Tubal ectopic pregnancy: comparative management between pre and Covid-19 pandemic periods.

Objective: To evaluate whether there were differences in the presentation of patients with tubal ectopic pregnancy (EP) during the first year of the COVID-19 pandemic. Methods: We performed a retrospective cohort study of all cases of tubal EP between March 2019 and March 2020 (pre-pandemic) and between March 2020 and March 2021 (pandemic). We compared between these two groups the risk factors, clinical characteristics, laboratory data, sonographic aspects, treatment applied and complications. Results: We had 150 EP diagnoses during the two years studied, of which 135 were tubal EP. Of these, 65 were included in the pre-pandemic and 70 in the pandemic period. The prevalence of lower abdominal pain was significantly higher in the pandemic compared to the pre-pandemic period (91.4% vs. 78.1%, p=0.031). There was no significant difference in shock index, initial beta-hCG level, hemoglobin level at diagnosis, days of menstrual delay, aspect of the adnexal mass, amount of free fluid on ultrasound, and intact or ruptured presentation between the groups. Expectant management was significantly higher during the pandemic period (40.0% vs. 18.5%, p=0.008), surgical management was lower during the pandemic period (47.1% vs. 67.7%, p=0.023), and number of days hospitalized was lower in the pandemic period (1.3 vs. 2.0 days, p=0.003). Conclusion: We did not observe a significant difference in patient history, laboratory and ultrasound characteristics. Abdominal pain was more common during the pandemic period. Regarding treatment, we observed a significant increase in expectant and a decrease in surgical cases during the pandemic period.

Reference charts for fetal biometric parameters in twin pregnancies according to chorionicity.

OBJECTIVE: The objective of this article is to determine reference values for fetal biometric parameters in twin pregnancies and to compare these values between monochorionic and dichorionic pregnancies. METHODS: A retrospective cross-sectional study was conducted among 157 monochorionic and 176 dichorionic twin pregnancies between 14 and 38 weeks of gestation. Biometric measurements included the biparietal diameter (BPD), abdominal circumference (AC), femurs length (FL) and estimated fetal weight (EFW). To evaluate the correlation between biometric parameters and gestational age, polynomial regression models were created, with adjustments using the coefficient of determination (R(2) ). Comparison between monochorionic and dichorionic pregnancies was performed using analysis of covariance. RESULTS: The mean BPD, AC, FL and EFW for the dichorionic pregnancies were 56.16 mm, 191.1 mm, 41.08 mm and 816.1 g, respectively. The mean BPD, AC, FL and EFW for the monochorionic pregnancies were 57.14 mm, 184.2 mm, 39.29 mm and 723.4 g, respectively. There was a statistical difference between mono and dichorionic pregnancies for all the biometric parameters (BPD p = 0.012; AC p = 0.047; FL p = 0.007; EFW p = 0.011). CONCLUSION: Reference curves of biometric parameters in twin pregnancies were determined. Biometric parameters were statistically different between monochorionic and dichorionic pregnancies.

Association study of vascular endothelial growth factor and polymorphisms of its gene with ectopic pregnancy.

PROBLEM: In ectopic pregnancy, increased levels of vascular endothelial growth factor are present. The aims of this study were to determine the association between -634C/G, -460T/C, and +936C/T vascular endothelial growth factor (VEGF) polymorphisms and ectopic pregnancy, and to determine whether serum levels of VEGF were affected by genetic factors. METHOD: of study This is a case-control study wherein 74 women with a history of ectopic pregnancy in a tertiary care center were compared to 134 post-menopausal controls with two pregnancies and no ectopic pregnancy for the genotyping of VEGF polymorphisms. For 35 patients with the diagnosis of ectopic pregnancy, serum concentrations of VEGF were obtained before the treatment. Genotyping of VEGF (-634C/G, -460T/C, and +936C/T) polymorphisms was performed by PCR, followed by endonuclease digestion. ELISA was performed to evaluate the VEGF serum levels. RESULTS: The -634C/G, -460T/C, and +936C/T VEGF polymorphisms were not associated with ectopic pregnancy (P = 0.170, P = 0.285, and P = 0.700, respectively). The serum levels of VEGF were not associated with the genotype of -634C/G, -460T/C, and +936C/T VEGF polymorphisms (P = 0.702; P = 0.347, and P = 0.256, respectively). CONCLUSION: There was no association between ectopic pregnancy and -634C/G, -460T/C, and +936C/T VEGF polymorphisms. There was no correlation between VEGF genotype and the expression of VEGF in blood samples.

Increment in beta-hCG in the 48-h period prior to treatment: a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate.

BACKGROUND: To evaluate the increment in beta-hCG levels (%) in the 48-h interval prior to treatment as a predictor of therapeutic success in the management of ectopic pregnancy with methotrexate. METHODS: A prospective observational study was carried out between April 2002 and November 2006 at the Federal University of São Paulo in 65 patients with an ectopic pregnancy treated with a single dose of 50 mg/m(2) of methotrexate administered intramuscularly. The following predictive factors were evaluated: beta-hCG level on the day of hospital admission and the percent increment in beta-hCG in the 48-h interval prior to treatment. RESULTS: Treatment was successful in 49 cases (75.4%). In these cases, beta-hCG levels at hospitalization were lower when compared to the levels found in cases of therapeutic failure (1,928.9 vs. 4,828.6 mIU/ml, respectively; P<0.01), and the increment in beta-hCG level in the 48-h interval prior to treatment was smaller (13.1 vs. 36.3%, respectively; P=0.01). A beta-hCG measurement

Values of beta-human chorionic gonadotropin as a risk factor for tubal obstruction after tubal pregnancy.

AIM: The hysterosalpingography (HSG) was evaluated after the clinical treatment of tubal pregnancy and the possible risk of tubal obstruction through the following parameters: beta-human chorionic gonadotropin (beta-hCG) levels, size of the adnexal mass, aspects of the image at ultrasound, and color Doppler. METHODS: Eighty patients were submitted to HSG after tubal pregnancy treatment from April 1994 to February 2002. Fifty received expectant management and 30 were treated with single-dose methotrexate (MTX) (50 mg/m(2) intramuscularly). RESULTS: The patency of the ipsilateral tube was 84% and 78% after the MTX and expectant treatments, respectively (P > 0.05). After the logistic regression was performed, it was observed that levels of beta-hCG >5000 mUI/ml were directly related to the tubal obstruction risk, odds ratio = 11.79 (95% CI = 2.27-61.32). Other variables were not directly related to the tubal obstruction risk. CONCLUSIONS: In this study, the probability of ipsilateral tubal obstruction depends on the beta-hCG levels. The increase in beta-hCG levels is followed by an enhancement in tubal obstruction risk. Therefore, the beta-hCG may be effective for the prognostic of the reproductive future of these patients.

Endometrial thickness as an orienting factor for the medical treatment of unruptured tubal pregnancy.

OBJECTIVES: To evaluate the efficacy of the endometrial thickness measurement through transvaginal ultrasound as an orienting factor for the medical treatment of unruptured tubal pregnancy with a single dose of methotrexate in order to select the best cases for the medical treatment. METHODS: A prospective study, in which the largest measurement of endometrial thickness in millimeters was evaluated, along the longitudinal uterine axis, by means of transvaginal ultrasound. A total of 38 patients meeting the inclusion criteria for single-dose methotrexate treatment [50 mg/m2 intramuscularly (i.m.)] were included in the study. We observed whether there was any difference in mean value of endometrial thickness and initial beta-human choriongonadotropin levels, between the cases that evolved successfully with the treatment, and those that failed. RESULTS: The mean value of endometrial thickness and initial beta-human choriongonadotropin (beta-hCG) levels, for patients evolving successfully with medical treatment (28 cases), were 6.39 mm and 1936.2 mUI/ml, respectively, while the mean values for failures were 11.70 mm and 6831.3 mUI/ml. We carried out statistical analysis using the 'Student's t-test', with p < 0.05. CONCLUSIONS: The mean value of endometrial thickness, along the longitudinal uterine axis through transvaginal ultrasound, reflects hormonal action and has been demonstrated to be another important parameter in indicating the medical treatment of an unruptured tubal pregnancy.