scholarly journals Diagnostic Criteria and Treatment Modalities of Ectopic Pregnancies: A Literature Review

2021 ◽  
pp. 83-94
Author(s):  
Ibrahim A. Abdelazim ◽  
Mohannad AbuFaza ◽  
Svetlana Shikanova ◽  
Bakyt Karimova
Keyword(s):  
Positive Predictive Value ◽  
Ectopic Pregnancy ◽  
Diagnostic Criteria ◽  
Predictive Value ◽  
Dose Regimen ◽  
Healthcare Providers ◽  
Human Reproduction ◽  
Treatment Modalities ◽  
Β Hcg ◽  
Interstitial Ectopic Pregnancy

Background: Ruptured ectopic or extrauterine pregnancy (EP) is responsible for 6% of maternal deaths in the first trimester. This review was designed to summarise the diagnostic criteria and treatment modalities of EPs. Methods: Recent guidelines of the international societies of obstetrics and gynaecology, including the Royal College of Obstetricians and Gynaecologists (RCOG), the American College of Obstetricians and Gynecologists (ACOG), and the European Society of Human Reproduction and Embryology (ESHRE), were reviewed to summarise the diagnostic criteria and treatment modalities of EPs. Results: A minimum β-human chorionic gonadotropin (β-hCG) rise of ≥35% in 48 hours was suggested to diagnose intrauterine pregnancy. A β-hCG rise <35% in 48 hours has 96.2% positive predictive value, 69.7% negative predictive value, and 80.2% overall accuracy in predicting EPs. The blob sign has >90% positive predictive value in diagnosing EPs in symptomatic females with positive β-hCG and no definite intrauterine gestational sac by transvaginal sonography. The interstitial ectopic pregnancy and cornual pregnancy are two separate entities of EPs. Interstitial line sign has 80% sensitivity and 98% specificity in diagnosing interstitial ectopic pregnancy. A meta-analysis reported 89% overall success rate for methotrexate in treatment of EPs; the multi-dose regimen was significantly more successful than the single-dose regimen. Conclusion: Institutes and healthcare providers should follow clear guidelines and/or protocols for the management of EPs. Institutes should implement competency-directed training programmes to increase healthcare providers’ skills to diagnose and treat EP variants using different modalities.

scholarly journals Comparison of transvaginal and transabdominal ultrasonography in the diagnosis of ectopic pregnancy

2014 ◽  
Vol 39 (3) ◽  
pp. 104-108 ◽  
Author(s):  
MN Nahar ◽  
MA Quddus ◽  
A Sattar ◽  
M Shirin ◽  
A Khatun ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Ectopic Pregnancy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Transvaginal Ultrasonography ◽  
Histopathological Diagnosis ◽  
College Hospital ◽  
Diagnostic Modality ◽  
Cross Sectional ◽  
Transabdominal Ultrasonography

This cross sectional study was carried out in the department of Radiology and Imaging, Dhaka Medical College Hospital from July 2008 to June 2010 to compare the accuracy of transvaginal ultrasonography and transabdominal ultrasonography in the diagnosis of clinically suspected cases of ectopic pregnancy. Initially 60 patients with clinical suspicion of ectopic pregnancy were included in this study after analyzing selection criteria 30 patients underwent both transvaginal and transabdominal ultrasonography. ‘Histopathological diagnosis’ was considered gold standard against which accuracies of two diagnostic modalities were compared. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of transabdominal ultrasonography as a diagnostic modality in evaluation of suspected ectopic pregnancy were 73.1%, 75%, 95%, 30% and 73.3% respectively where as transvaginal ultrasonography was found to have 92.3% sensitivity, 75% specificity, 96% positive predictive value, 60% negative predictive value and 90% accuracy. Transvaginal ultrasonography was superior to transabdominal ultrasonography in the evaluation of suspected ectopic pregnancies .so, transvaginal ultrasonography is important for early and accurate diagnosis of ectopic pregnancy. DOI: http://dx.doi.org/10.3329/bmrcb.v39i3.20309 Bangladesh Med Res Counc Bull 2013; 39: 104-108

scholarly journals Clinicoradiological features of intraneural perineuriomas obviate the need for tissue diagnosis

2018 ◽  
Vol 129 (4) ◽  
pp. 1034-1040 ◽  
Author(s):  
Thomas J. Wilson ◽  
B. Matthew Howe ◽  
Shelby A. Stewart ◽  
Robert J. Spinner ◽  
Kimberly K. Amrami
Keyword(s):  
Positive Predictive Value ◽  
Contrast Enhancement ◽  
Negative Predictive Value ◽  
Diagnostic Criteria ◽  
Predictive Value ◽  
High Specificity ◽  
Mr Images ◽  
Cancer History ◽  
Tissue Diagnosis ◽  
Intraneural Perineurioma

OBJECTIVEThis study aimed to define a set of clinicoradiological parameters with a high specificity for the diagnosis of intraneural perineurioma, obviating the need for operative tissue diagnosis.METHODSThe authors retrospectively reviewed MR images obtained in a large cohort of patients who underwent targeted fascicular biopsy and included only those patients for whom the biopsy yielded a diagnosis. Clinical and radiological findings were then tested for their ability to predict a tissue diagnosis of intraneural perineurioma. The authors propose a new set of diagnostic criteria, referred to as the Perineurioma Diagnostic Criteria. The sensitivity, specificity, positive predictive value, and negative predictive value of several clinicoradiological methods of diagnosis were compared.RESULTSA total of 195 patients who underwent targeted fascicular biopsy were included in the cohort, of whom 51 had a tissue diagnosis of intraneural perineurioma. When the clinicoradiological methods used in this study were compared, the highest sensitivity (0.86), negative predictive value (0.95), and F1 score (0.88) were observed for the decision trees generated in C5.0 and rPart, whereas the highest specificity (1.0) and positive predictive value (1.0) were observed for the Perineurioma Diagnostic Criteria.CONCLUSIONSThis study identified clinical and radiological features that are associated with a diagnosis of perineurioma. The Perineurioma Diagnostic Criteria were determined to be the following: 1) no cancer history, 2) unifocal disease, 3) moderate to severe hyperintensity on T2-weighted MR images, 4) moderate to severe contrast enhancement, 5) homogeneous contrast enhancement, 6) fusiform shape, 7) enlargement of the involved nerves, and 8) age ≤ 40 years. Use of the Perineurioma Diagnostic Criteria obviates the need for tissue diagnosis when all of the criteria are satisfied.

scholarly journals Evaluation of the Performance of Haemoglobin Colour Scale and Comparison with HemoCue Haemoglobin Assay in Diagnosing Childhood Anaemia: A Field Validation Study

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Maduka Donatus Ughasoro ◽  
Anazoeze Jude Madu ◽  
Iheoma Clara Kela-Eke
Keyword(s):  
Positive Predictive Value ◽  
Haemoglobin Level ◽  
Predictive Value ◽  
Healthcare Providers ◽  
Field Validation ◽  
Poor Countries ◽  
Colour Scale ◽  
Resource Poor ◽  
Underlying Causes ◽  
Sensitivity Specificity

Background. Anaemia in children has high mortality. We present the results of assessment of the accuracy of Haemoglobin Colour Scale in identifying anaemia compared with HemoCue assay. Methods. The presence of anaemia in 524 children from four communities was screened using the Haemoglobin Colour Scale (HCS) and HemoCue assay. Independent healthcare providers that estimated the haemoglobin level using Hb-301 haemoglobinometer were different from those that read the colour scale. The sensitivity, specificity, positive predictive value, and negative predictive value were estimated. Results. Of the 524 children surveyed, 44.5% (233/524), 50% (262/524), and 32.2% (168/524) were found to be anaemic using the HemoCue, HCS (p= 0.25), and clinical pallor (p=0.03) respectively. Using the HemoCue as standard, the sensitivity of the HCS and clinical pallor was 89.1% and 72.1%, respectively, and specificity 90.2% and 84.6%, respectively. 74.7 % of the colour scale result was within the 1.0g/dl of the HemoCue reading and 23 % was within 2.0g/dl. Conclusion. The HCS can improve the ability to detect anaemia especially where the use of the HemoCue is not feasible as in the resource poor countries. However, every case of anaemia requires further investigation to determine the underlying causes.

scholarly journals Measuring the Value of a Practical Text Mining Approach to Identify Patients With Housing Issues in the Free-Text Notes in Electronic Health Record: Findings of a Retrospective Cohort Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Elham Hatef ◽  
Gurmehar Singh Deol ◽  
Masoud Rouhizadeh ◽  
Ashley Li ◽  
Katyusha Eibensteiner ◽  
...  
Keyword(s):  
Text Mining ◽  
Positive Predictive Value ◽  
Pattern Matching ◽  
Predictive Value ◽  
Healthcare Providers ◽  
Improve Patient Care ◽  
Free Text ◽  
Study Population ◽  
Electronic Health ◽  
Matching Techniques

Introduction: Despite the growing efforts to standardize coding for social determinants of health (SDOH), they are infrequently captured in electronic health records (EHRs). Most SDOH variables are still captured in the unstructured fields (i.e., free-text) of EHRs. In this study we attempt to evaluate a practical text mining approach (i.e., advanced pattern matching techniques) in identifying phrases referring to housing issues, an important SDOH domain affecting value-based healthcare providers, using EHR of a large multispecialty medical group in the New England region, United States. To present how this approach would help the health systems to address the SDOH challenges of their patients we assess the demographic and clinical characteristics of patients with and without housing issues and briefly look into the patterns of healthcare utilization among the study population and for those with and without housing challenges.Methods: We identified five categories of housing issues [i.e., homelessness current (HC), homelessness history (HH), homelessness addressed (HA), housing instability (HI), and building quality (BQ)] and developed several phrases addressing each one through collaboration with SDOH experts, consulting the literature, and reviewing existing coding standards. We developed pattern-matching algorithms (i.e., advanced regular expressions), and then applied them in the selected EHR. We assessed the text mining approach for recall (sensitivity) and precision (positive predictive value) after comparing the identified phrases with manually annotated free-text for different housing issues.Results: The study dataset included EHR structured data for a total of 20,342 patients and 2,564,344 free-text clinical notes. The mean (SD) age in the study population was 75.96 (7.51). Additionally, 58.78% of the cohort were female. BQ and HI were the most frequent housing issues documented in EHR free-text notes and HH was the least frequent one. The regular expression methodology, when compared to manual annotation, had a high level of precision (positive predictive value) at phrase, note, and patient levels (96.36, 95.00, and 94.44%, respectively) across different categories of housing issues, but the recall (sensitivity) rate was relatively low (30.11, 32.20, and 41.46%, respectively).Conclusion: Results of this study can be used to advance the research in this domain, to assess the potential value of EHR's free-text in identifying patients with a high risk of housing issues, to improve patient care and outcomes, and to eventually mitigate socioeconomic disparities across individuals and communities.

scholarly journals the Forecast of Weekly β-HCG and Progesterone for Early Pregnancy

2020 ◽  
Author(s):  
Yan Yang ◽  
Jie Duan ◽  
Yan Wang ◽  
Xin Du ◽  
Wei wu ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Sensitivity And Specificity ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Intrauterine Pregnancy ◽  
The Status ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Sensitivity Specificity

Abstract Background: Serum beta human chorionic gonadotropin (β-HCG) and progesterone levels are both monitored to assess the status of early pregnancy. Deviations from the expected levels of these hormones may indicate abnormal pregnancy. However; the relationship between progesterone levels and the magnitude of weekly β-HCG increases, as well as their combined predictive value for pregnancy outcome, is still debated. This study evaluated the predictive value of weekly serum β-HCG multiplication and progesterone levels on early pregnancy outcomes. Methods: This retrospective study reviewed patients with pregnancy confirmed by β-HCG in our hospital. Weekly β-HCG and progesterone levels were analyzed and ultrasonography was performed as necessary to determine outcomes at 13 weeks gestation. Results: There were 277 viable intrauterine pregnancies, 102 spontaneous abortions, and 59 ectopic pregnancies. At weeks 5-8, β-HCG was multiplied by 6.76, 6.21, 2.11, and 0.68 respectively. Logit models were established with the logarithm of HCG (LHCG) and progesterone as independent variables to predict viable intrauterine pregnancy. The sensitivity, specificity, and overall accuracy for the models were 85.9% and 90.25%, 44.72% and 72.04%, and 70.77% and 83.6%, respectively. When progesterone was ≥10 ng/ml, the sensitivity and specificity for predicting viable pregnancy were 90.25% and 72.04%, respectively. When progesterone was <10 ng/ml, the sensitivity and specificity for predicting ectopic pregnancy and complete abortion were 94.2% and 81.57%78.86%, respectively. Progesterone values were significantly different for viable pregnancy, abortion, and ectopic pregnancy (p<0.0001). A joint progesterone and LHCG model to predict viable pregnancy had 88.8% sensitivity, 75.2% specificity, and 83.8% overall prediction accuracy.Conclusion: Weekly β-HCG multiplication and progesterone levels can predict early pregnancy outcomes individually or jointly.

scholarly journals the Forecast of Weekly β-HCG and Progesterone for Early Pregnancy

2019 ◽  
Author(s):  
Yan Yang ◽  
Jie Duan ◽  
Yan Wang ◽  
Xin Du
Keyword(s):  
Ectopic Pregnancy ◽  
Sensitivity And Specificity ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Intrauterine Pregnancy ◽  
The Status ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Sensitivity Specificity

Abstract Background: Serum beta human chorionic gonadotropin (β-HCG) and progesterone levels are both monitored to assess the status of early pregnancy. Deviations from the expected levels of these hormones may indicate abnormal pregnancy. However; the relationship between progesterone levels and the magnitude of weekly β-HCG increases, as well as their combined predictive value for pregnancy outcome, is still debated. This study evaluated the predictive value of weekly serum β-HCG multiplication and progesterone levels on early pregnancy outcomes. Methods: This retrospective study reviewed patients with pregnancy confirmed by β-HCG in our hospital. Weekly β-HCG and progesterone levels were analyzed and ultrasonography was performed as necessary to determine outcomes at 13 weeks gestation. Results: There were 277 viable intrauterine pregnancies, 102 spontaneous abortions, and 59 ectopic pregnancies. At weeks 5-8, β-HCG was multiplied by 6.76, 6.21, 2.11, and 0.68 respectively. Logit models were established with the logarithm of HCG (LHCG) and progesterone as independent variables to predict viable intrauterine pregnancy. The sensitivity, specificity, and overall accuracy for the models were 85.9% and 90.3%, 44.72% and 72%, and 70.77% and 83.6%, respectively. When progesterone was ≥10 ng/ml, the sensitivity and specificity for predicting viable pregnancy were 90.25% and 72.04%, respectively. When progesterone was <10 ng/ml, the sensitivity and specificity for predicting ectopic pregnancy and complete abortion were 94.2% and 81.57%, respectively. Progesterone values were significantly different for viable pregnancy, abortion, and ectopic pregnancy (p<0.0001). A joint progesterone and LHCG model to predict viable pregnancy had 88.8% sensitivity, 75.2% specificity, and 83.8% overall prediction accuracy. Conclusion: Weekly β-HCG multiplication and progesterone levels can predict early pregnancy outcomes individually or jointly.

scholarly journals Retrospective Evaluation of Patients Treated for Ectopic Pregnancy: Experience of a Tertiary Center

2020 ◽  
Vol 42 (12) ◽  
pp. 800-804
Author(s):  
Özge Kömürcü Karuserci ◽  
Seyhun Sucu
Keyword(s):  
Ectopic Pregnancy ◽  
Treatment Protocol ◽  
Expectant Management ◽  
Additional Treatment ◽  
Treatment Modalities ◽  
Cesarean Scar Pregnancy ◽  
Laboratory Findings ◽  
Interstitial Pregnancy ◽  
Tertiary Center ◽  
Β Hcg

Abstract Objective In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. Methods In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. Results Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. Conclusion The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.

The Validation of the Edinburgh Post-natal Depression Scale on a Community Sample

1990 ◽  
Vol 157 (2) ◽  
pp. 288-290 ◽  
Author(s):  
Lynne Murray ◽  
Andrew D. Carothers
Keyword(s):  
Primary Care ◽  
Positive Predictive Value ◽  
Diagnostic Criteria ◽  
Predictive Value ◽  
Post Partum ◽  
Community Sample ◽  
Depression Scale ◽  
Post Natal Depression ◽  
Large Random Sample ◽  
Sensitivity Specificity

The Edinburgh Post-natal Depression Scale (EPDS) was validated on a community sample of 702 women at six weeks post-partum using Research Diagnostic Criteria for depression. The estimates of sensitivity, specificity and positive predictive value, being based on a large random sample, offer improved guidelines for the use of the EPDS by the primary care team.

scholarly journals A novel approach in non-surgical management of tubal ectopic: combination of minimally invasive technique under ultrasound guidance with systemic methotrexate based on initial beta-HCG levels

2021 ◽  
Author(s):  
Mayoukh Kumar Chakraborty ◽  
Shalini Gainder ◽  
Subhas Chandra Saha ◽  
Rashmi Bagga
Keyword(s):  
Single Dose ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Surgical Management ◽  
Dose Regimen ◽  
Ultrasound Guided ◽  
Group 3 ◽  
Group 2 ◽  
Β Hcg ◽  
Group 1

Background: Single dose methotrexate is the most preferred method of non-surgical management of unruptured tubal ectopic. A 2-dose regimen is suggested to treat tubal ectopic with higher trophoblastic cell load. Minimally invasive technique of ultrasound guided intracardiac KCL instillation along with systemic methotrexate has been in use even for live ectopic pregnancy. Objective of the study was to evaluate the success rate of single dose regimen of MTX (Methotrexate), 2-dose regimen of MTX and ultrasound guided instillation of intracardiac KCl in three different cohort of unruptured tubal ectopic pregnancy with an attempt to increase success of non-surgical management.Methods: Fifty-eight women with unruptured tubal ectopic pregnancy were assigned to treatment protocols according to the initial β-HCG levels and presence/absence of FCA (fetal cardiac activity). Group 1: presence of FCA in the tubal ectopic; Group 2: initial β-HCG ≤5000 IU/ml; Group 3:  initial β-HCG ≥5000 IU/ml without FCA. Women in group 1 were treated with ultrasound guided instillation of intracardiac KCl combined with systemic MTX. While women in group 2 were administered single dose regimen of MTX and group 3 received 2-dose regimen of MTX.Results: Overall success rate of non-surgical management was 89.3% across all groups. Success rate in Group 1 was 78.6%. Success rate was 93.1% in group 2 while 92.3% in group 3. Rupture rate was 1.7% in the present study.Conclusions: For non-surgical management categorizing and treating is an option with good result. Women with presence of cardiac activity can opt for non-surgical option with likely resolution in 78% cases.

scholarly journals Developing and Validating an Algorithm to Identify Incident Chronic Dialysis Patients Using Administrative Data

2020 ◽  
Author(s):  
Dino Gibertoni ◽  
Claudio Voci ◽  
Marica Iommi ◽  
Benedetta D'Ercole ◽  
Marcora Mandreoli ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Administrative Data ◽  
Predictive Value ◽  
Healthcare Providers ◽  
High Sensitivity ◽  
Case Definition ◽  
Chronic Dialysis ◽  
Administrative Databases ◽  
Dialysis Patients ◽  
Case Definitions

Background: Administrative healthcare databases are widespread and are often standardized with regard to their content and data coding, thus they can be used also as data sources for surveillance and epidemiological research. Chronic dialysis requires patients to frequently access hospital and clinic services, causing a heavy burden to healthcare providers. This also means that these patients are routinely tracked on administrative databases, yet very few case definitions for their identification are currently available. The aim of this study was to develop two algorithms derived from administrative data for identifying incident chronic dialysis patients and test their validity compared to the reference standard of the regional dialysis registry. Methods: The algorithms are based on data retrieved from hospital discharge records (HDR) and ambulatory specialty visits (ASV) to identify incident chronic dialysis patients in an Italian region. Subjects are included if they have at least one event in the HDR or ASV databases based on the ICD9-CM dialysis-related diagnosis or procedure codes in the study period. Exclusion criteria comprise non-residents, prevalent cases, or patients undergoing temporary dialysis, and are evaluated only on ASV data by the first algorithm, on both ASV and HDR data by the second algorithm. We validated the algorithms against the Emilia-Romagna regional dialysis registry by searching for incident patients in 2014. Results: Algorithm 1 identified 680 patients and algorithm 2 identified 676 initiating dialysis in 2014, compared to 625 patients included in the regional dialysis registry. Sensitivity for the two algorithms was respectively 90.8% and 88.4%, positive predictive value 84.0% and 82.0%, and percentage agreement was 77.4% and 74.1%. Conclusions: These results suggest that administrative data have high sensitivity and positive predictive value for the identification of incident chronic dialysis patients. Algorithm 1, which showed the higher accuracy and has a simpler case definition, can be used in place of regional dialysis registries when they are not present or sufficiently developed in a region, or to improve the accuracy and timeliness of existing registries.

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