Diagnosis and treatment of ectopic pregnancy

CMAJ. Canadian Medical Association Journal

Volumn 173, Issue 8, 2005, Pages 905-912

  Murray, Heather ^a,c   Baakdah, Hanadi ^b   Bardell, Trevor ^a   Tulandi, Togas ^b  

^a QUEEN S UNIVERSITY   (Canada)

^b MCGILL UNIVERSITY   (Canada)

^c QUEEN S UNIVERSITY   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

CHORIONIC GONADOTROPIN BETA SUBUNIT; METHOTREXATE; PROGESTERONE; ABORTIVE AGENT; CHORIONIC GONADOTROPIN;

ABDOMINAL PAIN; BLEEDING; CANADA; CLINICAL TRIAL; COMPARATIVE STUDY; DIAGNOSTIC PROCEDURE; ECHOGRAPHY; ECTOPIC PREGNANCY; EMERGENCY WARD; FIRST TRIMESTER PREGNANCY; HEMATOMA; HORMONE BLOOD LEVEL; HORMONE DETERMINATION; HUMAN; LAPAROSCOPIC SURGERY; PAIN; PRENATAL SCREENING; PROGESTERONE BLOOD LEVEL; REVIEW; SALPINGECTOMY; SALPINGOSTOMY; ADULT; BLOOD; DIFFERENTIAL DIAGNOSIS; FEMALE; LAPAROSCOPY; PREGNANCY;

ABORTIFACIENT AGENTS, NONSTEROIDAL; ADULT; CHORIONIC GONADOTROPIN; CHORIONIC GONADOTROPIN, BETA SUBUNIT, HUMAN; DIAGNOSIS, DIFFERENTIAL; FEMALE; HUMANS; LAPAROSCOPY; METHOTREXATE; PREGNANCY; PREGNANCY TRIMESTER, FIRST; PREGNANCY, ECTOPIC; ULTRASONOGRAPHY, PRENATAL;

EID: 27144477401     PISSN: 08203946     EISSN: 14882329     Source Type: Journal    
DOI: 10.1503/cmaj.050222     Document Type: Review

References (74)

1. Goldner TE, Lawson HW, Xia Z, Atrash HK. Surveillance for ectopic pregnancy - United States, 1970-1989. MMWR CDC Surveill Summ 1993;42:73-85.
2. Ectopic pregnancy - United States, 1990-1992. MMWR Morb Mortal Wkly Rep 1995;44:46-8.
3. Shalev E, Peleg D, Tsabari A, Romano S, Bustan M. Spontaneous resolution of ectopic tubal pregnancy: natural history. Fertil Steril 1995;63:15-9.
4. Elson J, Tailor A, Banerjee S, Salim R, Hillaby K, Jurkovic D. Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis. Ultrasound Obstet Gynecol 2004;23:552-6.
5. Turner LA, Cyr M, Kinch RA, Liston R, Kramer MS, Fair M, et al.; Maternal Mortality and Morbidity Study Group of the Canadian Perinatal Surveillance System. Under-reporting of maternal mortality in Canada: a question of definition. Chronic Dis Can 2002;23:22-30.
6. Carson SA, Buster JE. Ectopic pregnancy. N Engl J Med 1993;329:1174-81.
7. Comments in N Engl J Med 1994;330:712-3.
8. Barnhart K, Mennuti MT, Benjamin I, Jacobson S, Goodman D, Coutifaris C. Prompt diagnosis of ectopic pregnancy in an emergency department setting. Obstet Gynecol 1994;84:1010-5.
9. Buckley RG, King KJ, Disney JD, Gorman JD, Klausen JH. History and physical examination to estimate the risk of ectopic pregnancy: validation of a clinical prediction model. Ann Emerg Med 1999;34:589-94.
10. Comment in Ann Emerg Med 1999;34:664-7.
11. Dart RG, Kaplan B, Varaklis K. Predictive value of history and physical examination in patients with suspected ectopic pregnancy. Ann Emerg Med 1999;33:283-90.
12. Durham B, Lane B, Burbridge L, Balasubramaniam S. Pelvic ultrasound performed by emergency physicians for the detection of ectopic pregnancy in complicated first-trimester pregnancies. Ann Emerg Med 1997;29:338-47.
13. Spandorfer SD, Barnhart KT. Role of previous ectopic pregnancy in altering the presentation of suspected ectopic pregnancy. J Reprod Med 2003;48:133-6.
14. Mateer JR, Valley VT, Aiman EJ, Phelan MB, Thoma ME, Kefer MP. Outcome analysis of a protocol including bedside endovaginal sonography in patients at risk for ectopic pregnancy. Ann Emerg Med 1996;27:283-9.
15. Sauer MV, Rodi IA. Utility of an algorithm to diagnose ectopic pregnancy. Int J Gynaecol Obstet 1990;31:29-34.
16. Stovall TG, Kellerman AL, Ling FW, Buster JE. Emergency department diagnosis of ectopic pregnancy. Ann Emerg Med 1990;19:1098-103.
17. Xiao GH, Chen DJ, Sun XF, She RQ, Mai YM. Abdominal pregnancy: full-term viable baby. Eur J Obstet Gynecol Reprod Biol 2005;118:117-8.
18. Ramachandran K, Kirk P. Massive hemorrhage in a previously undiagnosed abdominal pregnancy presenting for elective cesarean delivery. Can J Anaesth 2004;51:57-61.
19. Ankum WM, Mol BW, van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril 1996;65:1093-9.
20. Comment in Fertil Steril 1997;67:791-2.
21. Mol BW, Ankum WM, Bossuyt PM, van der Veen F. Contraception and the risk of ectopic pregnancy: a meta-analysis. Contraception 1995;52:337-41.
22. Cacciatore B, Stenman UH, Ylostalo P. Early screening for ectopic pregnancy in high-risk symptom-free women. Lancet 1994;343:517-8.
23. Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, van der Veen F, Hemrika DJ, et al. Can noninvasive diagnostic tools predict tubal rupture or active bleeding in patients with tubal pregnancy? Fertil Steril 1999;71:167-73.
24. Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, van der Veen F, Hemrika DJ, et al. Should patients who are suspected of having an ectopic pregnancy undergo physical examination? Fertil Steril 1999;71:155-7.
25. Brennan DF. Ectopic pregnancy - Part I: Clinical and laboratory diagnosis. Acad Emerg Med 1995;2:1081-9.
26. Kaplan BC, Dart RG, Moskos M, Kuligowska E, Chun B, Adel Hamid M, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med 1996;28:10-7.
27. Comment in Ann Emerg Med 1997;29:295-6.
28. Kohn MA, Kerr K, Malkevich D, O'Neil N, Kerr MJ, Kaplan BC. Beta-human chorionic gonadotropin levels and the likelihood of ectopic pregnancy in emergency department patients with abdominal pain or vaginal bleeding. Acad Emerg Med 2003;10:119-26.
29. Saxon D, Falcone T, Mascha EJ, Marino T, Yao M, Tulandi T. A study of ruptured tubal ectopic pregnancy. Obstet Gynecol 1997;90:46-9.
30. Comment in Obstet Gynecol 1997;90:866-7.
31. Kadar N, Caldwell BV, Romero R. A method of screening for ectopic pregnancy and its indications. Obstet Gynecol 1981;58:162-6.
32. Dart RG, Mitterando J, Dart LM. Rate of change of serial beta-human chorionic gonadotropin values as a predictor of ectopic pregnancy in patients with indeterminate transvaginal ultrasound findings. Ann Emerg Med 1999;34:703-10.
33. Barnhart KT, Sammel MD, Rinaudo PF, Zhou L, Hummel AC, Guo W. Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstet Gynecol 2004;104:50-5.
34. Mol BW, Lijmer JG, Ankum WM, van der Veen F, Bossuyt PM. The accuracy of single serum progesterone measurement in the diagnosis of ectopic pregnancy: a meta-analysis. Hum Reprod 1998;13:3220-7.
35. Buckley RG, King KJ, Disney JD, Riffenburgh RH, Gorman JD, Klausen JH. Serum progesterone testing to predict ectopic pregnancy in symptomatic first-trimester patients. Ann Emerg Med 2000;36:95-100.
36. Dart R, Ramanujam P, Dart L. Progesterone as a predictor of ectopic pregnancy when the ultrasound is indeterminate. Am J Emerg Med 2002;20:575-9.
37. Albayram F, Hamper UM. First-trimester obstetric emergencies: spectrum of sonographic findings. J Clin Ultrasound 2002;30:161-77.
38. Kadar N, DeVore G, Romero R. Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynecol 1981;58:156-61.
39. Comment in Obstet Gynecol 2003;102:672.
40. Mehta TS, Levine D, Beckwith B. Treatment of ectopic pregnancy: Is a human chorionic gonadotropin level of 2,000 mIU/mL a reasonable threshold? Radiology 1997;205:569-73.
41. Barnhart KT, Simhan H, Kamelle SA. Diagnostic accuracy of ultrasound above and below the beta-hCG discriminatory zone. Obstet Gynecol 1999;94:583-7.
42. Comment in Obstet Gynecol 2000;95:475-6.
43. Braffman BH, Coleman BG, Ramchandani P, Arger PH, Nodine CF, Dinsmore BJ, et al. Emergency department screening for ectopic pregnancy: a prospective US study. Radiology 1994;190:797-802.
44. Kadar N, Bohrer M, Kemmann E, Shelden R. The discriminatory human chorionic gonadotropin zone for endovaginal sonography: a prospective, randomized study. Fertil Steril 1994;61:1016-20.
45. Comment in Fertil Steril 1995;63:683-4.
46. Habana A, Dokras A, Giraldo JL, Jones EE. Cornual heterotopic pregnancy: contemporary management options. Am J Obstet Gynecol 2000;182:1264-70.
47. Comment in Am J Obstet Gynecol 2001;185:522.
48. Tal IJ, Haddad S, Gordon N, Timor-Tritsch I. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril 1996;66:1-12.
49. Mertz HL, Yalcinkaya TM. Early diagnosis of ectopic pregnancy. Does use of a strict algorithm decrease the incidence of tubal rupture? J Reprod Med 2001;46:29-33.
50. Dart RG, Kaplan B, Cox C. Transvaginal ultrasound in patients with low beta-human chorionic gonadotropin values: How often is the study diagnostic? Ann Emerg Med 1997;30:135-40.
51. Comment in Ann Emerg Med 1997;30:206-9.
52. Mateer JR, Aiman EJ, Brown MH, Olson DW. Ultrasonographic examination by emergency physicians of patients at risk for ectopic pregnancy. Acad Emerg Med 1995;2:867-73.
53. Mateer J, Plummer D, Heller M, Olson D, Jehle D, Overton D, et al. Model curriculum for physician training in emergency ultrasonography. Ann Emerg Med 1994;23:95-102.
54. Shih CH. Effect of emergency physician-performed pelvic sonography on length of stay in the emergency department [discussion 352]. Ann Emerg Med 1997;29:348-51.
55. Tulandi T, Hemmings R, Khalifa F. Rupture of ectopic pregnancy in women with low and declining serum beta-human chorionic gonadotropin concentrations. Fertil Steril 1991;56:786-7.
56. Lundorff P, Hahlin M, Kallfelt B, Thorburn J, Lindblom B. Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy. Fertil Steril 1991;55:911-5.
57. Murphy AA, Nager CW, Wujek JJ, Kettel LM, Torp VA, Chin HG. Operative laparoscopy versus laparotomy for the management of ectopic pregnancy: a prospective trial. Fertil Steril 1992;57:1180-5.
58. Vermesh M, Silva PD, Rosen GF, Stein AL, Fossum GT, Sauer MV. Management of unruptured ectopic gestation by linear salpingostomy: a prospective, randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecol 1989;73(3 pt 1):400-4.
59. Comment in Obstet Gynecol 1989;74:282-3.
60. Lundorff P, Thorburn J, Hahlin M, Kallfelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy. A randomized trial versus laparotomy. Acta Obstet Gynecol Scand 1991;70:343-8.
61. Bangsgaard N, Lund CO, Ottesen B, Nilas L. Improved fertility following conservative surgical treatment of ectopic pregnancy. BJOG 2003;110:765-70.
62. Comment in BJOG 2004;111:635-6.
63. Dubuisson JB, Morice P, Chapron C, De Gayffier A, Mouelhi T. Salpingectomy - the laparoscopic surgical choice for ectopic pregnancy. Hum Reprod 1996;11:1199-203.
64. Fernandez H, Marchal L, Vincent Y. Fertility after radical surgery for tubal pregnancy. Fertil Steril 1998;70:680-6.
65. Yao M, Tulandi T. Current status of surgical and nonsurgical management of ectopic pregnancy. Fertil Steril 1997;67:421-33.
66. Comment in Fertil Steril 1997;68:945-7.
67. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol 2003;101:778-84.
68. Lipscomb GH, Bran D, McCord ML, Portera JC, Ling FW. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol 1998;178:1354-8.
69. Hajenius PJ, Engelsbel S, Mol BW, van der Veen F, Ankum WM, Bossuyt PM, et al. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. Lancet 1997;350:774-9.
70. Comments in Lancet 1997;350:1554-5.
71. Fernandez H, Yves Vincent SC, Pauthier S, Audibert F, Frydman R. Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility. Hum Reprod 1998;13:3239-43.
72. Saraj AJ, Wilcox JG, Najmabadi S, Stein SM, Johnson MB, Paulson RJ. Resolution of hormonal markers of ectopic gestation: a randomized trial comparing single-dose intramuscular methotrexate with salpingostomy. Obstet Gynecol 1998;92:989-94.
73. Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopie surgery for the treatment of unruptured tubal pregnancy. BJOG 2001;108:192-203.
74. Nieuwkerk PT, Hajenius PJ, Ankum WM, van der Veen F, Wijker W, Bossuyt PM. Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients' health-related quality of life. Fertil Steril 1998;70:511-7.