Utility of a routine ultrasound for detection of ectopic pregnancies among women requesting abortion: a retrospective review

IntroductionRoutine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in its detection, in a community abortion service.MethodsRetrospective case record review of women requesting abortion over a 5-year period (2015–2019) with an outcome of ectopic pregnancy or pregnancy of unknown location (PUL) at a service (Edinburgh, UK) conducting routine ultrasound on all women. Records were searched for symptoms at presentation, development of symptoms during clinical care, significant risk factors and routine ultrasound findings.ResultsOnly 29/11 381 women (0.25%, 95% CI 0.18%, 0.33%) had an ectopic pregnancy or PUL (tubal=18, caesarean scar=1, heterotopic=1, PUL=9). Eleven (38%) cases had either symptoms at presentation (n=8) and/or significant risk factors for ectopic pregnancy (n=4). A further 12 women developed symptoms during their clinical care. Of the remaining six, three were PUL treated with methotrexate and three were ectopic (salpingectomy=2, methotrexate=1). In three cases, the baseline ultrasound indicated a probable early intrauterine pregnancy.ConclusionsEctopic pregnancies are uncommon among women presenting for abortion. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may provide false reassurance that a pregnancy is intrauterine.

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Ectopic Pregnancy and its Risk Factors: A Case Control Study in Nepalese Women

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v1i2.22075 ◽

2018 ◽

Vol 1 (2) ◽

pp. 30-34

Author(s):

G. Bhandari ◽

K.K. Yadav ◽

R. Shah

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Case Control Study ◽

Significant Risk ◽

Case Control ◽

Contraceptive Devices ◽

Significant Difference ◽

History Of ◽

Ectopic Pregnancies ◽

Control Study

Introduction: Ectopic pregnancy is a significant cause of maternal mortality and morbidity during the first trimester. The major risk factors for ectopic pregnancy include prior tubal infections, previous ectopic pregnancy, previous abortions, use of intrauterine contraceptive devices, contraception failure, tubal surgeries, infertility and use of artificial reproductive pregnancies. This study was carried out to evaluate the effect of different risk factors in the causation of ectopic pregnancies among women in the Nepalese setting. Materials and methods: This was a case-control study conducted at Kathmandu Medical College comparing 39 cases of ectopic pregnancies with 39 controls consisting of intra-uterine pregnancies. The suspected cases were confirmed through clinical examination, trans-abdominal or trans-vaginal ultrasonography and serum β-hCG levels with further confirmation obtained after laparotomy / laparoscopy among cases who underwent surgery. The two study groups matched with age, gravidity and contraceptive uses were studied. History of previous abortions, previous ectopics and past abdomino-pelvic surgeries were also studied. Results: There was statistically significant difference in the incidence of contraceptive failure among the two groups (p-value= 0.032) with women with such history having a relative risk of 1.667 with odds ratio of 3.400. The risk posed by previous abortions and previous ectopics wasn’t found significant (RR= 1.000 and 2.053 respectively). The history of past abdomino-pelvic surgeries also showed significant role in causation of ectopics (RR= 1.094). Conclusion: Among different risk factors studied, the contraception usage was the most significant risk factors. Oral contraceptive pills was the most identified among the contraception used in cases of ectopic pregnancy.

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Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study

BMJ Quality & Safety ◽

10.1136/bmjqs-2011-001159 ◽

2012 ◽

Vol 21 (9) ◽

pp. 737-745 ◽

Cited By ~ 169

Author(s):

Helen Hogan ◽

Frances Healey ◽

Graham Neale ◽

Richard Thomson ◽

Charles Vincent ◽

...

Keyword(s):

Retrospective Case ◽

Case Record ◽

Acute Hospitals ◽

Review Study ◽

Record Review

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Heterotopic pregnancy; case report

National Journal of Research in Ayurved Science ◽

10.52482/ayurlog.v7i05.425 ◽

2019 ◽

Vol 7 (05) ◽

Author(s):

Vipul R. Khandagale

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Adnexal Mass ◽

Heterotopic Pregnancy ◽

Free Fluid ◽

Threatening Condition ◽

Life Threatening ◽

Ectopic Pregnancies ◽

High Index Of Suspicion ◽

Low Risk Women

Heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It can be a life threatening condition and easily missed with the diagnosis. We present the case of a 37 year old patient who was treated for a heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation.The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.It is difficult to estimate exactly the incidence of ectopic pregnancies, but on an average it is approximately 1:300 normal pregnancies worldwide.

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Risk factors for post-polypectomy bleeding; a retrospective case-control study of a high-volume colonoscopy center

Zeitschrift für Gastroenterologie ◽

10.1055/a-1690-7795 ◽

2021 ◽

Author(s):

Dimitrios Eleftheriadis ◽

Christina Imalis ◽

Guido Gerken ◽

Heiner Wedemeyer ◽

Jan Duerig

Keyword(s):

Risk Factors ◽

Significant Risk ◽

Ileocecal Valve ◽

Binary Logistic Regression ◽

High Volume ◽

Binary Logistic Regression Analysis ◽

Care Hospital ◽

Retrospective Case ◽

Polyp Size ◽

Epinephrine Injection

Abstract Background and aim Post-polypectomy bleeding (PPB) remains an uncommon although serious complication of colonoscopy. The aim of this study is to determine the PPB-prevalence in a secondary care hospital and its associated risk factors. Patients and methods We collected data from 581 patients, with the removal of 1593 polyps between August 2017 and August 2019. A univariate binary logistic regression analysis was conducted retrospectively. Results PPB occurred in only 10 cases, representing 1.7% of patients: immediate in 1.2% and delayed in 0.5%. The number of removed polyps per patient [4.5 (SD 2.59) for hemorrhagic vs. 2.74 (SD 1.98) for non-hemorrhagic group] and the propofol dose [232 mg (SD 93.07) for hemorrhagic vs. 133 mg (SD 57.28) for non-hemorrhagic group] were relevant patient-related risk factors. The polyp-based analysis showed the polyp size [18.4 mm (SD 10.44) for hemorrhagic vs. 4.42 mm (SD 4.29) for non-hemorrhagic group], the morphology [wide-based: OR 24.83 (95 % CI 2.76 – 223.44), pedunculated: OR 56.67 (95 % CI 5.03 – 638.29)], the location at ileocecal valve [OR 20.48, 95 % CI 1.81 – 231.97)], and the polypectomy method [hot snare piecemeal with epinephrine injection: OR 75.38 (95 % CI 7.67 – 741.21)] as significant risk factors for PPB, too. Conclusions The low rate of PPB confirms the safety of the procedure in non-tertiary, high-volume colonoscopy centers. The number of polyps removed per patient, the polyp size, morphology and location, as well as the sedation dose and the method of polypectomy were shown as relevant risk factors.

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Surgical intervention in ectopic pregnancies

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.06.3587 ◽

2019 ◽

Vol 26 (06) ◽

Author(s):

Fouzia Rasool Memon ◽

Mini Poothavelil ◽

Samreen Memon

Keyword(s):

Ectopic Pregnancy ◽

Surgical Management ◽

Surgical Intervention ◽

University Hospital ◽

Time Interval ◽

Presenting Symptoms ◽

Beta Hcg ◽

Ultrasound Findings ◽

Ectopic Pregnancies ◽

Study Setting

Objectives: To find out the negative laparoscopy rate for suspected ectopic pregnancy. Study Design: Retrospective cohort study. Setting: Electronic medical record databases in North Cumbria University Hospital, Carlisle, United Kingdom. Period: August 2014 to August 2018. Material and Methods: The data of total 150 laparoscopies performed for ectopic pregnancy management was collected for gestational age at presentation, symptoms, serial beta human chorionic gonadotrophic hormone (HCG) levels, ultrasound findings, time interval for diagnosis, time to surgery and histology. Results: One hundred and fifty patients (52 under 5 weeks and 98 over 5 weeks’ gestation) were incorporated into this study. The primary presenting symptoms were pain and vaginal bleeding. Suboptimal rise in serial beta HCG (performed 48 hours apart) was seen in 69 patients (46%) while other 81 patients (54%) had confirmed ectopic on USS and were offered surgical management after the scan. One hundred forty for women (96%) went for surgical management and one patient had conservative management as she was asymptomatic with low HCG(less than 1000IU) at the first visit and rapid drop in serial BHG results. Fifty three women (35%) had surgery on the same day when they had ectopic pregnancies seen on USS, 63 (42%) went to theatre for surgery between 0-6 days, while 34 patients (23%) had surgery between 7-14 days of USS. All women were operated through laparoscopic route and tubal ectopic pregnancies were confirmed at laparoscopy. There was no negative laparoscopy in our study period. Conclusion: Judicious and timely surgical intervention made it possible to treat every case through laparoscopic route with zero negative laparoscopy rate.

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HEPATITIS B AND C: FREQUENCY, MODES OF TRANSMISSION AND RISK FACTORS ALONG WITH SOME UNORTHODOX ROUTES OF SPREAD

Pakistan Journal of Public Health ◽

10.32413/pjph.v9i3.273 ◽

2020 ◽

Vol 9 (3) ◽

pp. 161-165

Author(s):

Iftikhar Haider Naqvi ◽

Abu Talib ◽

Gohar Baloch ◽

Khalid Mahmood ◽

Zahid Qadari

Keyword(s):

Risk Factors ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Dental Treatment ◽

Significant Risk ◽

Transmission Risk ◽

Retrospective Case ◽

Leech Therapy ◽

Ear Piercing

Background: Pakistan's being a country placed in intermediate endemicity zone of HBV and HCV, with rising population, there is lack scarcity of knowledge about transmission of risk factors specially unorthodox and frequency of this health challenge. Methods: A retrospective case control study where case records of all patients aged from 18 - 70 years from 2012 to 2017 with either gender diagnosed as chronic hepatitis B and C were included. Information about shave from barber-shop, sharing of toothbrush at home, tattooing, cautery, and ear piercing were collected. Information about unorthodox risks for transmission of HBV and HCV, like skin branding, cupping of blood, circumcision by the barber, sharing of tooth brushes and leech therapy was collected. Results: Among 1134 patients of chronic hepatitis B (HBV) and chronic hepatitis C (HCV), Age > 35 years, shave from barber and dental treatment were found to be risk factor for both HCV and HBV transmission. Amongst unorthodox risk factors like skin branding, cupping of blood, circumcision by the barber, sharing of tooth brushes and leech therapy, only cupping of blood (Hijama) was a significant risk for transmission of both HBV and HCV. Conclusion: Viral related chronic hepatitis is frequently reported problem in this part of the world where HCV supersedes HBV. Socieodemographic factor like age > 35 year, shave from barbers and dental treatment were risk factors for transmission of both HCV and HBV. Among orthodox routes of transmission blood cupping (hijama) has shown as a significant transmission risk for both HCV and HBV.

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Ectopic pregnancy at the Gambian Tertiary hospital

African Health Sciences ◽

10.4314/ahs.v21i1.38 ◽

2021 ◽

Vol 21 (1) ◽

pp. 295-303

Author(s):

Matthew Anyanwu ◽

Grace Titilope

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Tertiary Hospital ◽

Clinical Feature ◽

Chi Square ◽

Mortality And Morbidity ◽

Significant Burden ◽

Incidence Risk ◽

Ectopic Pregnancies ◽

The Tropics

Background/Aims: Ectopic pregnancy is a gynaecological emergency with significant burden of maternal mortality and morbidity in the tropics. The incidence reported in the literature range from 1:60 to 1:250 pregnancies. The aim was to determine incidence and risk factors of ectopic pregnancy in the Gambia. Methodology: A longitudinal study of ectopic pregnancy at Gambian tertiary hospital from January 2016 to April 2018. Data was collected from patients’ folders, entered into SPSS version 20 and analysed with de- scriptive statistics. The test of variation and significance was by ANOVA and Chi-square respectively with error margin set at 0.05 and confidence interval of 95%. Results: A total number of 2562 pregnancies were recorded, 43 were ectopic pregnancies. The estimated incidence was 0.2%. Majority of the patients were between 26 – 35 years (56%), primiparous (32%), heterogeneous marriage (82%) and housewives (86%). Occupation was not associated with ruptured or unruptured ectopic pregnancy (p-0.421). Low parity was associated with more ectopic pregnancy than high parity (p-0.001). The commonest clinical feature was abdominal pain (65.1%), whilst the most prominent risk factors were pelvic inflamma- tory disease (27.9%) and previous abortion (23.3%). Ectopic pregnancy was seasonal. Conclusion: The incidence rate of 0.2% was in the range reported in the literature. Low parity, previous abortion and pelvic inflammatory disease were the risk factors. Keywords: Ectopic; pregnancy; incidence; risk factors.

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Differences in Risk Factors for Retinopathy of Prematurity Development in Paired Twins: A Chinese Population Study

The Scientific World JOURNAL ◽

10.1155/2014/212183 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Gordon S. K. Yau ◽

Jacky W. Y. Lee ◽

Victor T. Y. Tam ◽

Stan Yip ◽

Edith Cheng ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Retinopathy Of Prematurity ◽

Very Low Birth Weight ◽

Significant Risk ◽

The Mean ◽

Record Review ◽

Chinese Twins ◽

Retrospective Medical Record Review

Purpose.To determine the differences in risk factors for retinopathy of prematurity (ROP) in paired twins.Methods.A retrospective medical record review was performed for all paired twins screened for ROP between 2007 and 2012. Screening was offered to very low birth weight (≤1500 grams) and preterm (≤32 weeks) neonates. Twins 1 and 2 were categorized based on the order of delivery. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP.Results.In 34 pairs of Chinese twins, the mean gestational age (GA) was 30.2 ± 2.0 weeks. In Twin 1, smaller GA (OR = 0.44,P=0.02), higher mean oxygen concentration (OR = 1.34,P=0.03), presence of thrombocytopenia (OR = 1429.60,P<0.0001), and intraventricular hemorrhage (OR = 18.67,P=0.03) were significant risk factors for ROP. For Twin 2, a smaller GA (OR = 0.45,P=0.03) was the only risk factor. There were no significant risk factors for ROP in Twin 1 or Twin 2 on multivariate analysis.Conclusion.In Chinese twin pairs, smaller GA was the only common risk factor for ROP while Twin 1 was more susceptible to the postnatal risks for ROP.

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A clinical study of trends of ectopic pregnancy and its management in a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20195330 ◽

2019 ◽

Vol 8 (12) ◽

pp. 4834

Author(s):

Chandana M. Puttaraju ◽

Nagothi Nagendra Prasad ◽

M. P. A. Sailakshmi

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Sex Education ◽

Descriptive Analysis ◽

Tertiary Care ◽

Diagnostic Tools ◽

Care Hospital ◽

Care Teaching ◽

Β Hcg ◽

Ectopic Pregnancies

Background: Ectopic gestation is a gynaecological emergency which culminates in pregnancy loss and causes significant maternal morbidity, mortality besides jeopardizing future conception. The study discusses the incidence, risk factors, symptomatology and management of ectopic pregnancy in a tertiary care teaching hospital.Methods: This was a prospective study of 45 cases of ectopic pregnancies at a tertiary care teaching hospital from January 2012 to December 2013. Information was collected in a structured proforma, tabulated and descriptive analysis was carried out.Results: The incidence of ectopic pregnancy was 1.17%. Majority of the patients (80%) belonged to 20-30 yrs age group. Second gravidas predominated (42.2%). Fallopian tube was the most common site (95.5%). Rudimentary horn ectopic accounted for 4.65%. Previous abdominopelvic surgery (31.1%), IUCD usage (22.2%), PID (20%), abortions (20%), tubectomy (15.5%) were the principal risk factors. 42% of the patients had no risk factor. The triad of amenorrhea, bleeding per vaginum and abdominal pain was seen in 51.1% of cases. Ultrasound, UPT, β-hCG estimation were the diagnostic tools. Ruptured ectopic pregnancy accounted for 64.4%. Nearly 95.5% of patients underwent surgery; salpingectomy (76%). Methotrexate was successful in 4.44%. There was no maternal mortality.Conclusions: Mostly diagnosis, prompt surgical or medical management is cornerstone of treatment. Primary prevention such as improved access to family planning services, sex education, treatment of STI, PID, surgical asepsis and haemostasis, implementing legislation for dispensing MTP drugs ameliorate risk factors and hence reduce ectopic pregnancy.

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