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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. Creatine phosphokinase, a new marker in diagnosis of tubal ectopic pregnancy; A Systematic Review. (Abstract)

Creatine phosphokinase, a new marker in diagnosis of tubal ectopic pregnancy; A Systematic Review. Creatine phosphokinase (CPK) is an intracellular enzyme found in higher levels in the brain, myocardium, soft muscle and skeletal muscle, as well as the fallopian tube. This review was conducted to evaluate the role of serum CPK in early diagnosis of tubal ectopic pregnancy (EP).We performed an electronic literature search in Web of Science, Scopus, Embase and Medline databases and manual search

2020 Archives of academic emergency medicine

8. 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

9. Management of Bilateral Ectopic Pregnancies after Ovulation Induction Using Unilateral Salpingectomy and Methotrexate for the Remaining Ectopic with Subsequent Intrauterine Pregnancy (Full text)

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 PubMed abstract

11. Diagnosis and Management of Ectopic Pregnancy (Full text)

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 PubMed abstract

12. 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

13. 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

14. Detection of complicated ectopic pregnancies in the hospital discharge database: A validation study. (Full text)

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 PubMed abstract

15. Relation of Chlamydia trachomatis infections to ectopic pregnancy: A meta-analysis and systematic review. (Full text)

Relation of Chlamydia trachomatis infections to ectopic pregnancy: A meta-analysis and systematic review. In a multitude of previous studies, Chlamydia trachomatis (CT) plays an important role in the occurrence of ectopic pregnancy (EP). However, the predictive value of CT infections in the occurrence of EP has not been estimated worldwide. We thus evaluated, by means of a meta-analysis, the current status of the association between CT infections with EP and the potential predictive value of CT

2020 Medicine PubMed abstract

16. Chronic ectopic pregnancy: case report and systematic review of the literature. (Abstract)

Chronic ectopic pregnancy: case report and systematic review of the literature. Chronic ectopic pregnancy (CEP) is a variant of ectopic pregnancy (EP) characterized by low or absent serum human chorionic gonadotropin (hCG) levels, resistance to methotrexate (MTX), and an adnexal mass with fibrosis, necrosis, and blood clots due to repeated and gradual fallopian tube wall disintegration. CEP may complicate the course of patients with EP and is difficult to diagnose.The case of a 36-year-old

2020 Archives of gynecology and obstetrics

17. Endometriosis and Ectopic Pregnancy: A Meta-analysis. (Abstract)

Endometriosis and Ectopic Pregnancy: A Meta-analysis. To systematically review and perform a meta-analysis of the risk of ectopic pregnancy in endometriosis.MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), and Cochrane Library to April 1, 2019. Inclusion criteria were cohort or case-control studies from 1990 onward. Exclusion criteria were cohort studies without controls, case reports or series, or no English full-text.A total of 1361 titles/abstracts were screened after removal of duplicates, 39 (...) with a cutoff of ≥7 for higher quality. There were 10 case-control studies (17 972 ectopic pregnancy cases and 485 266 nonectopic pregnancy controls) and 5 cohort studies (30 609 women with endometriosis and 107 321 women without endometriosis). For case-control studies, endometriosis was associated with increased risk of ectopic pregnancy with an OR of 2.66 (95% confidence interval [CI] = 1.14-6.21, p = .02). For cohort studies, the OR was 0.95 (95% CI = 0.29-3.11, p = .94), but after post hoc analysis

2020 Journal of minimally invasive gynecology

18. The effect of salpingectomy on the ovarian reserve and ovarian response in ectopic pregnancy: A systematic review and meta-analysis. (Full text)

The effect of salpingectomy on the ovarian reserve and ovarian response in ectopic pregnancy: A systematic review and meta-analysis. Salpingectomy is routinely performed in ectopic pregnancy (EP). However, the effect of the surgery on the ovarian reserve and ovarian response in EP patients is still uncertain and has not been systematically evaluated. Therefore, we conducted this meta-analysis to provide a comparison of the ovarian reserve and ovarian response between the pre-salpingectomy

2020 Medicine PubMed abstract

19. Primary hepatic ectopic pregnancy in a patient with polycystic ovary syndrome: A case report. (Full text)

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 PubMed abstract

20. Anesthetic efficacy of propofol combined butorphanol in laparoscopic surgery for ectopic pregnancy: A protocol of systematic review and meta-analysis. (Full text)

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 PubMed abstract

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