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Ectopic Pregnancy and Pregnancy of Unknown Location

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Managing Ultrasonography in Human Reproduction

Abstract

Ectopic pregnancy (EP) represents the implantation of a fertilised ovum outside the uterine cavity. Majority of ectopic pregnancies are located in the fallopian tubes [27]. Other locations include ovaries and abdominal cavity. Some ectopic pregnancies such as cervical, Caesarean and intramural ectopic are located inside the uterus, but outside the uterine cavity typically invading the myometrium. The estimated incidence of ectopic pregnancy is 1–2 % worldwide [12]. Although death after ectopic pregnancy is rare, it is still considered as one of the leading causes for maternal morbidity and mortality [72].

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References

  1. Ackerman TE, Levi CS, Dashefsky SM, et al. Interstitial line: sonographic findings in interstitial corneal ectopic pregnancy. Radiology. 1993;189:83–7.

    Article  CAS  PubMed  Google Scholar 

  2. Alto WA. Abdominal pregnancy. Am Fam Physucuan. 1990;41:209–14.

    CAS  Google Scholar 

  3. Anandakumar C, Mohammed N. Three-dimensional transvaginal sonographic diagnosis of asymptomatic interstitial pregnancy. Acta Obstetricia et Gyecologica Scandinavica. 2004;83(4).

    Google Scholar 

  4. Ankum W, Mol BW, Van der Veen F, et al. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093–9.

    Article  CAS  PubMed  Google Scholar 

  5. Ankum W, Van der Veen F, Hamerlynck JV, et al. Pregnancy: Laparoscopy; A dispensable tool in the diagnosis of ectopic pregnancy? Hum Reprod. 1993;8:1301–6.

    CAS  PubMed  Google Scholar 

  6. Athey P, Lamki N, Matyas M, et al. Comparison of transvaginal and transabdominal ultrasonography in ectopic pregnancy. Can Assoc Radiol J. 1991;42:349–52.

    CAS  PubMed  Google Scholar 

  7. Atrash H, Friede A, Hogue C. Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynecol. 1987;69:333–7.

    CAS  PubMed  Google Scholar 

  8. Attapattu J, Menon S. Abdominal pregnancy. Int J Gynecol Obstet. 1993;43:51–5.1993.

    Article  CAS  Google Scholar 

  9. Banerjee S, Aslam N, Woelfer B, et al. Expectant management of early pregnancies of unknown location: a prospective evaluation of methods to predict spontaneous resolution of pregnancy. BJOG. 2001;108:158–63.

    CAS  PubMed  Google Scholar 

  10. Banerjee S, Aslam N, Zosmer B. The expectant management of women with early pregnancy of unknown location. Ultrasound Obstet Gynecol. 1999;14:231–6.

    Article  CAS  PubMed  Google Scholar 

  11. Barnhart K, Sammel M, Rinaudo P, et al. Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstet Gynecol. 2004;104:50–5.

    Article  PubMed  Google Scholar 

  12. Barnhart KT. Ectopic pregnancy. N Engl J Med. 2009;361:379–87.

    Article  CAS  PubMed  Google Scholar 

  13. Barnhart KT, Simhan H, Kamelle SA. Diagnostic accuracy of ultrasound above and below the beta-hCG discriminatory zone. Obstet Gynecol. 1999;94(4):583–7.

    CAS  PubMed  Google Scholar 

  14. Basama FM, Crosfill F, Price A. Women’s perception of transvaginal sonography in the first trimester; in an early pregnancy assessment unit. Arch Gynecol Obstet. 2004;269:117–20.

    Article  PubMed  Google Scholar 

  15. Benson C, Doubilet P. Strategies for conservative treatment of cervical ectopic pregnancy. Ultrasound Obstet Gynecol. 1996;8:371–2.

    Article  CAS  PubMed  Google Scholar 

  16. Bigrigg MA. Management of women refereed to an early pregnancy assessment unit: care and cost effectiveness. Br Med J. 1991;302:577–9.

    Article  CAS  Google Scholar 

  17. Bouyer J, Coste J, Shojaei T, et al. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol. 2003;157:185–94.

    Article  PubMed  Google Scholar 

  18. Braffman BH, Coleman BG, Ramchandani P, et al. Emergency department screening for ectopic pregnancy: a prospective US study. Radiology. 1994;190:797–802.

    Article  CAS  PubMed  Google Scholar 

  19. Brown DL, Doubilet PM. Transvaginal sonography for diagnosing ectopic pregnancy. J Ultrasound Med. 1994;13:259–66.

    CAS  PubMed  Google Scholar 

  20. Cacciatore B, Stenman UH, Ylostalo P. Diagnosis of ectopic pregnancy by vaginal ultrasonography in combination with a discriminatory serum hCG level of 1000IU/L. BJOG. 1990;97:904–8.

    Article  CAS  Google Scholar 

  21. Comstock C, Houston K, Lee W. The ultrasonographic appearance of ovarian ectopic pregnancy. Obst Gynecol. 2005;105:42–5.

    Article  Google Scholar 

  22. Condous G, Okaro E, Khalid A. A prospective evaluation of a single-visit strategy to manage pregnancies of unknown location. Hum Reprod. 2005;20(5):1398–403.

    Article  CAS  PubMed  Google Scholar 

  23. Condous G, Okaro E, Khalid A, et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod. 2005;20(5):1404–9.

    Article  PubMed  Google Scholar 

  24. Condous G, Timmerman D, Goldstein S, et al. Pregnancies of unknown location: consensus statement. Ultrasound Obstet Gynecol. 2006;28:121–2.

    Article  CAS  PubMed  Google Scholar 

  25. Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer—2006-2008. The eighth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011;118:1–203.

    Google Scholar 

  26. Cordina M, Schramm-Gajrai K, Ross J, et al. Introduction of a single visit protocol in the management of selected patients with pregnancy of unknown location: a prospective study. BJOG. 2011;118(6):693–7.

    Article  CAS  PubMed  Google Scholar 

  27. Crochet J, Bastian L, Chireau M. Does this woman have an ectopic pregnancy? The rational clinical examination systematic review. JAMA. 2013;309(16):1722–9.

    Article  CAS  PubMed  Google Scholar 

  28. Dart RG, Kaplan B, Varaklis K. Predictive value of history and physical examination in patients with suspected ectopic pregnancy. Ann Emerg Med. 1999;33(3):283–90.

    Article  CAS  PubMed  Google Scholar 

  29. De Boer C, Van Dongen PW, Willemesen W, et al. Ultrasound diagnosis of interstitial pregnancy. Eur J Obstet Gynecol Reprod Biol. 1992;47:164–6.

    Article  PubMed  Google Scholar 

  30. Dutta RL, Economides DL. Patient acceptance of transvaginal sonography in the early pregnancy unit setting. Ultrasound Obstet Gynecol. 2003;22:503–7.

    Article  CAS  PubMed  Google Scholar 

  31. Ehrenberg-Buchner S, Sandadi S, Moawad NS, et al. Ectopic pregnancy: role of laparoscopic treatment. Clin Obstet Gynecol. 2009;52:372–9.

    Article  PubMed  Google Scholar 

  32. Farquhar CM. Ectopic pregnancy. Lancet. 2005;366(9485):583–91.

    Article  PubMed  Google Scholar 

  33. Fridstrom M, Garoff L, Sjoblom P, et al. Human chorionic gonadotrophic patterns in early pregnancy after assisted conception. Acta Obstet Gynecol Scand. 1995;74:534–8.

    Article  CAS  PubMed  Google Scholar 

  34. Gaudoin M, Coulter K, Robin A, et al. Is the incidence of ovarian ectopic pregnancy increasing? Eur J Obstet Gynecol Reprod Biol. 1996;70:141–3.

    Article  CAS  PubMed  Google Scholar 

  35. Hahlin M, Thorburn J, Bryman I. The expectant management of early pregnancies of uncertain sites. Hum Reprod. 1995;10:1223–7.

    CAS  PubMed  Google Scholar 

  36. Jafri S, Loginsky S, Bouffard J, et al. Sonographic detection of interstitial pregnancy. J Clin Ultrasound. 1987;15:253–7.

    Article  CAS  PubMed  Google Scholar 

  37. Jayasinghe Y, Rane A, Stalewski H, et al. The presentation and early diagnosis of the rudimentary uterine horn. Obstet Gynecol. 2005;105:1456–67.

    Article  PubMed  Google Scholar 

  38. Jurkovic D, Hacket E, Campbell S. Diagnosis and treatment of early cervical pregnancy: a review and report of two cases treated conservatively. Ultrasound Obstet Gynecol. 1996;8:373–80.

    Article  CAS  PubMed  Google Scholar 

  39. Jurkovic D, Hillaby K, Woelfe B, et al. First trimester diagnosis of and management of pregnancies implanted into the lower uterine segment cesarean section scar. Ultrasound Obstet Gynecol. 2003;21:220–7.

    Article  CAS  PubMed  Google Scholar 

  40. Jurkovic D, Wilkinson H. Diagnosis and management of ectopic pregnancy. BMJ. 2011;342:d3397.

    Article  PubMed  Google Scholar 

  41. Kadar N, DeVore G, Romero R. Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynecol. 1981;58:156–61.

    CAS  PubMed  Google Scholar 

  42. Kaplan BC, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996;28:10–7.

    Article  CAS  PubMed  Google Scholar 

  43. Kirk E, Condous G, Bourne T. Pregnancies of unknown location. Acute gynaecology volume 1: early pregnancy complications. Best Pract Res Clin Obstet Gynaecol. 2009;23(4):493–9.

    Article  PubMed  Google Scholar 

  44. Kirk E, Papageorghiou A, Condous G, et al. The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod. 2007;22:2824–8.

    Article  PubMed  Google Scholar 

  45. Kobayashi M, Hellman L, Fillisti L. Ultrasound: an aid in the diagnosis of ectopic pregnancy. Am J Obstet Gynecol. 1969;103:1131–40.

    Article  CAS  PubMed  Google Scholar 

  46. Laing FC. Ultrasound in gynecology. 2nd ed. New York: Churchill Livingstone/Elsevier; 2007. p. 161–75.

    Book  Google Scholar 

  47. Lau S, Tulandi T. Conservative and surgical management of interstitial ectopic pregnancy. Fertil Steril. 1999;72:207–15.

    Article  CAS  PubMed  Google Scholar 

  48. Li TC, Tristram A, Hill A, et al. A review of 254 ectopic pregnancies in a teaching hospital in the Trent Region, 1977-1990. Hum Reprod. 1991;6:1002–7.

    CAS  PubMed  Google Scholar 

  49. Martin JN, et al. Abdominal pregnancy: current concepts of management. Obstet Gynecol. 1988;71:549–57.

    PubMed  Google Scholar 

  50. Marvelos D, Nicks H, Jamil A, et al. Efficacy and safety of a clinical protocol for expectant management of selected women diagnosed with a tubal ectopic pregnancy. Ultrasound Obstet Gynecol. 2013;42(1):102–7.

    Article  Google Scholar 

  51. Marvelos D, Sawyer E, Helmy S, et al. Ultrasound diagnosis of ectopic pregnancy in the non-communicating horn of a unicornuate uterus (corneal pregnancy). Ultrasound Obstet Gynecol. 2007;30:765–70.

    Article  Google Scholar 

  52. Mello N, Mol F, Ankum W, et al. Ectopic pregnancy: how the diagnostic and therapeutic management has changed. Fertil Steril. 2012;98(5):1066–73.

    Article  PubMed  Google Scholar 

  53. Mello N, Mol F, Opmeer B, et al. Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):603–17.

    Google Scholar 

  54. Mol B, Hajenius P, Engelsbel S, et al. Serum human chorionic gonadotropin measurement in the diagnosis of ectopic pregnancy when transvaginal sonography is inconclusive. Fertil Steril. 1998;70(5):972–81.

    Article  CAS  PubMed  Google Scholar 

  55. Mol B, Hajenuis P, Engelsbel S, et al. Should patients who are suspected of having an ectopic pregnancy undergo a physical examination? Fertil Steril. 1999;71:155–7.

    Article  CAS  PubMed  Google Scholar 

  56. Mol F, Mol B, Ankum W, et al. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod. 2008;14:309–19.

    Article  CAS  Google Scholar 

  57. Moro F, Mavrelos D, Patman K, et al. Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section. Ultrasound Obstet Gynecol. 2015;45(2):223–8.

    Article  CAS  PubMed  Google Scholar 

  58. Nahum C. Rudimentary uterine horn pregnancy. The 20th-century worldwide experience of 588 cases. J Reprod Med. 2002;47:151–63.

    PubMed  Google Scholar 

  59. Perriera L, Reeves MF. Ultrasound criteria for diagnosis of early pregnancy failure and ectopic pregnancy. Semin Reprod Med. 2008;26:373–82.

    Article  PubMed  Google Scholar 

  60. Raskin M. Diagnosis of cervical pregnancy by ultrasound: a case report. Am J Obstet Gynecol. 1978;130:234–5.

    Article  CAS  PubMed  Google Scholar 

  61. Raziel A, Golan A, Pansky M, et al. Ovarian pregnancy- a 12-year experience of 19 cases in one institute. Eur J Obstet Gynecol Reprod Biol. 2004;114:92–6.

    Article  PubMed  Google Scholar 

  62. Richardson A, Gallos I, Dobson S, et al. Accuracy of first trimester ultrasound features for diagnosis of tubal ectopic pregnancy in the absence of an obvious extra-uterine embryo: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;47:28–37.

    Article  CAS  PubMed  Google Scholar 

  63. Seow K, Huang L, LIN Y, et al. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23:247–53.

    Article  PubMed  Google Scholar 

  64. Shalev E, Yarom I, Bustan M, et al. Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases. Fertil Steril. 1998;69:62–5.

    Article  CAS  PubMed  Google Scholar 

  65. Shwartz R, Pietro D. B-hCG a diagnostic aid for suspected ectopic pregnancy. Obstet Gynecol. 1980;56:197–203.

    Google Scholar 

  66. Sivalingam V, Duncan W, Kirk E, et al. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011;37(4):231–40.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Stein M, Ricci Z, Novak L, et al. Sonographic comparison of tubal ring of ectopic pregnancy with the corpus luteum. J Ultrasound Med. 2004;23(1):57–62.

    PubMed  Google Scholar 

  68. Stovall T, Kellerman A, Ling F, et al. Emergency department diagnosis of ectopic pregnancy. Ann Emerg Med. 1990;19(10):1098–103.

    Article  CAS  PubMed  Google Scholar 

  69. Sultana C, Easley K, Collins R. Outcome of laparoscopic versus traditional surgery for ectopic pregnancies. Fertility Sterility. 1992;57:285–9.

    Article  CAS  PubMed  Google Scholar 

  70. Tay J, Moore J, Walker J. Ectopic pregnancy. BMJ. 2000;320:916–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. The management of tubal pregnancy. RCOG Guideline No. 21. May 2004 Reviewed 2010.

    Google Scholar 

  72. Trimor-Tritsch I, Monteagudo A, Mandeville E, et al. Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol. 1994;170(3):737–9.

    Article  Google Scholar 

  73. Ushakov F, Elchalal U, Aceman P, et al. Cervical pregnancy: past and future. Obstet Gynecol Surv. 1997;52(1):45–59.

    Article  CAS  PubMed  Google Scholar 

  74. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 2000;16:592–3.

    Article  CAS  PubMed  Google Scholar 

  75. Weckstein L, Boucher A, Tucker H, et al. Accurate diagnosis of early ectopic pregnancy. Obstet Gyecol. 1985;65:393–7.

    CAS  Google Scholar 

  76. Wedderburn C, Warner P, Graham B, et al. Economic evaluation of diagnosing and excluding ectopic pregnancy. Hum Reprod. 2010;25:328–33.

    Article  CAS  PubMed  Google Scholar 

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Salman, G., Jurkovic, D. (2017). Ectopic Pregnancy and Pregnancy of Unknown Location. In: Guerriero, S., Martins, W., Alcazar, J. (eds) Managing Ultrasonography in Human Reproduction. Springer, Cham. https://doi.org/10.1007/978-3-319-41037-1_13

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  • DOI: https://doi.org/10.1007/978-3-319-41037-1_13

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