Ectopic pregnancy in Aberdeen 1950-1985

The reported incidence of ectopic pregnancy in Aberdeen City and suburbs (1950-1985), using as denominators maternities, pregnancies and women aged 15-44 years, has increased threefold since 1970 to 6.4/1000 pregnancies. This increased incidence persisted after the exclusion of previously sterilized women. A total of 11,128 women were sterilized in Aberdeen City and suburbs between 1960 and 1982; 36 ectopic pregnancies occurred in this sterilized population. The prevalence of ectopic pregnancy was 3.55/1000 sterilizations. This did not alter significantly over the period of study despite changes in the method of sterilization. However, due to the increased popularity of sterilization, the proportion of ectopic pregnancies in women who had been sterilized increased from 0% in the 1950s to 21% in the quinquennium 1975-1979.     

Incidence of ectopic pregnancy in Rochester, Minnesota, 1950-1981

Trends in the occurrence of ectopic pregnancy from 1950 through 1981 were evaluated in the defined population of Rochester, Minnesota. The average ratio of ectopic pregnancies to live births was 1:171. The ratio declined from 1:141 to 1:217 from 1955-1959 to 1970-1974 and increased sharply to 1:122 by 1975-1980. Similarly, the average age-adjusted incidence rate of ectopic pregnancies per 100,000 women of childbearing age was 49 over the period studied. A peak rate of 79 per 100,000 was reached in 1955 to 1959, and a trough of 30 per 100,000 occurred in 1970 to 1974; this was followed by a sharp increase to 49 per 100,000 in 1975 to 1981. Methods of measuring ectopic pregnancy are contrasted, and possible risk factors are suggested.     

Hysteroscopic diagnosis of ectopic pregnancy.

Although vaginal ultrasonography combined with plasma beta-hCG determination can provide a reliable diagnosis and location of ectopic pregnancy, the results can be difficult to interpret in the early stages when hCG levels are low. Hysteroscopy can be used in such cases to differentiate between ectopic pregnancy and non-viable uterine pregnancy when viable uterine pregnancy has been ruled out. General anaesthesia and laparoscopy are avoided. We performed 60 hysteroscopic procedures between January 1989 and December 1990 in patients with suspected ectopic pregnancies. The pregnancy had been located by means of vaginal ultrasonography in every case in which the hCG was above 1500 IU/ml and in 36% of cases in which the beta-hCG was below this level. Hysteroscopy was hindered by metrorrhagia in three cases and was inconclusive in one, necessitating laparoscopy. Diagnosis was possible in all the remaining cases, as follows: ectopic pregnancy in 41 cases, with an empty uterus and occasional bleeding from an ostium; non-viable uterine pregnancy in 18 cases, with the presence of material within the cavity. Hysteroscopy therefore confirmed the diagnosis in 55% of the cases and was itself diagnostic in a further 43% of cases. Its sensitivity for the diagnosis of ectopic pregnancy was 100% and its specificity 95%. We propose a diagnostic decision tree.     

Ectopic pregnancy diagnosis and the pseudo-sac

OBJECTIVE: To evaluate the impact of an ultrasound finding of a pseudo-sac (PS), a uterine sac without a double decidual ring or a yolk sac, on the management of cases with possible ectopic pregnancy. DESIGN: A retrospective review of a series of cases. SETTING: A general hospital. PATIENT(S): Seventy-seven patients who had a diagnostic laparoscopy over a period of 3 years for suspected ectopic pregnancy. MAIN OUTCOME MEASURE(S): A logistic regression analysis was conducted to evaluate the effect of the ultrasound finding of a PS on predicting a negative finding at laparoscopy. RESULT(S): The report of a PS is significantly associated with a false-positive diagnosis of ectopic pregnancy. CONCLUSION(S): A diagnosis of PS should not be interpreted as indicative of an ectopic pregnancy because radiological differentiation between an early intrauterine pregnancy failure and an ectopic pregnancy is not possible.     

Ectopic pregnancy. II. Evaluation of the clinical value of a diagnostic algorithm for ectopic pregnancy

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.     

Ultrasound in the diagnosis of ectopic pregnancy

The majority of ectopic pregnancies can be diagnosed on transvaginal scan before treatment. Diagnosis should be based on positive visualization of an ectopic pregnancy rather the inability to visualize an intrauterine pregnancy. The majority of ectopic pregnancies will be visible on the initial transvaginal scan performed. Those who do not have their ectopic pregnancies visualized on the first examination will be initially classified as having a pregnancy of unknown location. They will then need follow-up until a diagnosis of ectopic pregnancy is confirmed. This review discusses the use of ultrasound in the diagnosis of ectopic pregnancy and the specific criteria for diagnosis of the different types of ectopic pregnancy.     

Problems in the diagnosis of ectopic pregnancy

Summary: Problems in the diagnosis of ectopic pregnancy have been assessed over a 4-month period at King Edward Memorial Hospital. Twenty-three of thirty women (77%) were sent home after their initial presentation with symptoms of their ectopic pregnancy. Thirteen were sent home from major teaching hospitals and the remaining 10 by their general practitioners.
In 76 patients, laparoscopy was performed to exclude ectopic pregnancy; the diagnosis was confirmed in only 30. Plasma β HCG values were elevated in all patients with an ectopic pregnancy within the Fallopian tube. The finding of a β HCG value of less than 2.5 i.u./1 could have allowed 36 of these patients to avoid diagnostic laparoscopy. Nine patients with intrauterine pregnancies (5 continuing and 4 aborting) might have avoided laparoscopy if ultrasonography had been used.
Careful application of these tests, together with good history taking, will minimise the number of patients in whom an incorrect diagnosis is made.     

Ultrasound. An aid in the diagnosis of ectopic pregnancy

Compound sector scanning has been employed in 39 cases of suspected ectopic pregnancy. In 21 of these, where the diagnosis was confirmed at operation, there was a 23.8 per cent negative error by sonogram. In 18 cases where the postoperative diagnosis was other than ectopic pregnancy, there was a positive sonographic error of 27.7 per cent. The over-all error was 25.6 per cent. The major diagnostic criteria were uterine enlargement with diffuse amorphous intrauterine echoes. An irregular, fairly diffuse extrauterine mass was a contributory diagnostic aid. Standardization of techniques and improved definition by the equipment should improve the diagnostic accuracy.     

New techniques in the diagnosis of ectopic pregnancy

Pulse and color Doppler studies have provided a potent method for the investigation of functional changes and pathologic conditions in the female pelvis, both in the gravid and nongravid state. Combined with transvaginal sonography, which optimizes the imaging capability, the transvaginal color Doppler ultrasonography provides a new major modality for reproductive flow studies that have hitherto been possible only in animal models because of the invasiveness of the technique. Apart from these potential applications of the technique for research purposes, however, transvaginal imaging and the Doppler technique have become major modalities in all patients suspected of ectopic pregnancy at our institution.     

多指标联合快速诊断异位妊娠的价值

目的探讨人绒毛膜促性腺激素（hCG）、孕酮（P）和肌酸激酶（CK）的腹腔血与静脉血比值（Rp/v-hCG、Rp/v-P、Rp/v-CK）联合诊断异位妊娠的价值。方法前瞻性分析120例可疑异位妊娠患者,其中明确异位妊娠共104例（异位妊娠组）,宫内妊娠合并腹腔积血（hIUP组）16例。所有患者同时取腹腔积血（后穹隆穿刺或术中抽取）和静脉血,双盲测定hCG、P、CK值并计算Rp/v-hCG、Rp/v-P、Rp/v-CK,使用受试者工作特征（ROC）曲线分析鉴别异位妊娠与hIUP的临界值,评估各指标及联合指标对诊断异位妊娠的敏感度、特异度。结果异位妊娠组中位Rp/v-hCG（5.74）及Rp/v-P（2.40）明显高于hlUP组（分别是0.57、0.74,P〈0.05）;异位妊娠组的中位Rp/v-CK（0.87）与hlUP组（0.91）差异无统计学意义（P〉0.05）。以Rp/v-hCG〉1.0诊断异位妊娠的灵敏度为94.23%,特异度为93.7%;以Rp/v-P〉1.0诊断异位妊娠的灵敏度为77.88%,特异度为93.75%;平行实验的灵敏度为96.15%,特异度为87.5%。系列实验的灵敏度为75.96%,特异度为100%。结论 Rp/v-hCG〉1.0联合Rp/v-P〉1.0可提高快速诊断异位妊娠的准确性,有利于术前和术中执行正确的决策。     

Reliability of urinary pregnancy tests in the diagnosis of ectopic pregnancy

Recently a new generation of urinary pregnancy tests with increased sensitivity and specificity for beta-human chorionic gonadotropin (beta-HCG) was introduced. The clinical sensitivity of seven of these tests was evaluated in patients with surgically proven ectopic pregnancy. Two enzyme-linked immunosorbent assays (Tandem Visual, Hybritech; Mod C1, Monoclonal Antibodies), with a sensitivity of 50 mIU of beta-HCG, were positive in 90% of ectopic pregnancies. The three-tube tests (Sensitex, Roche; UCG Beta Stat, Wampole; beta-Neocept, Organon), with a sensitivity of 150-250 mIU of beta-HCG, were positive in 81-85% of ectopic pregnancies. Two slide tests (UCG Beta Slide, Wampole, and Sensislide, Roche), with a sensitivity of 500-800 mIU of beta-HCG, were positive in 51-61% of ectopic pregnancies. Both the immunosorbent assays and the tube tests were statistically more sensitive than the slide tests (P less than .001). There was no statistically significant increase in sensitivity between the tube tests and the immunosorbent assays. The sensitivities of these tube tests in ectopic pregnancy are similar to those of tube tests from other manufacturers previously reported on.     

Medicosurgical approach to diagnosis and treatment of ectopic pregnancy.

Early ectopic pregnancy screening using vaginal ultrasonographic technology together with measurement of beta human chorionic gonadotropin (beta-hCG) and human chorionic somatomammotropin is possible within the first 2 weeks of the missing menses, prior to the appearance of symptoms. This article summarizes the main available treatment modalities, focusing primarily on the pelviscopic surgical tube-conserving approach and on instillation of intrachorionic drugs (methotrexate alone or in combination with ornipressin) and injection of prostaglandin F2 alpha. While the pelviscopic surgical approach can be applied in nearly all cases of ectopic pregnancy, irrespective of pregnancy duration, the pelviscopic medicosurgical approach is only appropriate for the treatment of early ectopic pregnancies until the 8th week of gestation in patients without fluid collection in the pouch of Douglas and beta-hCG values below 2000 mU/mL. The transvaginal intrachorionic drug instillation as a simple medicosurgical approach performed under ultrasonographic guidance without anesthesia remains restricted to the treatment of early viable ectopic pregnancy. A brief account of the expectant treatment of patients with nonviable ectopic pregnancy is given, underlining the prerequisites of decreasing beta-hCG values and the absence of fluid in the pouch of Douglas. Although spontaneous resorptions have been observed in a number of cases of the disease, no clear evidence is available on the reconstitution of tubal function and patency.