic pregnancy is presented. A literary review is carried out on the different management and treatment options. Case report: A 32-year-old woman in week 7 + 4 of pregnancy in which is objetived a vascularized isthmic gestational sac, which ofeers diagnostic doubt. The diagnosis of ectopic cervical pregnancy is established and cercaclage is performed by metrorrhagia. Conclusion: Cervical ectopic pregnancy remains a major challenge in the field of early pregnancy. The success of conservative treatment depends primarily on early diagnosis, which may reduce the chances of severe bleeding and require a hysterectomy.

Pregnancy in Non-Communicating Unicornuate Uterus: Diagnosis Difficulty and Outcomes - a Case Report / Gestação em útero unicorno não comunicante: dificuldade diagnóstica e desfechos - relato de caso

Abstract Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn.Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.

Resumo Aproximadamente 1 em cada 76 mil gestações se desenvolvememútero unicorno sem comunicação com o colo uterino. Anomalias müllerianas uterinas são, na maioria das vezes, assintomáticas, tornando difícil o diagnóstico, que geralmente é esclarecido durante a gestação ou por conta das complicações gestacionais, como ruptura uterina, hipertensão gestacional, parto pré-termo, hemorragias pós-parto e crescimento intrauterino restrito (CIUR). Com o intuito de evitar cesáreas desnecessárias e os riscos que esse procedimento envolve, considerações devem ser feitas quanto aos diferentes métodos utilizados, e por quanto tempo é viável induzir o parto na possibilidade de útero não comunicante, mesmo sendo uma anomalia rara. Este relato descreve um caso de uma gestação que se desenvolveu em um útero unicorno não comunicante com o colo uterino e as consequências do diagnóstico tardio.

Embarazo ectópico del segundo trimestre / Ectopic Pregnancy of the Second Trimester

Se considera embarazo ectópico a todo aquel que anida fuera de la cavidad endometrial. La incidencia global es de 1-2 por ciento del total de gestaciones, y en 97 por ciento de los casos se localiza en la trompa. El objetivo es describir un caso clínico peculiar de una paciente con embarazo ectópico tubárico que alcanzó el segundo trimestre. Se presenta una paciente de 32 años de edad que con 17 semanas de edad gestacional que fue remitida de su área por ecografía con diagnóstico de gemelar con un saco anembriónico. Se realizó laparotomía exploradora y como hallazgos se observó hemoperitoneo de 400 mL, embarazo tubario derecho de 17 semanas fisurado en región ampular, anejo izquierdo normal, útero de consistencia blanda con mioma de dos centímetros en la cara anterior del útero. Se realizó anexectomía derecha. No hubo complicaciones. Anatomía patológica: Biopsia 16-255: Embarazo ectópico tubárico. El embarazo tubárico que cursa de forma asintomática en el segundo trimestre es raro; y las publicaciones médicas sobre este tema son limitadas. La ecografía es útil para el diagnóstico del embarazo ectópico y localización topográfica, sobre todo para diferenciar la gestación tubárica de la abdominal ya que el manejo médico y quirúrgico es diferente en ambas localizaciones(AU)

Ectopic pregnancy is considered to be any which nests outside the endometrial cavity. The overall incidence is 1-2 percent of the total of pregnancies, and in 97 percent of cases is located in the tube. The objective is to describe a peculiar clinical case of a patient with tubal ectopic pregnancy that extended to the second trimester. We present a 32-year-old patient with 17 weeks of gestational age who was referred from her doctor. Twin pregnancy with an anembryonic sac was diagnosed by ultrasound. Exploratory laparotomy was performed. A hemoperitoneum of 400 mL was observed. A 17-week right tubal pregnancy was fissured in the ampullary region, the left annex was normal, the uterus was soft anad there was a 2 cm myoma on the anterior side of the uterus. Right adnexectomy was performed. There were no complications. The results of the pathological anatomical study showed (Biopsy 16-255) tubal ectopic pregnancy. The tubal pregnancy that occurs in the second trimester asymptomatically is rare. Medical publications on this subject are limited. Ultrasound is useful for the diagnosis and topographic location of ectopic pregnancy, especially to differentiate tubal from abdominal gestation since medical and surgical managements are different in both locations(AU)

Embarazo ectópico cervical / Cervical Ectopic Pregnancy

El embarazo ectópico cervical es la implantación del huevo fertilizado a nivel del orificio cervical interno o por debajo de este. Se describe un caso de embarazo ectópico cervical en una paciente de 43 años con historia obstétrica de tres gestaciones, un parto por cesárea hace 19 años y un aborto provocado. El embarazo ectópico cervical representa 0,1 por ciento de los embarazos ectópicos y su diagnóstico se realiza a través de criterios clínicos, ultrasonográficos y anatomopatológicos específicos. En mujeres en edad fértil que asisten a consulta por sangrado vaginal o dolor abdominal, siempre hay que tener presente esta afección, en especial si presentan factores de riesgo. Su manejo está estrechamente relacionado con la edad gestacional, condiciones clínicas y paridad de la paciente. Actualmente su tratamiento es controvertido por su poca frecuencia. La conducta es emergente en casos complicados pues la hemorragia puede conducir a la muerte materna(AU)

Cervical ectopic pregnancy is the implantation of embryo at the cervical internal hole or below. Case report: A case of cervical ectopic pregnancy is described in a 43-year-old patient with obstetric history of three gestations, one childbirth by means of cesarean surgery 19 years ago and one induced abortion. The cervical ectopic pregnancies represent 0,1 percent of ectopic pregnancies and its diagnosis is carried out through clinical exam, ultrasonography and specific anatomic pathological approaches. When treating childbearing-age women who attend consultation due to vaginal bleeding or abdominal pain, doctors must always keep in mind this condition, especially if they have risk factors. The management of this condition is closely related with the gestational age, clinical conditions and the patient's parity. Its treatment is now controverted since it is rare. The medical action is emergent in complicated cases, because hemorrhage can lead to mother´s death(AU)

Cirugía laparoscópica e histeroscópica para embarazo ectópico sobreinfectado en cicatriz de cesárea previa: presentación de un caso / Laparoscopic and hysteroscopic surgery for superinfected ectopic pregnancy in a previous cesarean section scar: a case report

El embarazo ectópico con implantación en la cicatriz de una cesárea previa es un evento muy raro a pesar de la alta tasa de cesárea a nivel mundial, el mecanismo fisiopatológico aún no se establece con claridad. Presentamos un caso de una paciente con diagnóstico de embarazo ectópico sobreinfectado en cicatriz de cesárea previa, tratada con resección quirúrgica de la lesión por histeroscopia y laparoscopia.

Ectopic pregnancy implantation in a previous cesarean scar is a very rare condition despite the high caesarean rate worldwide. The pathophysiological mechanism is not yet clearly established. We present a case of a patient with an overinfected ectopic pregnancy, implanted in a previous cesarean scar treated with resection of the lesion by hysteroscopy and laparoscopy.

Embarazo extrauterino abdominal / Abdominal ectopic pregnancy

El embarazo extrauterino abdominal es uno de los tipos de embarazo ectópico junto con el ovárico, menos frecuentes. El diagnóstico es difícil y suele realizarse de forma tardía, lo que contribuye a aumentar la morbimortalidad materna. Presentamos el caso de un embarazo abdominal diagnosticado a las 9 semanas de amenorrea con embrión de tamaño acorde con edad gestacional, asintomática al diagnóstico, que se resolvió satisfactoriamente mediante laparotomía(AU)

Abdominal pregnancy is one of the rarest types of ectopic pregnancy. The diagnosis is difficult and is generally delayed. We report the case of an abdominal pregnancy diagnosed at 9 weeks of amenorrea, with size of embryo according to gestational age, asymptomatic at diagnosis, whichwas resolved satisfactorily by laparotomy(AU)

Embarazo ectópico cornual recurrente: caso clínico y revisión de la literatura / Recurrent cornual ectopic pregnancy: clinical case and literature review

OBJETIVO: Reportar un caso de embarazo ectópico cornual recurrente, al que se le realizó manejo por laparoscopia. Realizar una revisión de la literatura sobre este tema. CASO CLÍNICO: Se presenta el caso de una paciente de 34 años, con embarazo cornual recurrente a quien se le realizó manejo exitoso por laparoscopia. MÉTODO: Se realizó una búsqueda bibliográfica en las bases de datos con las palabras clave: pregnancy, intersticial y cornual ectopic en Medline, PubMed, Embase, Cochrane Data base, Ovid, Hinari, Scielo y Bireme. Resultados: La búsqueda inicial arrojó 311 artículos, de los cuales se seleccionaron 116 y posteriormente 74 artículos, que estaban relacionados con el tema a revisar, finalmente se escogieron 38 artículos con texto completo. CONCLUSIÓN: El embarazo ectópico cornual o intersticial tienen los mismos factores de riesgo que el embarazo tubárico. El avance en ecografía y los niveles de ßHCG han permitido un diagnóstico precoz, lo que permite realizar tratamientos médico o quirúrgico más conservadores, donde la laparoscopia ha empezado a tener un papel muy importante.

OBJECTIVE: To report a recurrent cornual ectopic pregnancy who underwent laparoscopic management and review the literature on this topic. CASE REPORT: 34 year-old patient with a recurrent cornual ectopic pregnancy who underwent successful laparoscopic management. METHOD: A literature search was performed in databases Medline, PubMed, Embase, Cochrane Data Base, Ovid, Hinari, Scielo and Bireme, with the keywords: pregnancy, interstitial and cornual ectopic pregnancy. Results: The initial search yielded 311 articles of which 116 were selected and then 74 who were related to the subject to review, finally 38 full text articles were selected. CONCLUSION: Cornual or interstitial ectopic pregnancy has the same risk factors that tubal pregnancy. Advances in ultrasound and ßHCG levels have allowed earlier diagnosis allowing more conservative treatments either medical or surgical treatment where laparoscopy has begun to play an important role.

Gravidez ectópica em cicatriz de cesárea: uma complicação emergente / Cesarean scar ectopic pregnancy: an emerging complication

Entre as complicações de longo prazo da operação cesariana, destacam-se o acretismo placentário (placenta acreta, increta e percreta) e, mais recentemente, a implantação embrionária na cicatriz uterina de cesárea prévia. A denominada gravidez ectópica em cicatriz de cesárea persiste como um evento pouco divulgado em função da sua raridade; porém, apresenta incidência crescente devido principalmente ao aumento global das taxas de cesariana. Os atrasos no diagnóstico e no tratamento podem resultar em ruptura uterina, hemorragia grave, necessidade de histerectomia e elevada mortalidade materna. Dessa forma, os objetivos principais na condução dos casos de gravidez ectópica em cicatriz de cesárea devem incluir o diagnóstico ultrassonográfico precoce e acurado e a prevenção de hemorragias graves, além da preservação da fertilidade. Entretanto, devido à sua raridade, ainda não há consenso acerca da melhor forma de tratamento dessa complicação.(AU)

Among the long-term complications of cesarean section stand out the pathologically adherent placenta (accreta, increta and percreta) and, more recently, the embryonic implantation in the uterine scar from previous cesarean. The so-called cesarean scar ectopic pregnancy remains a little known event due to its rarity. But it shows increasing incidence due mainly to the overall increase in cesarean rates. The delay in diagnosis and treatment can result in uterine rupture, severe hemorrhage, need for hysterectomy and high maternal mortality. Thus, the main objectives in the management of cesarean scar ectopic pregnancy should include early and accurate ultrasound diagnosis and prevention of severe blood loss, and the preservation of fertility. However, due to its rarity, there is no consensus about the best treatment for this complication.(AU)

A Rare Case of Spontaneous Bilateral Tubal Ectopic Pregnancy.

The rarest form of ectopic pregnancy is bilateral tubal ectopic pregnancy in which twining occurs with pregnancy in both the tubes. The fates of two pregnancies are independent of each other. We report a 28 years woman with out any high risk factor of ectopic pregnancy had spontaneous right sided un-ruptured tubal ectopic and left sided ruptured tubal ectopic pregnancy. The diagnosis of ectopic pregnancy was made on clinical suspicion and ultrasonography. The diagnosis of bilateral tubal ectopic was made during surgery and confirmed on histopathological examination. To avoid missing ectopic pregnancy a high index of suspicion is required and close examination of both tubes at the time of surgery even in presence of significant adhesion.

[Conservative management of cervical pregnancy. Case-report]

Cervical pregnancy is one of the rarest ectopic locations. It can be responsible of spontaneous haemorrhage enquiring hysterectomy. Ultrasonography technical improvements allow early diagnosis and conservative treatment. This study aims to report a new case of cervical pregnancy treated conservatively. Patient with cervical pregnancy diagnosed on ultrasonography and treated by one dose systemic methotrexate requiring a second injection because of no decreasing of serum beta human chorionic gonadotrophin level leading to expulsion of the pregnancy one month later. Methotrexate is the standard treatment of early diagnosed cervical pregnancy. When haemorrhage occurs, many therapeutic methods allow conservative treatment in order to preserve fertility

Comparison of single and multidose of methotrexate in medical treatment of ectopic pregnancy

The purpose of this study was to compare the efficacy and safety of two regimens of methotrexate for medical treatment of ectopic pregnancy. In this prospective randomized clinical trial 100 women clinically suspected to have un ruptured ectopic pregnancy were randomly [One by one] treated with single [50mg/m2] and multi dose [1mg/kg MTX+ 0.1mg/kg folinic acid] Methotrexate [50 cases in each group]. Results of two groups were compared. The overall success rate of treatment was 94%. The use of single dose was associated with a greater chance of response to medical management than multi dose. [97% versus 91%]. The single dose regimen was associated with greater side effects. Women who experienced side effects were more likely to have successful treatment regardless of regimen. Three percent of patients had serum B hCG >10000IU/ml and in 5% of cases fetal heart reported in adnexal mass. Both these groups were much more responsive to single dose treatment. Efficacy of single dose in medical treatment of Ectopic pregnancy is better than multi dose regimen

Multiple parameters in the diagnosis of Ectopic pregnancy

To determine the role of emergency ultrasound examination in the diagnosis and management of ectopic pregnancy. A descriptive study done at the Radiology Department, Aga Khan University Hospital, Karachi from January 1999 to December 2000 using observational facts by non-probability convenient sampling method. Seventy one patients who presented with acute symptoms in early pregnancy, were subjected to emergency pelvic ultrasound. Both transabdominal and transvaginal ultrasound were done in 52 patients while in 19 patients only transabdominal ultrasound was performed. Serum Beta hCG levels, of all patients were greater than 1500 iu/ml. Ultrasound correctly identified ectopic pregnancy in 71 patients. Ultrasound diagnosis included live embryo in six patients, adnexal mass with pelvic fluid in 54 patients, extrauterine gestational sac in 4 patients and pelvic fluid without adnexal mass in 7 patients. There was no indeterminate ultrasound scan, resulting in 100% specificity and sensitivity. The use of multiple parameters in the diagnosis of ectopic pregnancy resulted in 100% sensitivity and specificity