ABSTRACT
In prospective study from 1988 to 1992 I analysed possibility of early non-invasive detection and treatment of ectopic pregnancy. In this purpose I used a gynecological examination, estimation of concentration of beta-hCG and progesterone in serum, transvaginal ultrasound and in certain patients, curettage. The fusion of all these methods permits to gain right diagnosis of ectopic pregnancy. In this work I described diagnostic and therapeutic algorithm of ectopic pregnancy allows in using conservative treatment in this pathology. Empty uterus (without gestational sac) in transvaginal ultrasound examination, in cases with beta-hCG concentration is higher than 3000 mIU/ml, allows recognise ectopic pregnancy. I introduced predictive scale for possibilities of conservative treatment and therapeutic algorithm allows to chose way of treatment (laparatomy, laparoscopy, Methotexate i.m. expectant management). The estimation of clinical value of diagnostic algorithm for ectopic pregnancy will present in part II and efficacy of conservative treatment methods in patients with ectopic pregnancy in part III.
Subject(s)
Algorithms , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Adult , Biomarkers/blood , Chorionic Gonadotropin, beta Subunit, Human/blood , Female , Humans , Physical Examination , Poland , Pregnancy , Pregnancy, Ectopic/blood , Prospective Studies , Sensitivity and Specificity , Ultrasonography, PrenatalABSTRACT
From 162 patients with recognised ectopic pregnancy, 75 was qualified to conservative treatment. We estimated efficacy of therapy in 63 women treated by administration 50 mg/m2 i.m., of Methotrexate. For 50 of them therapy was successful (79.4%), another 13 (20.6%) demanded surgical procedures(laparatomy or laparoscopy), remained 12 was qualified to expectant management. Efficacy, in treated by Methotrexate group, significantly increasing to 86.8% (46/53) in patients with initial beta-hCG concentration in serum lower than 10,000 mIU/ml.
Subject(s)
Methotrexate/administration & dosage , Pregnancy, Ectopic/therapy , Adolescent , Adult , Chorionic Gonadotropin, beta Subunit, Human/blood , Female , Humans , Laparoscopy , Laparotomy , Pregnancy , Pregnancy, Ectopic/blood , Pregnancy, Ectopic/diagnosisABSTRACT
In this work we assessed clinical value of diagnostic algorithm of ectopic pregnancy introduced in the first part of study. We calculated sensitivity, specificity, exactness and positive and negative predictive value. Studies embraced 374 women admitted to Polish Mother's Memorial Institute in Lodz with suspicion of ectopic pregnancy. In 143 patients we recognised ectopic pregnancy in remained 231 absence of pregnancy, intrauterine pregnancy or abortion. Diagnostic algorithm, with estimation hCG and progesterone concentration in serum and use transvaginal ultrasound, seems to be useful tool allowed diagnosed early ectopic pregnancy. We obtained 100% sensitivity and specificity of algorithm in diagnosis ectopic pregnancy.
Subject(s)
Algorithms , Pregnancy, Ectopic/diagnosis , Adult , Biomarkers/blood , Chorionic Gonadotropin/blood , Female , Humans , Predictive Value of Tests , Pregnancy , Pregnancy, Ectopic/blood , Progesterone/blood , Sensitivity and Specificity , Ultrasonography, PrenatalABSTRACT
The aim of the study was to determine Se, Zn, and Cu concentrations in blood plasma and milk of lactating women from central Poland who were in different stages of lactation and to investigate the relationship between the content of trace elements in mothers' blood and concentrations of microelements in their milk. Se and Zn concentrations in blood plasma of mothers were the lowest and Cu was the highest on the first 4 d of lactation (colostrum, n = 43) and were found to be 34.9 +/- 11.8 microg/L, 0.51 +/- 0.13 mg/L, and 1.70 +/- 0.55 mg/L, respectively. The highest plasma level of Se and Zn and the lowest content of Cu could be observed between d 10 and 30 of lactation (mature milk, n = 41), and were found to be 54.3 +/- 14.6 microg/L for Se (p < 0.001), 0.76 +/- 0.20 mg/L for Zn (p < 0.001), and 1.03 +/- 0.30 mg/L (p < 0.001) for Cu. The results of Se, Zn, and Cu determination in breast milk samples demonstrate a pattern of decline in their concentration with advancing stages of lactation. We found out that Se, Zn, and Cu concentrations were the highest in colostrum (n = 43) and amounted to 24.8 +/- 10.1 microg/L, 8.2 +/- 2.8 mg/L, and 0.45 +/- 0.11 mg/L, respectively. The content of all determined microelements declined significantly during the time of lactation. Statistically significant linear correlation was found between concentrations of Zn in blood plasma and milk in the first stage of lactation. Weak but statistically significant linear correlations were also found between plasma Se content in plasma and in transitional and mature milk of breast-feeding women.
