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Ectopic Pregnancy

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1. Ectopic pregnancy and miscarriage: diagnosis and initial management

be pregnant, and think about offering a pregnancy test even when symptoms are non-specific and and Ectopic pregnancy and miscarriage: diagnosis and initial management (NG126) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 8 of 33the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions – for example, gastrointestinal conditions or urinary tract infection. [2012] [2012 (...) Ectopic pregnancy and miscarriage: diagnosis and initial management Ectopic pregnancy and miscarriage: Ectopic pregnancy and miscarriage: diagnosis and initial management diagnosis and initial management NICE guideline Published: 17 April 2019 nice.org.uk/guidance/ng126 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

2. Ectopic pregnancy

Ectopic pregnancy Ectopic pregnancy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Ectopic pregnancy Last reviewed: February 2019 Last updated: October 2018 Summary Typically presents 6-8 weeks after last normal menstrual period, but can present earlier or later. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if pregnant (...) of referred pain from intraperitoneal blood. Definition A fertilised ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%). Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002 Dec;17(12):3224-30. http://humrep.oxfordjournals.org/content/17/12/3224.full http://www.ncbi.nlm.nih.gov/pubmed/12456628?tool

2018 BMJ Best Practice

3. Ectopic pregnancy

Ectopic pregnancy Ectopic pregnancy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Ectopic pregnancy Last reviewed: February 2019 Last updated: October 2018 Summary Typically presents 6-8 weeks after last normal menstrual period, but can present earlier or later. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if pregnant (...) of referred pain from intraperitoneal blood. Definition A fertilised ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%). Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002 Dec;17(12):3224-30. http://humrep.oxfordjournals.org/content/17/12/3224.full http://www.ncbi.nlm.nih.gov/pubmed/12456628?tool

2018 BMJ Best Practice

4. Injectable methotrexate and ectopic pregnancy. An alternative to surgery, but patients must be made aware of the risks

Injectable methotrexate and ectopic pregnancy. An alternative to surgery, but patients must be made aware of the risks Prescrire IN ENGLISH - Spotlight ''Injectable methotrexate and ectopic pregnancy. An alternative to surgery, but patients must be made aware of the risks'', 1 February 2018 {1} {1} {1} | | > > > Injectable methotrexate and ectopic pregnancy. An alternative to surgery, but patients must be made aware of the risks Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 (...) most recent :  |   |   |   |   |   |   |   |   |  Spotlight Injectable methotrexate and ectopic pregnancy. An alternative to surgery, but patients must be made aware of the risks FEATURED REVIEW For some women with an ectopic pregnancy, intramuscular injection of methotrexate can be an alternative to surgery. But methotrexate carries the risks of a cytotoxic drug, and is teratogenic: women treated with methotrexate should wait

2018 Prescrire

6. Tubal Ectopic Pregnancy

secondary to ascending pelvic infection, and prior pelvic or fallopian tube surgery (3, ). Among women who become pregnant through the use of assisted reproductive technology, certain factors such as tubal factor infertility and multiple embryo transfer are associated with an increased risk of ectopic pregnancy ( , ). Women with a history of infertility also are at increased risk of ectopic pregnancy independent of how they become pregnant (7). Other less significant risk factors include a history (...) instability or an acute abdomen, should be evaluated and treated urgently. Early diagnosis is aided by a high index of suspicion. Every sexually active, reproductive-aged woman who presents with abdominal pain or vaginal bleeding should be screened for pregnancy, regardless of whether she is currently using contraception ( , ). Women who become pregnant and have known significant risk factors should be evaluated for possible ectopic pregnancy even in the absence of symptoms. Transvaginal Ultrasonography

2018 American College of Obstetricians and Gynecologists

7. Flowchart: Ectopic pregnancy

Flowchart: Ectopic pregnancy Queensland Health State of Queensland (Queensland Health) 2018 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Queensland Clinical Guidelines www.health.qld.gov.au/qcg Ectopic pregnancy Queensland Clinical Guidelines: Early pregnancy loss. Flowchart version: F17.29-3-V5-R22 ß-hCG: human chorionic gonadtrophin, ELFT: electrolyte & liver function test, EPAS: Early Pregnancy Assessment Service (...) , FBC: full blood count, GP: General Practitioner, GTD: gestational trophoblast disease, IMI: intramuscular injection, IU/L: international units per litre, IUP: intrauterine pregnancy, IVI: intravenous injection, MFM: maternal fetal medicine, POC: products of conception, PUL: pregnancy of unknown location, PV: per vaginam, QTC: Queensland Trophoblast Centre, RhD-Ig: RhD immunoglobulin, TVS: transvaginal scan, USS: ultrasound scan, >: greater than, 5000 IU/L • Ectopic > 3 cm on TVS • Fetal heart

2017 Queensland Health

8. Management of Bilateral Ectopic Pregnancies after Ovulation Induction Using Unilateral Salpingectomy and Methotrexate for the Remaining Ectopic with Subsequent Intrauterine Pregnancy Full Text available with Trip Pro

Management of Bilateral Ectopic Pregnancies after Ovulation Induction Using Unilateral Salpingectomy and Methotrexate for the Remaining Ectopic with Subsequent Intrauterine Pregnancy Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial β-hCG trends have shown poor efficacy for accurate diagnosis. Management (...) of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy. While the standard of care is difficult to establish, we recommend individualizing

2018 Case reports in obstetrics and gynecology

10. Diagnosis and Management of Ectopic Pregnancy Full Text available with Trip Pro

Diagnosis and Management of Ectopic Pregnancy Diagnosis and Management of Ectopic Pregnancy - 2016 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

2016 Royal College of Obstetricians and Gynaecologists

11. Ectopic pregnancy and miscarriage: diagnosis and initial management

of 39they may be pregnant, and think about offering a pregnancy test even when symptoms are non-specific and and the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions – for example, gastrointestinal conditions or urinary tract infection. All healthcare professionals involved in the care of women of reproductive age should have access to pregnancy tests. Using ultrasound for diagnosis Offer women who attend an early pregnancy assessment service (or out (...) Ectopic pregnancy and miscarriage: diagnosis and initial management Ectopic pregnancy and miscarriage: Ectopic pregnancy and miscarriage: diagnosis and initial management diagnosis and initial management Clinical guideline Published: 12 December 2012 nice.org.uk/guidance/cg154 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

12. The Diagnosis of Ectopic Pregnancy

The Diagnosis of Ectopic Pregnancy Systematic Review Snapshot TAKE-HOME MESSAGE Transvaginal sonography should be used in conjunction with quantitative serum b-hCG testing to rule out ectopic pregnancy in hemodynamically stable patients. No single level of b-hCG can be used in isolation to rule out ectopic pregnancy. The Diagnosis of Ectopic Pregnancy EBEM Commentator Lisa T. Barker, MD University of Illinois College of Medicine at Peoria/OSF St. Francis Medical Center Peoria, IL Shelly Zhou (...) , MD Medical University of South Carolina Charleston, SC Results Table. Findings supporting the diagnosis of ectopic pregnancy. Finding LR (D) 95% CI LR (–) 95% CI Abdominal pain with cough or light palpation 4.2–4.5 * 0.78–0.81 * Bimanual examination Cervical motion tenderness 4.9 1.7–14 0.62 0.47–0.83 Palpated adnexal mass 2.4 1.6–3.7 0.94 0.87–1.0 Transvaginal sonography (þ) adnexal mass, absent IUP 111 (12–1,208) 0.12 (0.03–0.55) IUP, Intrauterine pregnancy. *Finding only included in 2 studies

2015 Annals of Emergency Medicine Systematic Review Snapshots

13. Detection of complicated ectopic pregnancies in the hospital discharge database: A validation study. Full Text available with Trip Pro

Detection of complicated ectopic pregnancies in the hospital discharge database: A validation study. Complicated ectopic pregnancies with severe bleeding (CEPSB) are life-threatening situations and should be considered maternal near-miss cases. Previous studies have found an association between severe maternal morbidity secondary to CEPSB and substandard care. Almost all women with CEPSB are hospitalized, generating administrative and medical records. The objective of this study was to propose

2019 PLoS ONE

14. Primary hepatic ectopic pregnancy in a patient with polycystic ovary syndrome: A case report. Full Text available with Trip Pro

Primary hepatic ectopic pregnancy in a patient with polycystic ovary syndrome: A case report. Hepatic ectopic pregnancy is an extremely rare ectopic pregnancy. This study aimed to report a case of primary hepatic pregnancy in a patient with polycystic syndrome.A 30-year-old woman presented with vaginal bleeding after 63 days of amenorrhea.The patient was initially diagnosed with liver ectopic pregnancy using abdominal ultrasound and abdominal computed tomography (CT).The patient underwent (...) (reference range 0-5 mIU/mL).If the level of beta-human chorionic gonadotropin (β-HCG) is higher than normal in women of childbearing age and no gestational sac is found in the uterine cavity, the location of pregnancy and gestational sac should be positively confirmed. Also, the possibility of ectopic pregnancy in the abdominal cavity should be considered, and the relevant imaging and biochemical examinations should be improved to avoid delay in diagnosis and treatment.

2020 Medicine

15. Anesthetic efficacy of propofol combined butorphanol in laparoscopic surgery for ectopic pregnancy: A protocol of systematic review and meta-analysis. Full Text available with Trip Pro

Anesthetic efficacy of propofol combined butorphanol in laparoscopic surgery for ectopic pregnancy: A protocol of systematic review and meta-analysis. Recent studies have suggested that propofol combined butorphanol (PB) has anesthetic effect in laparoscopic surgery (LS) for ectopic pregnancy (EP). But investigations of its potential effects are inconsistent. We will explore the current literature examining PB in LS for EP.We will perform a comprehensive search from MEDLINE, Embase, Cochrane

2020 Medicine

16. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. (Abstract)

Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. Early pregnancy losses are common, but their psychologic sequelae are often overlooked. Previous studies have established links between miscarriage and early symptoms of anxiety and depression. However, the incidence of posttraumatic stress symptoms and the psychologic response specifically to ectopic pregnancies have not been investigated.The purpose of this study (...) was to investigate levels of posttraumatic stress, depression, and anxiety in women in the 9 months after early pregnancy loss, with a focus on miscarriage and ectopic pregnancy. Morbidity at 1 month was compared with a control group in healthy pregnancy.This was a prospective cohort study. Consecutive women were recruited from the early pregnancy and antenatal clinics at 3 London hospitals and received emailed surveys that contained standardized psychologic assessments that included the Hospital Anxiety

2020 American Journal of Obstetrics and Gynecology

17. Ectopic pregnancy and outcomes of future intrauterine pregnancy. (Abstract)

Ectopic pregnancy and outcomes of future intrauterine pregnancy. To provide information on the birth outcomes of future intrauterine pregnancies in women whose first pregnancy was ectopic.Population-based longitudinal cohort study.All hospitals in Quebec, Canada, 1989-2013.Group surgically treated for an ectopic first pregnancy: 15,823 women; comparison group with an intrauterine first pregnancy: 1,101,748 women.Not applicable.Repeat ectopic pregnancy, future delivery of a live infant (...) , stillbirth, cesarean delivery, preterm birth, low birth weight, preeclampsia, gestational diabetes, and postpartum hemorrhage as well as other outcomes of pregnancy.The overall prevalence of ectopic first pregnancy was 14.2 per 1,000 women, of whom 10% of women with an ectopic first pregnancy had a future ectopic. Regardless of age, women with ectopic first pregnancies had an increased risk of adverse birth outcomes at future intrauterine pregnancies, including 1.27 times the risk of preterm birth (95

2019 Fertility and Sterility

18. Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy Full Text available with Trip Pro

Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART). Ultrasound (USS) and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy (...) is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage

2017 Case reports in obstetrics and gynecology

19. Ectopic pregnancy

[ ]: Intrauterine contraception — the overall risk of ectopic pregnancy with the copper intrauterine device (Cu-IUD) or the levonorgestrel intrauterine system (LNG-IUS) is very low, but if a woman becomes pregnant with the device in situ, the risk of ectopic pregnancy is about 1 in 20 [ ]. Progestogen-only pill (POP) — there is a small increased risk of ectopic pregnancy in women using the POP, but the absolute risk is lower than if not using contraception. Around 1 in 10 pregnancies that occur may be ectopic (...) culture and fewer embryos being transferred [ ; ]. The incidence of heterotopic pregnancy (when both an intrauterine and an ectopic pregnancy are present) varies (by article and decade) from 1 in 4000 women to 1 in 30,000 women in the general population [ ; ]. In women pregnant as a result of assisted conception, the reported incidence is 1–3% [ ; ]. There have been case reports of ectopic pregnancies occurring in women who have had a hysterectomy (both total and supracervical), but this is extremely

2018 NICE Clinical Knowledge Summaries

20. Risk factors for ectopic pregnancy in a population of Cameroonian women: A case-control study. Full Text available with Trip Pro

Risk factors for ectopic pregnancy in a population of Cameroonian women: A case-control study. To identify the risk factors for ectopic pregnancy (EP) in a population of Cameroonian women.We performed a matched case-control study; 88 women with diagnosed EP (cases), and 176 women with first trimester intrauterine pregnancy (IUP) (controls), who underwent questionnaires. Odds Ratio (OR) and 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors via

2018 PLoS ONE

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