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Archives of Gynecology and Obstetrics

, Volume 288, Issue 4, pp 747–757 | Cite as

Ectopic pregnancy: a review

  • Poonam Rana
  • Imran Kazmi
  • Rajbala Singh
  • Muhammad Afzal
  • Fahad A. Al-Abbasi
  • Ali Aseeri
  • Rajbir Singh
  • Ruqaiyah Khan
  • Firoz Anwar
Reproductive Medicine

Abstract

Purpose

Ectopic pregnancy (EP) presents a major health problem for women of child-bearing age. EP refers to the pregnancy occurring outside the uterine cavity that constitutes 1.2–1.4 % of all reported pregnancies. All identified risk factors are maternal: pelvic inflammatory disease, Chlamydia trachomatis infection, smoking, tubal surgery, induced conception cycle, and endometriosis. These developments have provided the atmosphere for trials using methotrexate as a non-surgical treatment for EP. The diagnosis measure of EP is serum human chorionic gonadotropin, urinary hCGRP/i-hCG, progesterone measurement, transvaginal ultrasound scan, computed tomography, vascular endothelial growth factor, CK, disintegrin and metalloprotease-12 and hysterosalpingography. The treatment option of EP involves surgical treatment by laparotomy or laparoscopy, medical treatment is usually systemic or through local route, or by expectant treatment.

Results

It was concluded that review data reflect a decrease in surgical treatment and not an actual decline in EP occurrence so that further new avenues are needed to explore early detection of the EP.

Keywords

β-hCG TVS Methotrexate Laparotomy 

Abbreviations

EP

Ectopic pregnancy

CEP

Cervical ectopic pregnancy

OEP

Ovarian ectopic pregnancy

CSEP

Cesarean scar ectopic pregnancy

IP

Interstitial pregnancy

PID

Pelvic inflammatory disease

PROKR

Prokineticin receptor

IVF

In vitro fertilization

ART

Assisted reproductive technology

β-hCG

Serum human chorionic gonadotropin

TVS

Transvaginal ultrasound scan

CT

Computed tomography

VEGF

Vascular endothelial growth factor

ADAM-12

Disintegrin and metalloprotease-12

Hsg

Hysterosalpingography

MTX

Methotrexate

PPV

Positive predictive value

Notes

Conflict of interest

None declared.

References

  1. 1.
    Kirk E, Bourne T (2011) Ectopic pregnancy. Obstet Gynecol Reprod Med 21:207–211Google Scholar
  2. 2.
    Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367:1066–1074PubMedCrossRefGoogle Scholar
  3. 3.
    Walker JJ (2007) Ectopic pregnancy. Clin Obstet Gynecol 50:89–99PubMedCrossRefGoogle Scholar
  4. 4.
    Varma R, Gupta J (2009) Tubal ectopic pregnancy. Clin Evid 20:406Google Scholar
  5. 5.
    Shaw JL, Dey SK, Critchley HO, Horne AW (2010) Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update 16:432–444PubMedCrossRefGoogle Scholar
  6. 6.
    Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW (2011) Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 37:231–240PubMedCrossRefGoogle Scholar
  7. 7.
    Bouyer J, Coste J, Fernandez H (2002) Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 17:3224–3230PubMedCrossRefGoogle Scholar
  8. 8.
    Musa J (2009) Ectopic pregnancy in Jos Northern Nigeria: prevalence and impact on subsequent fertility. Niger J Med 18:8–35Google Scholar
  9. 9.
    Barnhart KT (2009) Clinical practice. Ectopic pregnancy. N Engl J Med 361:379–387PubMedCrossRefGoogle Scholar
  10. 10.
    Stovall TG, Ling FW, Carson SA, Buster JE (1990) Nonsurgical diagnosis and treatment of tubal pregnancy. Fertil Steril 54:537–538PubMedGoogle Scholar
  11. 11.
    Chandrasekhar C (2008) Ectopic pregnancy: a pictorial review. Clin Imaging 32:468–473PubMedCrossRefGoogle Scholar
  12. 12.
    Farquhar CM (2005) Ectopic pregnancy. Lancet 366:583–591PubMedCrossRefGoogle Scholar
  13. 13.
    Dickens BM, Faundes A, Cook RJ (2003) Ectopic pregnancy and emergency care: ethical and legal issues. Int J Gynecol Obstet 82:121–126CrossRefGoogle Scholar
  14. 14.
    Gamzu R, Almog B, Levin Y, Avni A, Jaffa A, Lessing J (2002) Efficacy of methotrexate treatment in extrauterine pregnancies defined by stable or increasing human chorionic gonadotropin concentrations. Fertil Steril 77:761–765PubMedCrossRefGoogle Scholar
  15. 15.
    Valley VT, Mateer JR, Aiman EJ (1998) Serum progesterone endovaginal sonography by emergency physicians in the evaluation of ectopic pregnancy. Acad Emerg Med 5:309–313PubMedCrossRefGoogle Scholar
  16. 16.
    Marion LL, Meeks GR (2012) Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clin Obstet Gynecol 55:376–386PubMedCrossRefGoogle Scholar
  17. 17.
    Wedderburn CJ, Warner P, Graham B, Duncan WC, Critchley HO, Horne AW (2010) Economic evaluation of diagnosing and excluding ectopic pregnancy. Hum Reprod 25:328–333PubMedCrossRefGoogle Scholar
  18. 18.
    Bakken IJ, Skjeldestad FE (2003) Incidence and treatment of extrauterine pregnancies in Norway 1990–2001. Tidsskr Nor Laegeforen 123:3016–3020PubMedGoogle Scholar
  19. 19.
    Boufous S, Quartararo M, Mohsin M (2001) Trends in the incidence of ectopic pregnancy in New South Wales between 1990–1998. Aust N Z J Obstet Gynaecol 41:436–438PubMedCrossRefGoogle Scholar
  20. 20.
    Lewis G (2007) Saving mothers’ lives: reviewing maternal deaths to make motherhood safer 2003–2005. CEMACH, LondonGoogle Scholar
  21. 21.
    Al-Turki HA (2013) Trends in ectopic pregnancies in Eastern Saudi Arabia. ISRN Obstet Gynecol, article ID 975251Google Scholar
  22. 22.
    Calderon JL, Shaheen M, Pan D, Teklehaimenot S, Robinson PL, Baker RS (2005) Multi-cultural surveillance for ectopic pregnancy: California 1991–2000. Ethn Dis 15:S4–S5Google Scholar
  23. 23.
    Sewell CA, Cundiff GW (2002) Trends for inpatient treatment of tubal pregnancy in Maryland. Am J Obstet Gynecol 186:404–408PubMedCrossRefGoogle Scholar
  24. 24.
    Condous G (2004) The management of early pregnancy complications. Best Pract Res Clin Obstet Gynaecol 18:37–57PubMedCrossRefGoogle Scholar
  25. 25.
    Ackerman TE, Levi CS, Dashefsky SM (1993) Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 189:83–87PubMedGoogle Scholar
  26. 26.
    Kirk E, Daemen A, Papageorghiou AT (2008) Why are some ectopic pregnancies characterized as pregnancies of unknown location at the initial transvaginal ultrasound examination? Acta Obstet Gynecol Scand 87:1150–1154PubMedCrossRefGoogle Scholar
  27. 27.
    Webb EM, Green GE, Scoutt LM (2004) Adnexal mass with pelvic pain. Radiol Clin North Am 42:329–348PubMedCrossRefGoogle Scholar
  28. 28.
    Ushakov FB, Elchalal U, Aceman PJ (1996) Cervical pregnancy: past and future. Obstet Gynecol Surv 52:45–59CrossRefGoogle Scholar
  29. 29.
    Leeman LM, Wendland CL (2000) Cervical ectopic pregnancy: diagnosis with endocervical ultrasound examination and successful treatment with methotrexate. Arch Fam Med 9:72–77PubMedCrossRefGoogle Scholar
  30. 30.
    Jurkovic D, Marvelos D (2007) Catch me if you can: ultrasound diagnosis of ectopic pregnancy. Ultrasound Obstet Gynecol 30:1–7PubMedCrossRefGoogle Scholar
  31. 31.
    Lemus JF (2000) Ectopic pregnancy: an update. Curr Opin Obstet Gynecol 12:369–375PubMedCrossRefGoogle Scholar
  32. 32.
    Odejinmi F, Rizzuto MI, MacRae R, Olowu O, Hussain M (2009) Diagnosis and laparoscopic management of 12 consecutive cases of ovarian pregnancy and review of literature. J Minim Invasive Gynecol 16:354–359PubMedCrossRefGoogle Scholar
  33. 33.
    Gon S (2011) Two cases of primary ectopic ovarian pregnancy. OJHAS 10(1):26Google Scholar
  34. 34.
    Plotti F, Di GA, Oliva C, Battaglia FG (2008) Plotti, “Bilateral ovarian pregnancy after intrauterine insemination and controlled ovarian stimulation”. Fertil Steril 90(5):2015.e3–2015.e5CrossRefGoogle Scholar
  35. 35.
    Panda S, Darlong LM, Singh S, Borah T (2009) Case report of a primary ovarian pregnancy in a primigravida. J Hum Reprod Sci 2:90–92PubMedCrossRefGoogle Scholar
  36. 36.
    Odejinmi F, Sangrithi M, Olowu O (2011) Operative laparoscopy as the mainstay method in management of hemodynamically unstable patients with ectopic pregnancy. J Minim Invasive Gynecol 18:179–183PubMedCrossRefGoogle Scholar
  37. 37.
    Seow K, Hang L, Lin Y (2004) Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 23:247–253PubMedCrossRefGoogle Scholar
  38. 38.
    Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107:1373–1381PubMedCrossRefGoogle Scholar
  39. 39.
    Jin H, Shou J, Yu Y (2004) Intramural pregnancy, a report of two cases. J Reprod Med 49:569–572PubMedGoogle Scholar
  40. 40.
    Graesslin O, Dedecker F, Quereux C (2005) Conservative treatment of ectopic pregnancy in a cesarean scar. Obstet Gynecol 105:869–871PubMedCrossRefGoogle Scholar
  41. 41.
    Shufaro Y, Nadjari M (2001) Implantation of a gestational sac in a cesarean section scar. Fertil Steril 75:1217PubMedCrossRefGoogle Scholar
  42. 42.
    Katz DL, Barrett JP, Sanfilippo JS, Badway DM (2003) Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy. Am J Obstet Gynecol 188:1113–1114PubMedCrossRefGoogle Scholar
  43. 43.
    Nahum GG (2002) Rudimentary uterine horn pregnancy. The 20th century worldwide experience of 588 cases. J Reprod Med 47:151–163PubMedGoogle Scholar
  44. 44.
    Malinowski A, Bates SK (2006) Semantics and pitfalls in the diagnosis of cornual/interstitial pregnancy. Fertil Steril 86:e11–e14PubMedCrossRefGoogle Scholar
  45. 45.
    Kun WM, Tung WK (2001) On the look out for a rarity—interstitial/cornual pregnancy. Eur J Emerg Med 8:147–150PubMedCrossRefGoogle Scholar
  46. 46.
    Moon HS, Choi YJ, Park VH, Kim SG (2000) New simple endoscopic operations for interstitial pregnancies. Am J Obstet Gynecol 152:114–121CrossRefGoogle Scholar
  47. 47.
    Sonmezer M, Taskin S, Atabekoglu C (2006) Laparoscopic management of rudimentary uterine horn pregnancy: case report and literature review. JSLS 10:396–399PubMedGoogle Scholar
  48. 48.
    Panayotidis C, Abdel FM, Leggott M (2004) Rupture of rudimentary uterine horn of a unicornuate uterus at 15 weeks’gestation. J Obstet Gynecol 24:323–324CrossRefGoogle Scholar
  49. 49.
    Yildizhan R, Kurdoglu M, Kolusari A, Erten R (2008) Primary omental pregnancy. Saudi Med J 29:606–609PubMedGoogle Scholar
  50. 50.
    Sarwat A, Nadia A (2011) Abdominal pregnancy: a diagnostic dilemma. Prof Med J 18:479–484Google Scholar
  51. 51.
    Ayinde OA, Aimakhu CO, Adeyanju OA (2005) Abdominal pregnancy at the University College Hospital, Ibadan: a ten-year review. Afr J Reprod Health 9:123–127PubMedCrossRefGoogle Scholar
  52. 52.
    Oki T, Baba Y, Yoshinaga M (2008) Super-selective arterial embolization for uncontrolled bleeding in abdominal pregnancy. Obstet Gynecol 112:427–429PubMedCrossRefGoogle Scholar
  53. 53.
    Ludwig M (1999) Heterotopic pregnancy in a spontaneous cycle: do not forget about it. Eur J Obstet Gynecol Reprod Biol 87:91–103PubMedCrossRefGoogle Scholar
  54. 54.
    Rojansky N, Schenker JG (1996) Heterotopic pregnancy and assisted reproduction—an update. J Assist Reprod Genet 13:594–601PubMedCrossRefGoogle Scholar
  55. 55.
    Condous G, Okaro E, Bourne T (2003) The conservative management of early pregnancy complications: a review of the literature. Ultrasound Obstet Gynecol 22:420–430PubMedCrossRefGoogle Scholar
  56. 56.
    Glassner MJ, Aron E, Eskin BA (1990) Ovulation induction with clomiphene and the rise in heterotopic pregnancies: a report of two cases. J Reprod Med 35:175–178PubMedGoogle Scholar
  57. 57.
    Madhuri P (2012) Ectopic pregnancy after infertility treatment. J Hum Reprod Sci 5:154–165CrossRefGoogle Scholar
  58. 58.
    Onan MA, Turp AB, Saltik A, Akyurek N, Taskiran C, Himmetoglu O (2005) Primary omental pregnancy: case report. Hum Reprod 20:807–809PubMedCrossRefGoogle Scholar
  59. 59.
    Bakken IJ (2008) Chlamydia trachomatis and ectopic pregnancy: recent epidemiological findings. Curr Opin Infect Dis 21:77–82PubMedCrossRefGoogle Scholar
  60. 60.
    Bjartling C, Osser S, Persson K (2007) Deoxyribonucleic acid of Chlamydia trachomatis in fresh tissue from the fallopian tubes of patients with ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 134:95–100PubMedCrossRefGoogle Scholar
  61. 61.
    Low N, Egger M, Sterne JA, Harbord RM, Ibrahim F, Lindblom B, Herrmann B (2006) Incidence of severe reproductive tract complications associated with diagnosed genital chlamydial infection: the Uppsala Women’s Cohort Study. Sex Transm Infect 82:212–218PubMedCrossRefGoogle Scholar
  62. 62.
    Van Valkengoed IG, Morré SA, van den Brule AJ, Meijer CJ, Bouter LM, Boeke AJ (2004) Overestimation of complication rates in evaluations of Chlamydia trachomatis screening programmes—implications for cost-effectiveness analyses. Int J Epidemiol 33:416–425PubMedCrossRefGoogle Scholar
  63. 63.
    Ault KA, Statland BD, King MM, Dozier DI, Joachims ML, Gunter J (1998) Antibodies to the chlamydial 60 kilodalton heat shock protein in women with tubal factor infertility. Infect Dis Obstet Gynecol 6:163–167PubMedGoogle Scholar
  64. 64.
    Rank RG, Dascher C, Bowlin AK, Bavoil PM (1995) Systemic immunization with Hsp60 alters the development of chlamydial ocular disease. Invest Ophthalmol Vis Sci 36:1344–1351PubMedGoogle Scholar
  65. 65.
    Shaw JL, Oliver E, Lee KF (2010) Cotinine exposure increases fallopian tube PROKR1 expression via nicotinic AChRalpha-7: a potential mechanism explaining the link between smoking and tubal ectopic pregnancy. Am J Pathol 177:2509–2515PubMedCrossRefGoogle Scholar
  66. 66.
    Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M (2000) Maternal age and fetal loss: population based register linkage study. BMJ 320(7251):1708–1712PubMedCrossRefGoogle Scholar
  67. 67.
    Goddijn M, van der Veen F, Schuring Blom GH, Ankum WM, Leschot NJ (1996) Cytogenetic characteristics of ectopic pregnancy. Hum Reprod 11:2769–2771PubMedCrossRefGoogle Scholar
  68. 68.
    Bouyer J, Coste J, Shojaei T (2003) Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol 157:185–194PubMedCrossRefGoogle Scholar
  69. 69.
    Knoll M, Shaoulian R, Magers T, Talbot P (1995) Ciliary beat frequency of hamster oviducts is decreased in vitro by exposure to solutions of mainstream and sidestream cigarette smoke. Biol Reprod 53:29–37PubMedCrossRefGoogle Scholar
  70. 70.
    Riveles K, Roza R, Arey J, Talbot P (2004) Pyrazine derivatives in cigarette smoke inhibit hamster oviductal functioning. Reprod Biol Endocrinol 2:23PubMedCrossRefGoogle Scholar
  71. 71.
    Talbot P, Riveles K (2005) Smoking and reproduction: the oviduct as a target of cigarette smoke. Reprod Biol Endocrinol 3:52PubMedCrossRefGoogle Scholar
  72. 72.
    Li YY, Li L, Hwang IS, Tang F, O WS (2008) Coexpression of adrenomedullin and its receptors in the reproductive system of the rat: effects on steroid secretion in rat ovary. Biol Reprod 79:200–208PubMedCrossRefGoogle Scholar
  73. 73.
    Evans J, Catalano RD, Morgan K, Critchley HO, Millar RP, Jabbour HN (2008) Prokineticin 1 signaling and gene regulation in early human pregnancy. Endocrinology 149:2877–2887PubMedCrossRefGoogle Scholar
  74. 74.
    Clayton HB, Schieve LA, Peterson HB, Jamieson DJ, Reynolds MA, Wright VC (2006) Ectopic pregnancy risk with assisted reproductive technology procedures. Obstet Gynecol 107:595–604PubMedCrossRefGoogle Scholar
  75. 75.
    Strandell A, Thorburn J, Hamberger L (1999) Risk factors for ectopic pregnancy in assisted reproduction. Fertil Steril 71:282–286PubMedCrossRefGoogle Scholar
  76. 76.
    Weigert M, Gruber D, Pernicka E, Bauer P, Feichtinger W (2009) Previous tubal ectopic pregnancy raises the incidence of repeated ectopic pregnancies in in vitro fertilization-embryo transfer patients. J Assist Reprod Genet 26:13–17PubMedCrossRefGoogle Scholar
  77. 77.
    Furlong LA (2002) Ectopic pregnancy risk when contraception fails. A review. J Reprod Med 47:881–885PubMedGoogle Scholar
  78. 78.
    McCord ML, Muram D, Buster JE, Arheart KL, Stovall TG, Carson SA (1996) Single serum progesterone as a screen for ectopic pregnancy: exchanging specificity and sensitivity to obtain optimal test performance. Fertil Steril 66:513–516PubMedGoogle Scholar
  79. 79.
    Daponte A, Pournaras S, Zintzaras E, Kallitsaris A, Lialios G, Maniatis AN (2005) The value of a single combined measurement of VEGF, glycodelin, progesterone, PAPP-A, HPL and LIF for differentiating between ectopic and abnormal intrauterine pregnancy. Hum Reprod 20:3163–3166PubMedCrossRefGoogle Scholar
  80. 80.
    Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, Hobbs MM, Cohen MS, Harris KM, Udry JR (2004) Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA 291:2229–2236PubMedCrossRefGoogle Scholar
  81. 81.
    Kucera-Sliutz E, Schiebel I, Konig F, Leodolter S, Sliutz G, Koelbl H (2002) Vascular endothelial growth factor (VEGF) and discrimination between abnormal intrauterine and ectopic pregnancy. Hum Reprod 17:3231–3234PubMedCrossRefGoogle Scholar
  82. 82.
    Felemban A, Sammour A, Tulandi T (2002) Serum vascular endothelial growth factor as a possible marker for early ectopic pregnancy. Hum Reprod 17:490–492PubMedCrossRefGoogle Scholar
  83. 83.
    Jae KL, Min JOh, Joong SS, Kyung JL, Jung HN, Jung HC, Jin DC, Dong HC, In-Soo K, Paul IL (2005) Clinical effectiveness of urinary human chorionic gonadotropin related protein (hCGRP) quantification for diagnosis of ectopic pregnancy. J Korean Med Sci 20:461–467CrossRefGoogle Scholar
  84. 84.
    Kaplan BC, Dart RG, Moskos M, Kuligowska E, Chun B, Adel HM (1996) Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med 28:10–17PubMedCrossRefGoogle Scholar
  85. 85.
    Kohn MA, Kerr K, Malkevich D, ONeil N, Kerr MJ, Kaplan BC (2003) Beta-human chorionic gonadotropin levels and the likelihood of ectopic pregnancy in emergency department patients with abdominal pain or vaginal bleeding. Acad Emerg Med 10:119–126PubMedCrossRefGoogle Scholar
  86. 86.
    Barnhart KT, Sammel MD, Rinaudo PF, Zhou L, Hummel AC, Guo W (2004) Symptomatic patients with an early viable intrauterine pregnancy: hCG curves redefined. Obstet Gynecol 104:50–55PubMedCrossRefGoogle Scholar
  87. 87.
    Heather M, Hanadi B, Trevor B, Togas T (2005) Diagnosis and treatment of ectopic pregnancy progesterone measurement. CMAJ 173(8):905–912CrossRefGoogle Scholar
  88. 88.
    Stovall TG, Ling FW, Gray LA, Carson SA, Buster JE (1991) Methotrexate treatment of unruptured ectopic pregnancy: a report of 100 cases. Obstet Gynecol 77(5):749–753PubMedGoogle Scholar
  89. 89.
    Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, van der Veen F, Hemrika DJ (1999) Can noninvasive diagnostic tools predict tubal rupture or active bleeding in patients with tubal pregnancy? Fertil Steril 71:167–173PubMedCrossRefGoogle Scholar
  90. 90.
    Dart R, Ramanujam P, Dart L (2002) Progesterone as a predictor of ectopic pregnancy when the ultrasound is indeterminate. Am J Emerg Med 20:575–579PubMedCrossRefGoogle Scholar
  91. 91.
    Buckley RG, King KJ, Disney JD, Riffenburgh RH, Gorman JD, Klausen JH (2000) Serum progesterone testing to predict ectopic pregnancy in symptomatic first-trimester patients. Ann Emerg Med 36:95–100PubMedCrossRefGoogle Scholar
  92. 92.
    Elson J, Tailor A, Banerjee S, Salim R, Hillaby K, Jurkovic D (2004) Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis. Ultrasound Obstet Gynecol 23:552–556PubMedCrossRefGoogle Scholar
  93. 93.
    Condous G (2006) Ectopic pregnancy—risk factors and diagnosis. Aust Fam Physician 35:854–857PubMedGoogle Scholar
  94. 94.
    Mehta TS, Levine D, Beckwith B (1997) Treatment of ectopic pregnancy: is a human chorionic gonadotropin level of 2,000 mIU/mL a reasonable threshold. Radiology 205:569–573PubMedGoogle Scholar
  95. 95.
    Murray H, Baakdah H, Bardell T, Tulandi T (2005) Diagnosis and treatment of ectopic pregnancy. CMAJ 173:905–912PubMedCrossRefGoogle Scholar
  96. 96.
    Kirsch JD, Scoutt LM (2010) Imaging of ectopic pregnancy. Appl Radiol 39:10–25Google Scholar
  97. 97.
    Cano AR, Borruel NS, Díez MP (2009) Role of multidetector CT in the management of acute female pelvic disease. Emerg Radiol 16:453–472CrossRefGoogle Scholar
  98. 98.
    Pham H, Lin EC (2007) Adnexal ring of ectopic pregnancy detected by contrast-enhanced CT. Abdom Imaging 32(1):56–58PubMedCrossRefGoogle Scholar
  99. 99.
    Shin BS, Park MH (2010) Incidental detection of interstitial pregnancy on CT imaging. Korean J Radiol 11(1):123–125PubMedCrossRefGoogle Scholar
  100. 100.
    Tamai K, Koyama T, Togashi K (2007) MR features of ectopic pregnancy. Eur Radiol 17(12):3236–3246PubMedCrossRefGoogle Scholar
  101. 101.
    Yoshigi J, Yashiro N, Kinoshita T (2006) Diagnosis of ectopic pregnancy with MRI: efficacy of T2 weighted imaging. Magn Reson Med Sci 5(1):25–32PubMedCrossRefGoogle Scholar
  102. 102.
    Torry DS, Torry RJ (1997) Angiogenesis and the expression of vascular endothelial growth factor in endometrium and placenta. Am J Reprod Immunol 37:21–29PubMedCrossRefGoogle Scholar
  103. 103.
    Ugurlu EN, Ozaksit G, Karaer A, Zulfikaroglu E, Atalay A, Ugur M (2008) The value of vascular endothelial growth factor, pregnancy-associated plasma protein-A, and progesterone for early differentiation of ectopic pregnancies, normal intrauterine pregnancies, and spontaneous miscarriages. Fertil Steril 91(5):1657–1661PubMedCrossRefGoogle Scholar
  104. 104.
    Chandra L, Jain A (1995) Maternal serum creatine kinase as a biochemical marker of tubal pregnancy. Int J Gynaecol Obstet 49:21–23PubMedCrossRefGoogle Scholar
  105. 105.
    Saha PK, Gupta I, Ganguly NK (1999) Evaluation of serum creatine kinase as a diagnostic marker for tubal pregnancy. Aust N Z J Obstet Gynaecol 39:366–367PubMedCrossRefGoogle Scholar
  106. 106.
    Katsikis I, Rousso D, Farmakiotis D, Kourtis A, Diamanti KE, Zournatzi KV (2006) Creatine phosphokinase in ectopic pregnancy revisited: significant diagnostic value of its MB and MM isoenzyme fractions. Am J Obstet Gynecol 194:86–91PubMedCrossRefGoogle Scholar
  107. 107.
    Yagami HT, Sato T, Kurisaki T, Kamijo K, Nabeshima Y, Fujisawa SA (1995) A metalloprotease-disintegrin participating in myoblast fusion. Nature 377:652–656CrossRefGoogle Scholar
  108. 108.
    Abe E, Mocharla H, Yamate T, Taguchi Y, Manolagas SC (1999) Meltrin-alpha, a fusion protein involved in multinucleated giant cell and osteoclast formation. Calcif Tissue Int 64:508–515PubMedCrossRefGoogle Scholar
  109. 109.
    Huppertz B, Bartz C, Kokozidou M (2006) Trophoblast fusion: fusogenic proteins, syncytins and ADAMs, and other prerequisites for syncytial fusion. Micron 37:509–517PubMedCrossRefGoogle Scholar
  110. 110.
    Poon LC, Chelemen T, Granvillano O, Pandeva I, Nicolaides KH (2008) First-trimester maternal serum a disintegrin and metalloprotease 12 (ADAM12) and adverse pregnancy outcome. Obstet Gynecol 112:1082–1090PubMedCrossRefGoogle Scholar
  111. 111.
    Laigaard J, Cuckle H, Wewer UM, Christiansen M (2006) Maternal serum ADAM12 levels in Down and Edwards’ syndrome pregnancies at 9–12 weeks’ gestation. Prenat Diagn 26:689–691PubMedCrossRefGoogle Scholar
  112. 112.
    Spencer K, Cowans NJ, Stamatopoulou A (2008) ADAM12s in maternal serum as a potential marker of pre-eclampsia. Prenat Diagn 28:212–216PubMedCrossRefGoogle Scholar
  113. 113.
    Swart P, Mol BWJ, Vander VF, Van BM, Redekop WK, Bossuyt PMM (1995) The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril 64:486–491PubMedGoogle Scholar
  114. 114.
    Elito J Jr, Han KK, Camano L (2005) Tubal patency after clinical treatment of unruptured ectopic pregnancy. Int J Gynecol Obstet 88:309–313CrossRefGoogle Scholar
  115. 115.
    Mol BWJ, Swart P, Bossuyt PMM, Van BM, Vander VF (1996) Reproducibility of the interpretation of hysterosalpingography in the diagnosis of tubal pathology. Hum Reprod 11:1204–1208PubMedCrossRefGoogle Scholar
  116. 116.
    Papaioannou S, Afnan M, Jafettas J (2007) Tubal assessment tests: still have not found what we are looking for. Reprod Bio Med Online 15:376–382CrossRefGoogle Scholar
  117. 117.
    Fertility Assessment and Treatment for People with Fertility Problems (2004) Clinical Guideline. RCOG Press, LondonGoogle Scholar
  118. 118.
    Sowter M, Farquhar C, Petrie K, Gudex G (2001) A randomized trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. Brit J Obstet Gynaecol 108:192–203CrossRefGoogle Scholar
  119. 119.
    Seror V, Gelfucci F, Gerbaud L, Pouly JL, Fernandez H, Job Spira N, Bouyer J, Coste J (2007) Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis. Fertil Steril 87:737–748PubMedCrossRefGoogle Scholar
  120. 120.
    Carson SA, Stovall TG, Ling FW, Buster JE (1991) Low human chorionic somatomammotropin fails to predict spontaneous resolution of unruptured ectopic pregnancies. Fertil Steril 55:629–630PubMedGoogle Scholar
  121. 121.
    Quasim SM, Trias A, Sachdev R, Kenmann E (1996) Evaluation of serum creatinine kinase levels in ectopic pregnancy. Fertil Steril 65:443–445Google Scholar
  122. 122.
    Rajesh V, Lawrence M (2002) Evidence-based management of ectopic pregnancy. Curr Obstet Gynaecol 12:191–199CrossRefGoogle Scholar
  123. 123.
    Barnhart KT, Fay CA, Suescum M, Sammel MD, Appleby D, Shaunik A, Dean AJ (2011) Clinical factors affecting the accuracy of ultrasonography in symptomatic first-trimester pregnancy. Obstet Gynecol 117:299–306PubMedCrossRefGoogle Scholar
  124. 124.
    American College of Obstetricians and Gynecologists (1998) Medical management of tubal pregnancy. ACOG Practice Bulletin No. 3. Obstet Gynecol 92:1–7CrossRefGoogle Scholar
  125. 125.
    Rodrigues SP, de Burlet KJ, Hiemstra E, Twijnstra AR, van Zwet EW, Trimbos-Kemper TC, Jansen FW (2012) Ectopic pregnancy: when is expectant management safe? Gynecol Surg 9:421–426PubMedCrossRefGoogle Scholar
  126. 126.
    Raughley MJ, Frishman GN (2007) Local treatment of ectopic pregnancy. Semin Reprod Med 25(2):99–115PubMedCrossRefGoogle Scholar
  127. 127.
    van Mello NM, Mol F, Mol BW, Hajenius PJ (2009) Conservative management of tubal ectopic pregnancy. Best Pract Res 23:509–518CrossRefGoogle Scholar
  128. 128.
    Hajenius PJ, Mol BWJ, Ankum WM, Van der Veen F (2003) Systemic and local medical therapy of tubal pregnancy. In: Timmerman D, Deprest J, Bourne T (eds) Ultrasound and endoscopic surgery in obstetrics and gynaecology. A combined approach to diagnosis and treatment. Springer, London. ISBN 3540762124Google Scholar
  129. 129.
    Condous G, Okaro E, Khalid A, Lu C, Van HS, Timmerman D (2005) A prospective valuation of a single-visit strategy to manage pregnancies of unknown location. Hum Reprod 20:1398–1403PubMedCrossRefGoogle Scholar
  130. 130.
    Seeber BE, Barnhart KT (2006) Suspected ectopic pregnancy. Obstet Gynecol 107:399–413PubMedCrossRefGoogle Scholar
  131. 131.
    Jeng CJ, Ko ML, Shen J (2007) Transvaginal ultrasound-guided treatment of cervical pregnancy. Obstet Gynecol 109:1076–1082PubMedCrossRefGoogle Scholar
  132. 132.
    Lin CY, Chang CY, Chang HM, Tsai EM (2008) Cervical pregnancy treated with systemic methotrexate administration and resectoscopy. Taiwan J Obstet Gynecol 47:4Google Scholar
  133. 133.
    Sijanovic S, Vidosavljevic D, Sijanovic I (2011) Methotrexate in local treatment of cervical heterotopic pregnancy with successful perinatal outcome: case report. J Obstet Gynaecol Res 37:1241–1245PubMedCrossRefGoogle Scholar
  134. 134.
    Gabbur N, Sherer DM, Hellmann M (2006) Do serum beta-human chorionic gonadotropin levels on day 4 following methotrexate treatment of patients with ectopic pregnancy predict successful single-dose therapy? Am J Perinatol 23:193–196PubMedCrossRefGoogle Scholar
  135. 135.
    Barnhart KT, Gosman G, Ashby R, Sammel M (2003) The medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol 101:778–784PubMedCrossRefGoogle Scholar
  136. 136.
    Kirk E, Condous G, Van Calster B (2007) A validation of the most commonly used protocol to predict the success of single-dose methotrexate in the treatment of ectopic pregnancy. Hum Reprod 22:858–863PubMedCrossRefGoogle Scholar
  137. 137.
    Barnhart K, Hummel AC, Sammel MD, Menon S, Jain J, Chakhtoura N (2007) Use of “2-dose” regimen of methotrexate to treat ectopic pregnancy. Fertil Steril 87:250–256PubMedCrossRefGoogle Scholar
  138. 138.
    Hossam O, Hamed A, Salah R, Ahmed A, Abdullah A (2012) Comparison of double- and single-dose methotrexate protocols for treatment of ectopic pregnancy. Alghasham Int J Gynecol Obstet 116:67–71CrossRefGoogle Scholar
  139. 139.
    Buster JE, Carson SA (1995) Ectopic pregnancy; new advances in diagnosis and treatment. Curr Opinion Obstet Gynecol 7:168–176CrossRefGoogle Scholar
  140. 140.
    Fritz MA, Speroff L (2011) Clinical gynecologic endocrinology and infertility, 8th edn. Wolters Kluwer Health/Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  141. 141.
    Lozeau AM, Potter B (2005) Diagnosis and management of ectopic pregnancy. Am Fam Physician 1707–14(19):20Google Scholar
  142. 142.
    Hajenius PJ, Mol BW, Bossuyt PM, Ankum WM, Vander VF (2000) Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev (2):CD000324Google Scholar
  143. 143.
    Hoppe DE, Bekkar BE, Nager CW (1994) Single-dose systemic methotrexate for the treatment of persistent ectopic pregnancy after conservative surgery. Obstet Gynecol 83:51–54PubMedGoogle Scholar
  144. 144.
    Graczykowski JW, Mishell DR (1997) Methotrexate prophylaxis for persistent ectopic pregnancy after conservative treatment by salpingostomy. Obstet Gynecol 89:118–122PubMedCrossRefGoogle Scholar
  145. 145.
    Seifer DB (1997) Persistent ectopic pregnancy: an argument for heightened vigilance and patient compliance. Fertil Steril 68:402–404PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Siddhartha Institute of PharmacyDehradunIndia
  2. 2.Department of Biochemistry, Faculty of ScienceKing Abdulaziz UniversityJeddahSaudi Arabia
  3. 3.Lab Director, Jeddah Eye HospitalMinistry of HealthJeddahSaudi Arabia
  4. 4.Alchemist HospitalPanchkulaIndia

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