Pregnancy of Unknown Location and Ectopic Pregnancy

2018 ◽  
Author(s):  
Bri Anne McKeon ◽  
Sarah Lambeth
Keyword(s):  
Early Pregnancy ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Early Evaluation ◽  
Diagnostic Strategies ◽  
Ectopic Pregnancies ◽  
Review Current ◽  
Pregnancy Of Unknown Location

The ability to diagnose early pregnancy and manage normal and abnormal findings associated with early pregnancy is important and commonly used in the medical care of women of reproductive age. The purpose of this review is to describe the evaluation of early pregnancy, discuss indications for early evaluation of pregnancy location, delineate diagnostic strategies to further evaluate pregnancy of unknown location, and review current treatment strategies for ectopic pregnancies, both tubal and nontubal in location.   This review contains 11 figures, 4 tables and 39 references Key words: early pregnancy, ectopic, human chorionic gonadotropin, methotrexate, pregnancy of unknown location, salpingectomy, salpingostomy, ultrasound criteria, vaginal bleeding

scholarly journals Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 884
Author(s):  
Chiara Belcaro ◽  
Federica Scrimin ◽  
Alessandro Mangogna ◽  
Emanuele Filippo Galati ◽  
Stefania Biffi ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Low Risk ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Female Population ◽  
Diagnostic Strategies ◽  
Study Results

Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system’s resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (n = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination.

scholarly journals Chronic Niche Inflammation in Endometriosis-Associated Infertility: Current Understanding and Future Therapeutic Strategies

2018 ◽  
Vol 19 (8) ◽  
pp. 2385 ◽  
Author(s):  
Yi-Heng Lin ◽  
Ya-Hsin Chen ◽  
Heng-Yu Chang ◽  
Heng-Kien Au ◽  
Chii-Ruey Tzeng ◽  
...  
Keyword(s):  
Stem Cell ◽  
Treatment Strategies ◽  
Oocyte Retrieval ◽  
Reproductive Age ◽  
Immunomodulatory Effects ◽  
Women Of Reproductive Age ◽  
Ovulatory Dysfunction ◽  
Potential Applications ◽  
Implantation And Pregnancy Rates

Endometriosis is an estrogen-dependent inflammatory disease that affects up to 10% of women of reproductive age and accounts for up to 50% of female infertility cases. It has been highly associated with poorer outcomes of assisted reproductive technology (ART), including decreased oocyte retrieval, lower implantation, and pregnancy rates. A better understanding of the pathogenesis of endometriosis-associated infertility is crucial for improving infertility treatment outcomes. Current theories regarding how endometriosis reduces fertility include anatomical distortion, ovulatory dysfunction, and niche inflammation-associated peritoneal or implantation defects. This review will survey the latest evidence on the role of inflammatory niche in the peritoneal cavity, ovaries, and uterus of endometriosis patients. Nonhormone treatment strategies that target these inflammation processes are also included. Furthermore, mesenchymal stem cell-based therapies are highlighted for potential endometriosis treatment because of their immunomodulatory effects and tropism toward inflamed lesion foci. Potential applications of stem cell therapy in treatment of endometriosis-associated infertility in particular for safety and efficacy are discussed.

scholarly journals Chronic Vitamin E Deficiency in Rural Bangladeshi Women

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 648-648
Author(s):  
Sabi Gurung ◽  
Kerry Jean Schulze ◽  
Abu Ahmed Shamim ◽  
Saijuddin Shaikh ◽  
Hasmot Ali ◽  
...  
Keyword(s):  
Vitamin E ◽  
Early Pregnancy ◽  
Post Partum ◽  
Reproductive Age ◽  
Rural Setting ◽  
Women Of Reproductive Age ◽  
Vitamin E Deficiency ◽  
Tocopherol Concentration ◽  
Pregnancy And Postpartum ◽  
Cluster Randomized

Abstract Objectives Vitamin E deficiency (VED) appears to be common in rural areas of South Asia, with prevalence of ≥ 50% reported among women of reproductive age. Long term deficiency may impart neurological damage, but little information exists about persistence of VED. We provide initial estimates of chronic VED (CVED) in women of reproductive age living in Gaibandha District, a typical rural setting in NW Bangladesh. Methods We assessed α-tocopherol concentrations by HPLC in early pregnancy and 3-month postpartum (PP) plasma samples of women participating in biochemical sub-studies of JiVitA-1 (n = 2,319), a cluster-randomized, placebo-controlled, weekly vitamin A or β-carotene supplementation trial from 2001–7, and JiVitA-3 (N = 2,073), a cluster-randomized, daily multiple micronutrient (MMS) versus iron-folic acid (IFA) supplementation trial from 2008–12. VED was conventionally defined by an α-tocopherol concentration < 12 μmol/L and CVED as α-tocopherol < 12 μmol/L at both early pregnancy and postpartum assessments, an interval spanning a median (IQR) of 9.4 (2.8) months. Results Across both trials combined (N = 4,392), the mean ± SD plasma α-tocopherol concentration and prevalence of VED in early pregnancy and at 3 months post-partum was 11.28 ± 4.07 and 10.86 ± 4.41 μmol/L, and 53.5% and 42.2%, respectively. In JiVitA-3, the post-partum prevalence of VED among women not previously receiving MMS (containing 15 mg of vitamin E as all-rac-α-tocopheryl acetate) was 57.5% (vs 42.5% among MMS recipients, p < 0.001). The prevalence of CVED among women in both trials combined was 32.0% (34.45% in JiVitA-1 and 26.65% in JiVitA-3, IFA group only). Across a maternal age range of 11–43 [median: 20 (IQR: 8) years, risk of CVED decreased comparably per year of age in the JiVitA-1 [OR = 0.94 (95% CI: 0.93–0.95)] and JiVitA-3 [OR = 0.93 (95% CI:0.92–0.95)] trials. Conclusions In rural NW Bangladesh, where over half of women enter pregnancy vitamin E-deficient, about one-third are also deficient postpartum, ∼10 months later, providing a provisional estimate of chronic maternal vitamin E deficiency in a South Asian setting. Funding Sources Bill & Melinda Gates Foundation (Grant GH614, OPP1141435) and US Agency for International Development (AID (HRN-A-00–97-00015–00).

scholarly journals Delayed Relapse of Paracoccidioidomycosis in the Central Nervous System: A Case Report

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Rifat Rahman ◽  
Leela Davies ◽  
Amir M Mohareb ◽  
Paula M Peçanha-Pietrobom ◽  
Nirav J Patel ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Case Report ◽  
Treatment Strategies ◽  
Current Treatment ◽  
System A ◽  
History Of ◽  
The Central Nervous System ◽  
Relapsed Disease ◽  
Review Current

Abstract Paracoccidioidomycosis is a dimorphic fungal infection endemic in Latin America. We report a patient with a history of pulmonary paracoccidioidomycosis who presented with relapsed disease in the central nervous system 4 years after initial treatment. We review current treatment strategies for paracoccidioidomycosis and neuroparacoccidioidomycosis.

scholarly journals Precision global health and comorbidity: a population-based study of 16 357 people in rural Uganda

2018 ◽  
Vol 15 (147) ◽  
pp. 20180248 ◽  
Author(s):  
Goylette F. Chami ◽  
Narcis B. Kabatereine ◽  
Edridah M. Tukahebwa ◽  
David W. Dunne
Keyword(s):  
Low Socioeconomic Status ◽  
Low Income ◽  
Treatment Strategies ◽  
Disease Diagnosis ◽  
Reproductive Age ◽  
Low Income Countries ◽  
Human Phenotype ◽  
Diagnostic Strategies ◽  
Symptom Profiles ◽  
Comorbidity Burden

In low-income countries, complex comorbidities and weak health systems confound disease diagnosis and treatment. Yet, data-driven approaches have not been applied to develop better diagnostic strategies or to tailor treatment delivery for individuals within rural poor communities. We observed symptoms/diseases reported within three months by 16 357 individuals aged 1+ years in 17 villages of Mayuge District, Uganda. Symptoms were mapped to the Human Phenotype Ontology. Comorbidity networks were constructed. An edge between two symptoms/diseases was generated if the relative risk greater than 1, ϕ correlation greater than 0, and local false discovery rate less than 0.05. We studied how network structure and flagship symptom profiles varied against biosocial factors. 88.05% of individuals (14 402/16 357) reported at least one symptom/disease. Young children and individuals in worse-off households—low socioeconomic status, poor water, sanitation, and hygiene, and poor medical care—had dense network structures with the highest comorbidity burden and/or were conducive to the onset of new comorbidities from existing flagship symptoms, such as fever. Flagship symptom profiles for fever revealed self-misdiagnoses of fever as malaria and sexually transmitted infections as a potentially missed cause of fever in individuals of reproductive age. Network analysis may inform the development of new diagnostic and treatment strategies for flagship symptoms used to characterize syndromes/diseases of global concern.

scholarly journals Clinical and statistical assessment of the reproductive health of fertilized women in the Tyumen region and the risks of miscarriage in Western Siberia

2022 ◽  
pp. 198-204
Author(s):  
E. A. Mateykovich ◽  
I. I. Kukarskaya ◽  
T. V. Legalova
Keyword(s):  
Pregnant Women ◽  
Spontaneous Abortion ◽  
Birth Rate ◽  
Federal District ◽  
Medical Abortion ◽  
Reproductive Age ◽  
Steady Increase ◽  
Fertility Rates ◽  
Women Of Reproductive Age ◽  
Ectopic Pregnancies

Introduction. Loss of pregnancy remains an extremely acute public health problem today. Live birth accounts for only 30% of gestational outcomes, all other pregnancies that occur end in reproductive losses: 30% – implantation, 30% – postimplantation, 10% – spontaneous miscarriages. In conditions of declining birth rates, reducing reproductive losses is the most important element of the state’s demographic policy.Аim. Тo assess the reproductive health of women of fertile age in the Tyumen region, registered in antenatal clinics and other medical institutions in connection with pregnancy, as well as the risks associated with an increase in the frequency of diseases endemic for the West Siberian region.Materials and methods. The study used data from federal statistical observation. Statistical analysis of the data was carried out using the statistical program Statistica (version 13.0). Quantitative features are described by absolute and relative (percent) indicators. The difference is considered significant at p < 0.05. Results. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. The incidence of HIV and hepatitis C among pregnant women for five years and for each of the given nosologies exceeds 1% of the number of patients admitted under the supervision of health care facilities. At the same time, since 2018, the incidence of ectopic pregnancy associated with HIV has significantly increased (p >< 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in  the  Ural Federal District, as well as in  Russia  as a  whole. The  5-year dynamics of  registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. ><  0.05.Results. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in the Ural Federal District, as well as in Russia as a whole. The 5-year dynamics of registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. The incidence of HIV and hepatitis C among pregnant women for five years and for each of the given nosologies exceeds 1% of the number of patients admitted under the supervision of health care facilities. At the same time, since 2018, the incidence of ectopic pregnancy associated with HIV has significantly increased (p < 000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in  the  Ural Federal District, as well as in  Russia  as a  whole. The  5-year dynamics of  registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. ><  000.1). These data also indicate an increased risk of spontaneous abortion in HIV-infected pregnant women (p < 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control. Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in  the  Ural Federal District, as well as in  Russia  as a  whole. The  5-year dynamics of  registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate. >< 000.1). From 2016 to 2019, there has been a steady increase in the incidence of ectopic pregnancies and spontaneous abortion in primary pregnant women. The situation has improved somewhat in 2020. Noteworthy is the high share of medical abortion in birth control.Сonclusions. Despite the increase in the number of women of reproductive age, fertility rates are declining both in the Tyumen region and in  the  Ural Federal District, as well as in  Russia  as a  whole. The  5-year dynamics of  registered pregnancies in the Tyumen region correlates with the dynamics of the birth rate.

Breast Cancer Heterogeneity: Need to Review Current Treatment Strategies

2012 ◽  
Vol 4 (4) ◽  
pp. 225-231 ◽  
Author(s):  
Fayaz Malik ◽  
Hasan Korkaya ◽  
Shawn G. Clouthier ◽  
Max S. Wicha
Keyword(s):  
Breast Cancer ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Cancer Heterogeneity ◽  
Review Current

Problems in early pregnancy

2016 ◽  
Author(s):  
W. Colin Duncan
Keyword(s):  
Early Pregnancy ◽  
First Trimester ◽  
Repeated Measurements ◽  
Reproductive Age ◽  
Management Options ◽  
Medical Practitioners ◽  
Pelvic Ultrasonography ◽  
Maternal Morbidity And Mortality ◽  
Ectopic Pregnancies ◽  
Laparoscopic Salpingectomy

One in three women will present with problems, usually bleeding and/or pain, in early pregnancy prior to their planned maternity booking appointment at the end of the first trimester. The mainstay of investigation is pelvic ultrasonography. However, often the diagnosis is not clear and further ultrasound scans or repeated measurements of serum human chorionic gonadotropin concentrations are required. Most women with bleeding in early pregnancy will have an ongoing pregnancy and can be reassured. However, around 15% of pregnancies will miscarry in the first trimester. Management of miscarriage is often conservative but there are both surgical and medical, using misoprostol, management options. Importantly, approximately 1 in 80 pregnancies are ectopic pregnancies. These can be difficult to diagnose and are associated with increased maternal morbidity and mortality. Management is usually by laparoscopic salpingectomy or systemic methotrexate administration. As ectopic pregnancy can present to disparate medical practitioners it is important to have an awareness and suspicion of this condition as well as considering the possibility of pregnancy in all women of reproductive age.

scholarly journals Miscarriage and Anti TPO antibodies

2018 ◽  
Vol 8 (2) ◽  
pp. 1408-1411
Author(s):  
Santosh Pradhan ◽  
Keyoor Gautam
Keyword(s):  
Pregnant Women ◽  
Early Pregnancy ◽  
Thyroid Dysfunction ◽  
Reproductive Age ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Women Of Reproductive Age ◽  
Fetal Outcomes ◽  
Autoimmune Thyroid ◽  
Thyroglobulin Antibody

Autoimmune thyroid disorders are common in women of reproductive age. Anti-TPO antibody and thyroglobulin antibody are frequently found to be associated. Anti-TPO antibodies are responsible for the activation of complement and are thought to be significantly involved in thyroid dysfunction. In early pregnancy women with anti TPO antibodies are prone to develop subclinical or overt hypothyroidism leading to adverse obstetric and fetal outcomes. An association between the risk of a miscarriage and anti TPO antibodies has also been reported even in absence of overt thyroid dysfunction. However, screening for these antibodies and Levothyroxin supplement in anti TPO antibodies -positive euthyroid pregnant women has not been established yet.

scholarly journals Latent iron deficiency and iron deficiency anemia in pregnancy: effects on maternal and fetal health, possible ways to solve the problem

2021 ◽  
pp. 170-173
Author(s):  
A. P. Magomedova ◽  
N. A. Lomova ◽  
T. Eh. Karapetyan ◽  
E. Yu. Amiraslanov
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Oral Iron ◽  
Reproductive Age ◽  
Deficiency Anemia ◽  
Severe Anemia ◽  
Poor Treatment ◽  
Latent Iron Deficiency

Iron deficiency with or without anemia in pregnant women is quite common today. In fact, anemia affects nearly 30% of women of reproductive age, and its prevalence among pregnant women is estimated to be 38% worldwide. Although iron deficiency (IR) is not the only cause of anemia, it is the most prevalent one. Anemia-reduction strategies among pregnant women are often ineffective, and severe anemia can greatly increase the risk of maternal mortality, as reported by WHO. Now therefore, the current guidelines for screening and treatment of ID-anemia (IDA) in pregnant women and new-borns require change. Severe anemia can greatly increase the risk of maternal death and adversely affect a developing fetus and new-born. In this review, we analyse the available data on the epidemiology and the effects of iron deficiency on mothers and infants, current treatment strategies and screening recommendations, as well as examine the treatment of IDA in pregnant women and newborns and the problem of poor compliance in patients with latent iron deficiency. A continuous long-term course of administration of oral iron supplements is one of the components of success in the treatment of IDA, and particularly latent forms of iron deficiency in pregnant women. It is often the case that poor patients’ compliance with therapy leads to poor treatment outcomes and misleading conclusions about the ineffectiveness of oral iron dosage forms in the battle against IDA. The data we have analysed suggest the possibility of increasing compliance with IDA treatment in pregnant women.

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