scholarly journals Unexpected rupture of an expectantly managed tubal ectopic pregnancy: a reminder for enhanced diligence

2019 ◽  
Vol 12 (12) ◽  
pp. e230876
Author(s):  
Amenda Ann Davis ◽  
Kusum Lata ◽  
Akshita Panwar ◽  
Alka Kriplani
Keyword(s):  
Ectopic Pregnancy ◽  
Chorionic Gonadotropin ◽  
Expectant Management ◽  
Close Monitoring ◽  
Original Diagnosis ◽  
Tubal Ectopic Pregnancy ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Asymptomatic Women ◽  
Low Serum

Expectant management of tubal ectopic pregnancies is a feasible and possibly preferable method of management in asymptomatic women with low serum β-human chorionic gonadotropin (hCG). This involves serial monitoring of β-hCG until negative, after which it is deemed as spontaneously resolved ectopic pregnancy. We describe a case of tubal ectopic pregnancy which was expectantly managed with an initial β-hCG of 585 mIU/mL until undetectable. This patient presented with ruptured ectopic pregnancy 8 weeks after the original diagnosis, at the level of 5 mIU/mL. This highlights the importance of close monitoring in the expectant management of tubal ectopic pregnancies, with the incorporation of imaging, even when serial β-hCG shows a persistently reducing trend.

scholarly journals Non-surgical management of unruptured tubal ectopic pregnancy

2017 ◽  
Vol 6 (7) ◽  
pp. 3041
Author(s):  
Anjali Choudhary ◽  
Priyanka Chaudhari ◽  
Neeta Bansal
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Management ◽  
Expectant Management ◽  
First Trimester ◽  
Response To Treatment ◽  
Surgical Trauma ◽  
Tubal Ectopic Pregnancy ◽  
Beta Hcg ◽  
Surgical Options ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is still the leading cause of pregnancy related morbidity in the first trimester. Since majority of the women who present with ectopic pregnancies are sub fertile and young, there is a role for non-surgical options of managing these pregnancies. Expectant and medical management not only serves to conserve the fallopian tubes but also saves women from surgical trauma and morbidity. The objective of this retrospective study was to share our experience of treating un-ruptured tubal ectopic pregnancies conservatively.Methods: Women diagnosed with un-ruptured tubal ectopic pregnancy, fit for conservative /medical management were included. Women with serum beta HCG levels less than 1000 mIU/L were treated expectantly and women with Bet HCG levels >1000 but <10,000 mIU /L were given Injectable methotrixate. Response to treatment was monitored by serial beta HCG levels.Results: Total 37 women included in the study.12% women showed complete resolution with expectant treatment alone and 88% resolved after a single dose methotrixate.Conclusions: Many women with un-ruptured tubal ectopic pregnancies would benefit from expectant management, or methotrixate therapy. Methotrixate used in carefully selected women is safe and effective in resolving these cases with good post treatment reproductive outcome.

scholarly journals Comparison of outcome in medical versus expectant management in unruptured tubal pregnancy with β-hCG 1000-3000 IU/L

2020 ◽  
Vol 9 (6) ◽  
pp. 2239
Author(s):  
Sidra Arshad ◽  
Sonia Andeel ◽  
Samia Asghar ◽  
Sana Hafeez ◽  
Sana Asghar ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Management ◽  
Expectant Management ◽  
Tubal Pregnancy ◽  
Free Fluid ◽  
Tubal Ectopic Pregnancy ◽  
Group A ◽  
The Mean ◽  
Β Hcg ◽  
Group B

Background: Ectopic pregnancy (EP) is an important cause of maternal morbidity as well as mortality in the 1st trimester. This study was done to compare outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hCG 1000-3000 IU/L.Methods: In this randomized controlled trial, 82 (41 in each group) women with tubal ectopic pregnancy (TEP) having β-hCG levels between 1000-3000 IU/L and 18 to 40 years of age were enrolled. Women having non-tubal pregnancy, ruptured ectopic pregnancy, heterotopic pregnancy, hypersensitivity to methotrexate were excluded. Included women were randomly assigned to either Group-A (expectant management) or Group-B (medical management). Outcome was measured after one week and considered successful if patient had β-hCG levels negligible i.e. <10 IU/L and complete resolution on ultrasonography (absence of adnexal mass, pelvic free fluid, gestational sac).Results: Overall mean age was 30.65±6.37 years. The mean gestational age in Group-A was 7.12±2.12 weeks and 7.63±2.41 weeks in Group-B. The mean β-hCG levels in Group-A was 1984.63±515.81 IU/L and 1937.33±519.68 IU/L in Group-B. Outcome was successful in 90.24% in Group-A and 63.41% in Group-B (p-value=0.004).Conclusions: Expectant management is associated with better outcome as compared to medical management in tubal ectopic pregnancy having β-hCG between 1000-3000 IU/L.

scholarly journals Non-surgical management of ectopic pregnancy

2021 ◽  
Vol 10 (7) ◽  
pp. 2686
Author(s):  
Vineeta Gupta ◽  
Shweta Nimonkar ◽  
Priyanka Chaudhari ◽  
Namrata Saxena ◽  
Parul Singh
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Medical Management ◽  
Uterine Cavity ◽  
Expectant Management ◽  
Clinical Profile ◽  
Close Monitoring ◽  
Mortality And Morbidity ◽  
Future Fertility ◽  
Β Hcg

Background: Ectopic pregnancy is a condition when a fertilized ovum is implanted outside the uterine cavity. It is one of the important causes of maternal mortality and morbidity in India. Treatment includes expectant management, medical management and surgical management. Expectant and medical management are the treatment of choice for hemodynamically stable patients who do not want surgical treatment and are desirous of future fertility. The aim of study was to analyse the clinical profile, regimen of medical method used and outcome of non-surgical management in patients with ectopic pregnancy.Methods: It was a retrospective observational distributive study conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences from January 2015 to December 2019. There were total 182 diagnosed cases of ectopic pregnancy during this duration. Out of them, 87 patients were given non-surgical management. Data was obtained from their medical records to analyse the clinical profile, outcome of expectant and medical management and efficacy of regimen used.Results: Total 87 patient out of 182 diagnosed cases of ectopic pregnancy were studied. Out of these, 57 (65.5%) patients were in the age group of 20 to 30 years, 44 (50.6%) patients were third gravidas and 32 (36.8%) patients did not have any live issue. Thirty three (37.93%) patients had haemoglobin less than 10 gm%, 41 (47.13%) patients had one or more previous caesarean sections and 73 (83.91%) patients had tubal ectopic pregnancy. Overall success rate with non-surgical management was 94.25%.Conclusions: Our study emphasised the role of expectant and medical management in stable patients of ectopic pregnancy and recommends to use methotrexate as therapy even when initial serum β HCG levels are more than 5000 IU and haemoglobin level less than 10 gm% under close monitoring.

Comparison of Successful Outcome in Medical Versus Expectant Management in Patients with Unruptured T. P. having Β-Hcg 1000-3000 Iu/L

2021 ◽  
Vol 15 (10) ◽  
pp. 2729-2932
Author(s):  
Bilqees Akhtar Malik ◽  
Andleeb Arshad ◽  
Misbah Kausar Javaid
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Management ◽  
Expectant Management ◽  
Successful Outcome ◽  
Military Hospital ◽  
Free Fluid ◽  
Tubal Ectopic Pregnancy ◽  
Group A ◽  
Β Hcg ◽  
Group B

Objective: To compare the successful outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hcg 1000-3000 IU/L. Materials & Methods: In this randomized controlled trial, total 90 patients of ectopic pregnancy having age 18-40 years and having size of ectopic mass< 4cm were selected from the Department of Obstetrics & Gynecology Combined Military Hospital, Bahawalpur from March 20 to September 20. Group A included patients in which expectant management was done while Group B included the patients in which medical management (single intramuscular injection of methotrexate in a dose of 50mg/m2) was done. After one week, successful outcome was compared between the both groups. Results: Total 90 women with tubal ectopic pregnancy were selected for this study. Comparison of successful outcome between the bot study groups was done. Mean age of the patients was 31.66 ± 6.44 years, mean gestational age was 7.83 ± 2.33 weeks and mean β-hcg levels 1565.45 ± 517.89 IU/L. In study group A, outcome was found successful in 40 (88.89%) patients and 31 (68.89%) patients of group B was found with successful outcome. After applying chi-square test, difference of successful outcome between the both groups was found statistically significant with p value 0.037. Conclusion: This study concluded that expectant management is associated with better outcome (β-hcg levels negligible i.e. <10 IU/L and complete resolution on ultrasonography (absence of adnexal mass, pelvic free fluid, gestational sac) within one week) as compared to medical management in women with tubal ectopic pregnancy having β-hcg between 1000-3000 IU/L Keywords: Ectopic pregnancy, methotrexate, expectant, resolution

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

scholarly journals Lung neoplasm mimicking as ectopic pregnancy due to paraneoplastic secretion of human chorionic gonadotropin: a case report and literature review

2021 ◽  
Author(s):  
Jin Peng ◽  
Shangge lv ◽  
Lin Liu ◽  
Shuai Feng ◽  
Naidong Xing
Keyword(s):  
Systematic Review ◽  
Ectopic Pregnancy ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Lung Neoplasm ◽  
High Serum ◽  
Pregnancy Test ◽  
Positive Pregnancy Test ◽  
Β Hcg ◽  
Present Systematic Review

Abstract Purpose The present systematic review aimed to examine the relationship between lung neoplasm and human chorionic gonadotropin (HCG). Especially, women with lung neoplasm mimicking as ectopic pregnancy were explored. Methods A rare case of lung neoplasm with high serum β-HCG, which was initially thought to be ectopic pregnancy, was reported. A literature search was performed of the US National Library of Medicine (MEDLINE), EMBASE, PubMed, and the Cochrane Database of Systematic Reviews using appropriate keywords and subject headings to February 2020. Results Studies assessed lung neoplasm patients with positive HCG were included. Twenty studies, including 24 patients, were included. These cases illustrate the importance of considering the possibility of paraneoplastic secretion of β-HCG in patients who have a positive pregnancy test. This may prevent a delay in the diagnosis and treatment of malignancy in young women. Of the 24 cases, only 7 (29.17%) were managed surgically; others were managed conservatively or with chemotherapy or radiation. Conclusion The present systematic review shows the need to re-awaken awareness and high index of suspicion to lung neoplasm diagnosis in patients with positive pregnancy test.

Mature solid tubal teratoma producing β-HCG simulating a ruptured tubal ectopic pregnancy

2016 ◽  
Vol 198 ◽  
pp. 165-166
Author(s):  
Diana Dopico Vázquez ◽  
Ana Pereda Ríos ◽  
Cristina Freire Calvo ◽  
Pedro Rodríguez Barro ◽  
Cristina Guillán Maquieira ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Β Hcg

scholarly journals Diagnostic Clues and Management of ectopic Pregnancy in Sir Salimullah Medical College and Mitford Hospital, Dhaka

2020 ◽  
Vol 33 (1) ◽  
pp. 49-53
Author(s):  
Nazia Islam
Keyword(s):  
Surgical Treatment ◽  
Ectopic Pregnancy ◽  
Expectant Management ◽  
Cross Sectional Study ◽  
Abdominal Pregnancy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Ectopic Pregnancies ◽  
Condition Diagnosis

Background: Ectopic pregnancy is a common clinical condition. Diagnosis and managementof this condition is necessary in due to day practice. Methods: A cross sectional study on ectopic pregnancy was conducted in Sir SalimullahMedical College and Mitford Hospital (SSMC & MH) , Dhaka, with the objective to analyzethe risk factors and assess the results of management with respect to maternal morbidityand mortality of ectopic pregnancy during the last two years. Result: Fifty patients were admitted with ectopic pregnancy from 1st January 2008 to 31stDecember 2010.Frequency of ectopic pregnancy were 1.5% of total 3252 pregnancies. Riskfactors were found in 45% of cases. Surgical treatment were performed in total 43 patients.There was one heterotrophic pregnancy and one case of abdominal pregnancy. Four patientswere given intramuscular Methotrexate and two un-ruptured ectopics resolved spontaneouslyafter by expectant management. Conclusion: Conservative management was an option but surgical treatment was donemore often because of late referrals. Screening of high risk cases, early diagnosis and earlyintervention would reduce the morbidity in ectopic pregnancies. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 49-53

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