| 1. Title: Intrauterine devices: an effective alternative to oral hormonal contraception. Source: Prescrire International. 2009 Jun;18(101):125-30. Abstract: (1) Intrauterine devices (IUDs) are placed in the uterine cavity with the objective of providing long-term contraception, mainly by preventing fertilisation. The best-known IUDs contain copper, but there is also an IUD delivering levonorgestrel, a progestin; (2) How effective are these devices, and what are their adverse effects? To answer these questions, we analysed the literature using the standard Prescrire methodology; (3) T-shaped copper IUDs, with a copper surface area of 380 mm2 on 3 arms, and the levonorgestrel-releasing device, have similar contraceptive efficacy as combined oral contraceptives that are used correctly. In contrast, IUDs are more effective than oral contraception used incorrectly; (4) Among IUD users, there are on average about 6 pregnancies per 1000 woman-years. There is less experience with the levonorgestrel IUD which seems to be at least as effective as copper IUDs; (5) The rare intrauterine pregnancies that occur in women using an IUD generally end in miscarriage. About 25% of these pregnancies end in a live birth if the device is left in place, compared to about 90% if the device is removed; (6) Ectopic pregnancies are rarer in IUD users than in women who do not use contraception. However, about one in 20 pregnancies that occur in women using an IUD is ectopic; (7) The IUD is expelled in about 5% to 10% of cases within 5 years, and expulsion recurs in about 30% of these women; (8) Problems such as difficult insertion, pain, bleeding and syncope are reported in less than 1.5% of cases overall; (9) Uterine perforation during insertion is rare, occurring in 0.6 to 16 cases per 1000 insertions, regardless of the type of IUD. The risk of perforation is higher when the IUD is inserted less than 4 to 6 weeks after delivery or elective abortion; (10) During the first 3 months after insertion, the risk of pelvic infection is slightly higher than in the general population, especially in women with pre-existing asymptomatic Chlamydia trachomatis infection. There are about 6 pelvic infections per 1000 woman-years of IUD use. Routine antibiotic prophylaxis is unnecessary. The interview and physical examination may lead to diagnosis of C. trachomatis infection or other sexually transmitted infections. In these cases, treatment may be needed before IUD insertion. Women must be warned that IUDs do not protect them from sexually transmitted diseases; (11) Menstrual bleeding is often heavier in women with cooper IUDs than in women who do not use IUDs, and may be associated with menstrual pain; (12) The levonorgestrel IUD is associated with a marked reduction in menstrual blood loss and irregular bleeding; amenorrhoea occurs in 35% of women after 2 years of use. The levonorgestrel IUD also has hormonal adverse effects such as headache, acne, breast tension and functional ovarian cysts; (13) IUDs can safely be used in breastfeeding women, immediately after a pregnancy, in cases of diabetes or HIV infection, during nonsteroidal antiinflammatory drug therapy, and after an ectopic pregnancy. The only problems occurring in women who have never had children are pain during insertion and more frequent expulsions; (14) A copper IUD is a first-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or coronary events; (15) It is better to postpone IUD insertion when the woman has a genital tract infection or unexplained vaginal bleeding; (16) IUD insertion is an effective alternative to "morning-after" hormonal contraception. Language: English Keywords: GLOBAL | LITERATURE REVIEW | IUD | CONTRACEPTIVE MODE OF ACTION | IUD COMPLICATIONS | IUD EXPULSION | INSERTION | IUD SIDE EFFECTS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE SAFETY | PREGNANCY, ECTOPIC | UTERINE PERFORATION | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Safety | Public Health | Pregnancy Complications | Diseases | Perforations Document Number: 342301 |
3.  Peer Reviewed Title: Ectopic pregnancy following levonorgestrel emergency contraception: a case report. Author: Ghosh B; Dadhwal V; Deka D; Ramesan CK; Mittal S Source: Contraception. 2009 Feb;79(2):155-7. Abstract: Use of levonorgestrel as emergency contraception is a safe and effective measure to prevent unwanted pregnancy. However, ectopic gestation in case of failure is a known risk. Access to levonorgestrel without a prescription in many countries has made it impossible to estimate the exact incidence of this potential adverse event. Thus, spontaneous reporting of cases serves to alert physicians to this possibility. We present a case of ectopic pregnancy following use of levonorgestrel emergency contraception. To our knowledge, this is the first case report from India following introduction of levonorgestrel emergency contraception in 2001. Language: English Keywords: INDIA | RESEARCH REPORT | EMERGENCY CONTRACEPTION | LEVONORGESTREL | CONTRACEPTIVE SAFETY | PREGNANCY, ECTOPIC | PREGNANCY, UNWANTED | Developing Countries | Asia, Southern | Asia | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Safety | Public Health | Health | Pregnancy Complications | Diseases | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population Document Number: 329608 |
| 4. Peer Reviewed Title: Coexistent lithopedion and live abdominal ectopic pregnancy. Author: Massinde AN; Rumanyika R; Im HB Source: Obstetrics and Gynecology. 2009 Aug;114(2 Pt 2):458-60. Abstract: BACKGROUND:: Abdominal pregnancy is a rare, life-threatening variant of ectopic pregnancy, and thus its diagnosis and management remain controversial. CASE:: A multigravida was admitted for complaints of abdominal swelling that had been occurring for 2 years and symptoms of pregnancy in the 3 months before admission. Radiologic studies revealed a live intraabdominal pregnancy at 15 weeks of gestation with a concurrent lithopedion of advanced gestation. The patient underwent laparotomy, removing both fetuses; the placenta was left in situ. She was discharged 1 week later in good condition. CONCLUSION:: The case of a concurrent lithopedion of advanced gestation and a live intraabdominal ectopic pregnancy was successfully managed. Language: English Keywords: TANZANIA | SUMMARY REPORT | CASE HISTORIES | CLIENTS | PREGNANCY, ABDOMINAL | PREGNANCY, ECTOPIC | EXAMINATIONS AND DIAGNOSES | PRODUCTS OF CONCEPTION, RETENTION | LAPAROTOMY | ULTRASONICS | FETAL MEMBRANES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Pregnancy Complications | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Surgery | Treatment | Fetus | Pregnancy | Reproduction Document Number: 342273 |
| 5. Peer Reviewed Title: The frameless copper IUD (GyneFix) and the TCu380A IUD: results of an 8-year multicenter randomized comparative trial. Author: Meirik O; Rowe PJ; Peregoudov A; Piaggio G; Petzold M Author: IUD Research Group at the UNDP/UNFPA/WHO/World Bank Special Programme of Source: Contraception. 2009 Aug;80(2):133-41. Abstract: BACKGROUND: Clinical performance of the frameless copper IUD (GyneFix), designed to reduce side effects related to the frame of conventional IUDs, and TCu380A was compared. STUDY DESIGN: Randomized Multicenter randomized comparative trial. Parous women requesting and eligible to use IUD were admitted in 21 centers in eight countries in 1989-1993 and followed-up for up to 8 years. RESULTS: Two thousand twenty-seven women were randomized to the frameless IUD and 2036 to TCu380A; 43 insertions of the frameless IUD failed and none for TCu380A. First-year expulsion rate of the frameless IUD was 5.3 (95% CI: 4.4-6.4) per 100 and 2.5 (95% CI: 1.9-3.3) for the TCu380A; second- through eighth-year expulsion rates were not different. First-year pregnancy rates for the frameless IUD and TCu380A were 1.3 (95% CI: 0.9-2.0) and 0.5 (95% CI: 0.3-0.9), respectively; second- through eighth-year cumulative pregnancy rates were 1.2 (95% CI: 0.7-1.9) and 2.5 (95% CI: 1.8-3.4), respectively. The 8-year cumulative rates of ectopic pregnancy and IUD removal for pain were lower for the frameless IUD than for TCu380A. Removals for other reasons were not different. CONCLUSIONS: The frameless IUD had more insertion failures, expulsions and pregnancies in the first year than TCu380A, but fewer pregnancies from the second through the eighth year, and by 8 years had fewer ectopic pregnancies and removals for pain. Language: English Keywords: GLOBAL | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN | IUD, COPPER RELEASING | INSERTION | IUD EXPULSION | IUD SIDE EFFECTS | PAIN | PREGNANCY, ECTOPIC | CONTRACEPTION FAILURE | Clinical Research | Research Methodology | Studies | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Pregnancy Complications | Contraceptive Usage Document Number: 342393 |
| 6. Title: Ectopic pregnancy in Jos Northern Nigeria: prevalence and impact on subsequent fertility. Author: Musa J; Daru PH; Mutihir JT; Ujah IA Source: Nigerian Journal of Medicine. 2009 Jan-Mar;18(1):35-8. Abstract: BACKGROUND: Ectopic pregnancy remains a major gynaecological problem in contemporary gynaecological practice. Not only do women die from this disease, but also of greater clinical importance is the indirect morbidity of poor fertility prognosis and adverse outcome in subsequent pregnancies. We were interested in documenting the prevalence of ectopic pregnancy and its impact on subsequent fertility. METHODOLOGY: This retrospective descriptive study was done at the Jos University Teaching Hospital. The case notes of all patients who had tubal ectopic pregnancy managed in JUTH between January 1997 and December 2000 were retrieved. Subsequent fertility and reproductive outcome were assessed among women who reported back for follow up fora minimum period of twelve months post surgery. The data was analyzed using frequencies. RESULTS: During the study period, January 1997 and December 2000 a total of 168 ectopic pregnancies were managed and 9,638 deliveries occurred during the same period. This gives a prevalence rate of 1.74%. Of the 168 cases of ectopics, 130 case records containing relevant information were retrieved (77.4%) and this constituted the sample population for the study. Majority (53.8%) of the women were between 20 and 29 years. Majority of the women were either nulliparous or primiparous (23.8% and 20.0% respectively). Tubal rupture occurred in 86.9% of the women at the time of laparotomy. Total salpingectomy was the surgical modality in 77.7% of the cases. The right fallopian tube was affected in 66.2% and the left 33.8% of the cases. The contralateral fallopian tube was grossly normal in 73.1% of cases. Of the 64 women who were followed up for a minimum of 12 months, 40.6% achieved viable intra uterine pregnancies, 6.3% had a repeat ectopic pregnancy in the contra lateral tube and 53.1% were unable to achieve pregnancy. CONCLUSION: Ectopic pregnancy is prevalent in our environment affecting mainly young women of low parity who desire future pregnancies. The subsequent impact on future fertility of these women could be improved if efforts are focused on early diagnosis to prevent tubal rupture. Early diagnosis prior to rupture offers opportunity for medical management and conservative surgical procedures that are proven to improve future fertility prognosis. Language: English Keywords: NIGERIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREVALENCE | PREGNANCY, ECTOPIC | TUBAL EFFECTS | IMPACT | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Measurement | Pregnancy Complications | Diseases | Fallopian Tubes | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Communication Document Number: 341758 |
| 7. Title: The safety of conception occurring shortly after methotrexate treatment of an ectopic pregnancy. Author: Svirsky R; Rozovski U; Vaknin Z; Pansky M; Schneider D; Halperin R Source: Reproductive toxicology. 2009 Jan;27(1):85-7. Abstract: The objective of this study was to determine whether a single or repeated injection of methotrexate (MTX) to treat ectopic pregnancy results in either teratogenicity or other bad obstetric outcome in the pregnancy that shortly follows treatment. Data were retrieved from the medical records of 314 women treated with MTX for ectopic pregnancy in our institute (2000-2006) included age, MTX dosage, interval between last MTX treatment to conception, results of ultrasonographic follow-up of the subsequent pregnancy, triple test, karyotype testing, pregnancy outcome, and newborn weight and Apgar score. A logistic regression model based on pregnancy outcome as the dependent variable and interval since last MTX treatment as the independent variable estimated the odds ratio for the safety of conception occurring shortly after the treatment. Complete information was obtained for 125 pregnancies. Forty-five pregnancies occurred within 6 months (mean 3.6+/-1.7) after the last MTX treatment. The outcome of these pregnancies was compared with that of 80 pregnancies which occurred > or =6 months (mean 23.6+/-14.7) after the last MTX treatment. The fetal malformation and adverse outcome rates for both groups were similar (odds ratio 1.003, 95% CI 0.98-1.02). According to a logistic regression analysis, the interval between the last MTX treatment for ectopic pregnancy had no effect on the outcome of the pregnancy that shortly followed it. The results of this study support the notion that conceiving within the first 6 months after treatment with MTX for ectopic pregnancy is safe and not associated with any increase in the examined adverse pregnancy outcome parameters. Language: English Keywords: MALAWI | RESEARCH REPORT | RECORDS | DATA COLLECTION | PREGNANCY | PREGNANCY, ECTOPIC | BIRTH DEFECTS | PREGNANCY OUTCOMES | METHOTREXATE | TREATMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Information Processing | Information | Research Methodology | Reproduction | Pregnancy Complications | Diseases | Neonatal Diseases and Abnormalities | Drugs | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 331042 |
| 8. Title: Contraception for women. Intrauterine devices and ectopic pregnancy [letter] Author: Vessey MP Source: BMJ. 2009;339:b3864. Abstract: This letter speaks of the relation between intrauterine devices (IUDs) and ectopic pregnancy. It stresses that women with an IUD in situ present with an accidental pregnancy are far more likely than other women without those circumstances to have an ectopic pregnancy. Language: English Keywords: UNITED KINGDOM | CRITIQUE | IUD | CONTRACEPTION FAILURE | PREGNANCY, ECTOPIC | RISK FACTORS | CONTRACEPTIVE EFFECTIVENESS | Developed Countries | Europe, Western | Europe | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Pregnancy Complications | Diseases | Health Document Number: 342931 |
| 9. Peer Reviewed Title: Cervical ectopic pregnancy successfully treated with local methotrexate injection. Author: Cerveira I; Costa C; Santos F; Santos L; Cabral F Source: Fertility and Sterility. 2008 Nov;90(5):2005.e7-2005.e10. Abstract: OBJECTIVE: To report a case where intra-amniotic injection of methotrexate (MTX) was used to terminate a cervical ectopic pregnancy that was resistant to IM MTX treatment. DESIGN: Case report. PATIENT(S): A 31-year-old woman, gravida 2, para 1, presented with painless vaginal bleeding. An early cervical pregnancy was diagnosed by transvaginal ultrasound. INTERVENTION(S): Intramuscular MTX therapy was started without success, and an intra-amniotic injection of MTX under ultrasonographic guidance was performed. MAIN OUTCOME MEASURE(S): Pregnancy termination. RESULT(S): Pregnancy termination was successful, without complications or side effects. CONCLUSION(S): Local installation of MTX appears to be an effective and safe method; however, choice depends on gestational age, desire to preserve fertility, and, most of all, hemodynamic stability. Language: English Keywords: PORTUGAL | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | PREGNANT WOMEN | PREGNANCY, ECTOPIC | CERVIX | ULTRASONICS | ABORTION | METHOTREXATE | Europe, Southwestern | Europe | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Drugs | Treatment Document Number: 329303 Notification |
| 10. Peer Reviewed Title: Conservative management of cervical ectopic pregnancy: case report and review of literature. Author: Corticelli A; Grimaldi M; Caporale E Source: Clinical and Experimental Obstetrics and Gynecology. 2008;35(4):297-8. Abstract: PURPOSE OF INVESTIGATION: The aim of the study is to describe the management of a case of cervical ectopic pregnancy at six weeks. CASE: A 34-year-old patient presented with six weeks of amenorrhea and a cervical pregnancy diagnosed by transvaginal ultrasound. Obstetrical anamnesis showed previous cesarean section and celiac disease as medical complications. At six weeks and one day 50 mg intramuscular methotrexate (MTX) was started and repeated three days later. At six weeks + six days the patient had vaginal bleeding so she was submitted to an emergency surgical procedure consisting of dilatation and curettage followed by a Foley balloon tamponade, which was gradually deflated and removed after two days. CONCLUSION: Early diagnosis and an appropriate MTX regimen in combination with adjuvant conservative procedures allow successful treatment of a cervical pregnancy, preserving the uterus and future reproductive outcome. However further studies are needed to define the best approach for management of cervical pregnancy. Language: English Keywords: ITALY | RESEARCH REPORT | LITERATURE REVIEW | MANAGEMENT | PREGNANCY, ECTOPIC | OBSTETRICAL SURGERY | Developed Countries | Europe, Southern | Europe | Organization and Administration | Pregnancy Complications | Diseases | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 331139 |
| 11. Peer Reviewed Title: Successful methotrexate treatment of an abdominal pregnancy in the pouch of Douglas. Author: Crespo R; Campillos JM; Villacampa A; Madani B; Navarro R; Tobajas JJ Source: Clinical and Experimental Obstetrics and Gynecology. 2008;35(4):289-90. Abstract: Abdominal pregnancy is a rare localization of ectopic pregnancy. Early diagnosis and treatment are advised and the choice of treatment is crucial. A successful case of conservative treatment with combined systemic and intra-amniotic methotrexate is presented. This treatment option should be considered in the management of this potentially life-threatening condition. Language: English Keywords: SPAIN | RESEARCH REPORT | PREGNANCY, ECTOPIC | SIGNS AND SYMPTOMS | PAIN | TREATMENT | RISK FACTORS | Developed Countries | Europe, Southwestern | Europe | Pregnancy Complications | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 331140 |
| 12. Title: Ectopic pregnancy with oral contraceptive use [letter] Author: Lin HH; Huang MC; Lin CJ; Chen CP Source: Taiwanese Journal of Obstetrics and Gynecology. 2008 Sep;47(3):341-2. Abstract: Language: English Keywords: TAIWAN | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREGNANCY, ECTOPIC | ORAL CONTRACEPTIVES | BLEEDING | ULTRASONICS | LAPAROSCOPY | CONTRACEPTION FAILURE | Asia, Eastern | Asia | Developed Countries | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Contraceptive Methods | Contraception | Family Planning | Signs and Symptoms | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Contraceptive Usage Document Number: 329827 |
| 13. Title: Heterotopic pregnancy: a clinical case report from rural Nigeria. Author: Odewale MA; Afolabi MO Source: Rural and Remote Health. 2008 Jul-Sep;8(3):979. Abstract: Heterotopic pregnancy (HP) is the co-existence of intrauterine and ectopic pregnancies; it is said to be rare. We report the case of a 22 year old woman with HP after unsuccessful attempts at abortion. This report illustrates the treatment difficulties encountered in a delayed presentation, and the nature HP is assuming in rural practice. It also highlights the role of family physicians in reducing maternal mortality in resource-limited settings. Language: English Keywords: NIGERIA | RESEARCH REPORT | RURAL AREAS | PREGNANT WOMEN | PREGNANCY | PREGNANCY, ECTOPIC | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Geographic Factors | Population | Population Characteristics | Demographic Factors | Reproduction | Pregnancy Complications | Diseases Document Number: 329024 |
| 14. Peer Reviewed Title: Increased expression of uteroglobin associated with tubal inflammation and ectopic pregnancy. Author: Quintar AA; Mukdsi JH; Bonaterra M; Aoki A; Maldonado CA Source: Fertility and Sterility. 2008 Jun;89(6):1613-1617. Abstract: The objective was the evaluation of uteroglobin (UG) expression in the fallopian tube in different tubal diseases. The UG was screened and quantified in samples of fallopian tubes from patients with salpingitis, hydrosalpinx, and ectopic pregnancy by exposing the UG with immunohistochemical techniques. The setting was the University hospital and electron microscopy center. The patient(s) were women with pelvic inflammatory disease (PID) and complicated tubal ectopic pregnancy consulting for medical care. The intervention was Salpingectomy. Tubal tissues were collected and examined using regular pathologic techniques. The UG immunoreactivity in the tubal epithelium was also assessed. Fallopian tube epithelium displayed an increased UG expression in patients with PID and complicated tubal pregnancy compared with control patients. Uteroglobin is present in the human fallopian tube as a secretory protein and appears to be involved in immunosuppressive responses in the fallopian tube. (author's) Language: English Keywords: ARGENTINA | RESEARCH REPORT | SCREENING | PREGNANT WOMEN | PREGNANCY, ECTOPIC | PREGNANCY, TUBAL | FALLOPIAN TUBES | TUBAL EFFECTS | PELVIC INFLAMMATORY DISEASE | PREGNANCY COMPLICATIONS | South America, Southern | South America | Latin America | Americas | Developing Countries | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Reproductive Tract Infections | Infections Document Number: 327232 |
| 15. Title: Caesarean section and tubal infertility: is there an association? Author: Saraswat L; Porter M; Bhattacharya S; Bhattacharya S Source: Reproductive Biomedicine Online. 2008 Aug;17(2):259-64. Abstract: Rising Caesarean section (CS) rates have fuelled concerns about the effect of abdominal delivery on female fertility due to post-surgical complications affecting the Fallopian tubes. The association between exposure to CS and subsequent tubal infertility was explored by means of a case-control study. This study compared 220 women with secondary infertility due to tubal factor with 1244 women with secondary infertility due to non-tubal causes and 18,376 fertile women (women with a previous live birth followed by another live birth during the time period when the infertile cases were trying to conceive) in terms of exposure to CS. Exposure to CS in women with secondary tubal infertility was similar to other infertile women (21.4% versus 21.6%) but lower in fertile controls (14.5%). After adjusting for confounding factors, CS does not appear to be significantly associated with tubal infertility [adjusted odds ratio (95% confidence interval) for previous CS for infertile and fertile controls were 1.06 (0.73-1.52) and 1.2 (0.9-1.7), respectively]. However, other factors that were found to be predictive of secondary tubal infertility include history of intrauterine device use, pelvic inflammatory disease, ectopic pregnancy, endometriosis and previous pelvic surgery. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CASE CONTROL STUDIES | WOMEN | PREVALENCE | CESAREAN SECTION | FALLOPIAN TUBES | TUBAL EFFECTS | INFERTILITY | COMPLICATIONS | IUD | PELVIC INFLAMMATORY DISEASE | PREGNANCY, ECTOPIC | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Demographic Factors | Population | Measurement | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Reproduction | Diseases | Contraceptive Methods | Contraception | Family Planning | Reproductive Tract Infections | Infections | Pregnancy Complications Document Number: 328958 |
| 16. Title: Ectopic pregnancy in adolescents. Author: Vichnin M Source: Current Opinion in Obstetrics and Gynecology. 2008 Oct;20(5):475-8. Abstract: PURPOSE OF REVIEW: Ectopic pregnancy continues to be an important cause of morbidity and mortality in women. Tubal damage is the likely cause of ectopic pregnancy. Healthcare providers who care for adolescents must screen for and treat sexually transmitted diseases like Chlamydia in order to decrease the risk of tubal damage and ectopic pregnancy. Smoking is a risk factor for ectopic pregnancy and teens should be encouraged to never start smoking or to quit if they already do smoke. Though ectopic pregnancy is more likely to occur in adults, teens are at risk as well, and early diagnosis allows for the possibility of conservative management. RECENT FINDINGS: Any teen who presents with amenorrhea, pain, or vaginal bleeding should be evaluated for a possible ectopic pregnancy. Adolescents are more likely to present with pain than adults. Transvaginal ultrasound should be performed and if an intrauterine pregnancy or ectopic pregnancy is not clearly seen, correlation with serum beta-human chorionic gonadotropin levels is done. If the beta-human chorionic gonadotropin level is above the 'discriminatory zone' of 1500 mIU and the transvaginal ultrasound does not show an intrauterine pregnancy, ectopic pregnancy should be suspected. SUMMARY: Unruptured ectopic pregnancy may be treated with expectant management, surgical management, or medical management (methotrexate). Healthy teens with unruptured ectopic pregnancies and who are able and willing to undergo close surveillance may be treated with methotrexate. There are case reports of successful treatment of ectopic pregnancy with methotrexate in adolescents. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | MANAGEMENT | ADOLESCENTS | PREGNANCY, ECTOPIC | RISK FACTORS | Developed Countries | North America | Americas | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Biology Document Number: 329704 |
| 17. Title: Analysis of metallothionein, RCAS1 immunoreactivity regarding immune cell concentration in the endometrium and tubal mucosa in ectopic pregnancy during the course of tubal rupture. Author: Wicherek L; Galazka K; Lazar A Source: Gynecologic and Obstetric Investigation. 2008 Jan;65(1):52-61. Abstract: Tubal rupture seems to be linked to a disturbance in maternal immune response and trophoblast cell invasion. The immunomodulating activity of endometrial cells is necessary for the coexistence of activated immune cells and endometrial cells. RCAS1 and metallothionein (MT) participate in this process. Tissue samples derived from fallopian tubes and endometrium were collected during one surgical procedure and divided into three groups: unruptured ectopic pregnancy (EP) without bleeding, unruptured EP with hemorrhage into the peritoneal cavity, and ruptured tubal pregnancy. Immunoreactivity of MT, RCAS1, CD56, CD3, CD69 and CD25 were assessed by immunohistochemical methods. The number of CD3+ and CD56+ cells as well as CD69 antigen immunoreactivity in ruptured tubal mucosa of EP were statistically significantly higher than those measured for unruptured EP without bleeding, while at the same time the number of CD56+ cells in endometrium was statistically significantly lower. The growth of immune cell numbers in tubal mucosa during tubal rupture was not associated with an adequate MT and RCAS1 level. Tubal perforation seems to be linked to a concentration of immune cells and a growth of their activity without an adequate increase of the level of proteins compensating for immune cell response. (author's) Language: English Keywords: POLAND | RESEARCH REPORT | PREGNANT WOMEN | PREGNANCY, ECTOPIC | TUBAL EFFECTS | ENDOMETRIUM | COMPLICATIONS | BLEEDING | ANTIGENS | ANALYSIS | IMMUNITY, CELLULAR | Europe, Central | Europe | Developing Countries | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Fallopian Tubes | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Uterus | Signs and Symptoms | Immunologic Factors | Immunity | Immune System | Research Methodology Document Number: 323126 |
18.  Title: Ultrasonographic characteristics in patients clinically diagnosed with threatened abortion. Author: Boriboonhirunsarn D; Buranawattanachoke S Source: Journal of the Medical Association of Thailand. 2007 Nov;90(11):2266-2270. Abstract: The objective was to determine ultrasonographic appearances in pregnant women clinically diagnosed with threatened abortion. The design used was a cross-sectional study Seven hundred and seventy six pregnant women clinically diagnosed with threatened abortion and receiving ultrasonographic examination were enrolled. Data on ultrasonographic characteristics were obtained from records at the Maternal-fetal Medicine unit. Pregnancy outcomes were reviewed from medical records. The ultrasonographic findings demonstrated 328 (42.3%) viable pregnancy, 178 (22.9%) embryonic death, 176 (22.7%) anembryonic pregnancy, 25 (3.2%) incomplete abortion, 24 (3.1%) complete abortion, seven (0.9%) molar pregnancy, four (0.5%) ectopic pregnancy, and 34 (4.4%) inconclusive finding. Two hundred and sixty viable pregnancies were available for follow-up and revealed that 229 (88.1%) eventually delivered while 31 (11.9%) ended up with abortion. The two groups were not significantly different regarding age, parity, historyof abortion, and gestational age at diagnosis. Ultrasonographic findings in patients clinically diagnosed with threatened abortion demonstrated viable pregnancy in nearly half of the cases. Transvaginal ultrasonography is useful in establishing definite diagnosis and appropriate treatment among these patients. (author's) Language: English Keywords: THAILAND | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREGNANT WOMEN | ULTRASONICS | PREGNANCY COMPLICATIONS | ABORTION | PREGNANCY, ECTOPIC | EXAMINATIONS AND DIAGNOSES | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Fertility Control, Postconception | Family Planning Document Number: 323863 Notification |
| 19. Peer Reviewed Title: Arias-Stella reaction in upper genital tract in pregnant and non-pregnant women: A study of 120 randomly selected cases. Author: Dhingra N; Punia RS; Radotra A; Mohan H Source: Archives of Gynecology and Obstetrics. 2007 Jul;276(1):47-52. Abstract: The aims were to: 1. To study the diagnostic importance of the Arias-Stella reaction. 2. To study tubal epithelial changes in ectopic pregnancy. 3. To study the occurrence of Arias-Stella reaction in non-pregnant women receiving hormonal treatment. A prospective study was conducted on 120 patients who underwent endometrial curettage and/or salpingectomy. The patients were divided into four groups, each comprising of 30 patients. Groups 1 and 4 included non-pregnant patients who were being evaluated for infertility and dysfunctional uterine bleeding respectively, while pregnant patients were included in Group 2 (intra-uterine abortions) and Group 3 (ectopic tubal gestation). The endometrial curettings and fallopian tube lining epithelial cells were examined for the changes described by Arias-Stella. Cases which showed the presence of the Arias-Stella reaction were further classified. The changes of the Arias-Stella reaction in endometrial glands were observed in 80% cases of intra-uterine abortions. Secretory/hypersecretory pattern was the most commonly observed type (36.67%). The reaction was seen in 3.33% each of patients evaluated for infertility and patients on hormonal therapy with oral progestational agents for the management of dysfunctional uterine bleeding. Although uncommon, the Arias-Stella reaction was noted in the epithelium of fallopian tubes (16.67%) from patients with ectopic tubal gestation. The findings of the present study emphasize the diagnostic importance of the Arias-Stella reaction. The changes of the reaction are a histological clue to the presumptive diagnosis of the presence of chorial tissue in cases in which the chorionic material is not found in the endometrial biopsy. The morphological features can be mistaken for malignancy if the pathologist is not aware of the patient's pregnancy or history of hormonal intake. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | WOMEN | INFERTILITY | ENDOMETRIAL EFFECTS | BLEEDING | ABORTION | PREGNANCY, ECTOPIC | EXAMINATIONS AND DIAGNOSES | HORMONES | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Reproduction | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Diseases | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endocrine System Document Number: 317649 Notification |
| 20. Peer Reviewed Title: Ectopic pregnancy with Implanon. Author: Henderson PM; Gillespie MD Source: Journal of Family Planning and Reproductive Health Care. 2007 Apr;33(2):125-126. Abstract: Implanon is a subdermal implant comprising an ethylene vinyl acetate copolymer cylinder with a core containing 68mg etonogestrel, the biologically active metabolite of desogestrel, a progestogen widely used in oral contraceptives. Clinical trials performed during the implant's development reported no pregnancies. In 1998, data were available for 4103 woman-years (in excess of 531000 treatment cycles) giving a Pearl index of 0.0. Implanon was introduced in Europe in 1998 and in the UK in October 1999. Experience of Implanon's use since then has produced some unintended pregnancies, although in many of these cases the conceptions have occurred as a result of failures arising from non-insertion, prior conception, drug interaction with enzyme inducers, and so on, rather than due to primary failure of the contraceptive effect. Implanon achieves its contraceptive effect by inhibition of ovulation and by effecting changes in the cervical mucus which hinders the passage of spermatozoa. The release rate ofetonogestrel decreases with time so that by the end of the first year of use the mean concentration of etonogestrel is 200 (range, 150-261) pg/ml and by the end of the third year is 156 (range, 111-202) pg/ml. There needs to be a plasma level of etonogestrel of at least 90 pg/ml to suppress ovulation. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | CASE STUDIES | WOMEN | PREGNANCY, ECTOPIC | CONTRACEPTIVE IMPLANTS | CONTRACEPTION FAILURE | North America | Americas | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Pregnancy Complications | Diseases | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage Document Number: 314555 |
| 21. Peer Reviewed Title: Transvaginal ultrasound-guided treatment of cervical pregnancy. Author: Jeng CJ; Ko ML; Shen J Source: Obstetrics and Gynecology. 2007 May;109(5):1076-1082. Abstract: The objective was to describe our experience with sonographically guided injection of methotrexate and potassium chloride (KCl) to treat early cervical pregnancy. We prospectively reviewed all cases of cervical pregnancies treated conservatively through transvaginal ultrasound-guided therapy at our institutions. Thirty-eight cases were identified, from 1993 through 2004. All cases were managed with transvaginal intraamniotic and intrachorionic injection of 50 mg of methotrexate under ultrasound guidance. An additional intracardiac fetal injection of 2 mL KCl was given for those cervical pregnancies with documented cardiac activity. Follow-up sonographic examinations and serum ß-hCG measurements were performed twice weekly for 2 weeks after the procedure, then weekly. The mean initial ß-hCG level was 38,948 milli-International Units/mL and ranged from 5,608 to 103,256 milli-International Units/mL for 22 cases with fetal heart activity and from 2,765 to 18,648 milli-International Units/mL for 16 cases without. Gestational age ranged from 5.4 to 14 weeks (mean 8.8 weeks). All cervical pregnancies were successfully aborted, with an average resolution of the cervical mass in 49 days. Postoperative ß-hCG declined to less than 5 milli-International Units/mL within a mean of 38 days. A mean 4.5-year follow-up showed that, of 21 patients who desired pregnancy, 18 had achieved subsequent successful pregnancies. Cervical pregnancies can be successfully managed without surgical intervention through local injection of methotrexate and KCl. This treatment not only ablates the ectopic pregnancy but also preserves the uterus for subsequent pregnancies. (author's) Language: English Keywords: TAIWAN | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANCY COMPLICATIONS | PREGNANCY, ECTOPIC | ULTRASONICS | TREATMENT | INTERVENTIONS | Developed Countries | Asia, Eastern | Asia | Studies | Research Methodology | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration Document Number: 315913 |
| 22. Title: Laparoscopic salpingectomy in tubal pregnancy: Prospective randomized trial using endoloop versus electrocautery. Author: Lim YH; Ng SP; Ng PH; Tan AE; Jamil MA Source: Journal of Obstetrics and Gynaecology Research. 2007 Dec;33(6):855-862. Abstract: Ectopic pregnancy is conventionally managed by laparoscopic salpingectomy. Electrocautery has been used widely to secure hemostasis during salpingectomy. However, this method is associated with a risk of thermal injury to the visceral organs. Endoloop, a pre-tied suture used in laparoscopic surgery may be an alternative treatment tool and its potential use in the management of ectopic pregnancy is explored here. Our study aims to compare the effectiveness of the endoloop technique to electrocautery during laparoscopic salpingectomy for tubal pregnancy. A prospective randomized controlled study was conducted over 24 months at the Hospital Universiti Kebangsaan Malaysia. One hundred and two patients with tubal pregnancy were randomized into two treatment groups: those treated with endoloop and those treated with electrocautery during laparoscopic salpingectomy. The use of an endoloop was associated with a shorter operating time (48.85 min +or- 21.019 vs 61.14 min +or- 22.603, 95% CI -20.864 to -3.724), lower visual analog scores for postoperative pain at day 1 (2.02 +or- 0.960 vs 2.74 +or- 0.828, 95% CI -1.074 to -0.368) and day 7 (0.85 +or- 0.802 vs 1.44 +or- 0.837, 95% CI -0.916 to -0.272), and lesser total analgesia required by patients at day 7 after the operation (7.65 +or- 6.119 vs 15.32 +or- 8.326, 95% CI -10.529 to -4.804). There was no significant difference in the ability to secure hemostasis when both techniques were compared. Duration of hospitalization (2.37 days +or- 0.817 vs 2.34 days +or- 0.519, 95% CI -0.245 to -0.296) and interval from operation to discharge were similar. The endoloop appeared to be as effective as electrocautery and is a safe alternative to electrocautery for laparoscopic salpingectomy in tubal pregnancy. (author's) Language: English Keywords: MALAYSIA | RESEARCH REPORT | CLINICAL TRIALS | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREGNANCY, TUBAL | LAPAROSCOPY | PREGNANCY, ECTOPIC | OBSTETRICAL SURGERY | TIME FACTORS | PAIN | ANALGESIA | Developing Countries | Asia, Southeastern | Asia | Clinical Research | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Pregnancy Complications | Diseases | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Surgery | Treatment | Population Dynamics | Signs and Symptoms Document Number: 322692 |
| 23. Title: Recent developments in gynaecology [editorial] Author: Lindeque BG Source: South African Family Practice. 2007 Apr;49(3):18. Abstract: Recent developments in operative gynaecology, especially in the field of endoscopic surgery, are more than matched by developments in consultation gynaecology. Only a few areas will be mentioned. Endoscopic gynaecologic surgery has become widely practiced in South Africa. This has expanded into gynaecologic cancer surgery where gynaecologic oncologists may perform laparoscopic lymph node dissection on patients with endometrial or cervical cancers under certain circumstances: The standardization for the technique of radical trachellectomy as surgical management of patients with Stage IB1 cervical cancers desiring future fertility opened new possibilities for young women. The trachellectomy (radical removal of the cervix) can be performed transabdominally or transvaginally. In the latter case laparoscopic lymphadenectomy complements the technique greatly. Radical trachellectomy has been performed in several centres in South Africa with subsequent successful pregnancies occurring in a number of patients. In patients with endometrial cancers with co-morbid disease where vaginal hysterectomy is elected as the surgical technique to remove the cancer, available evidence shows that laparoscopic lymphadenectomy is a safe and effective way to perform the full cancer operation. (excerpt) Language: English Keywords: SOUTH AFRICA | CRITIQUE | GYNECOLOGY | CERVICAL CANCER | LAPAROSCOPY | GYNECOLOGIC SURGERY | PREGNANCY, ECTOPIC | HPV | VACCINES | PAP SMEAR | ABORTION | WOMEN'S HEALTH | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Urogenital Surgery | Surgery | Treatment | Pregnancy Complications | Viral Diseases | Laboratory Examinations and Diagnoses | Fertility Control, Postconception | Family Planning Document Number: 319561 Notification |
| 24. Peer Reviewed Title: Ectopic pregnancy -- an analysis of 180 cases. Author: Majhi AK; Roy N; Karmakar KS; Banerjee PK Source: Journal of the Indian Medical Association. 2007 Jun;105(6):308-314. Abstract: Ectopic pregnancy is the most life threatening emergency in pregnancy. Increase in incidence and impairment in fertility are now the real concerns. The aim of this study was to estimate the epidemiological, diagnostic and therapeutic aspects of ectopic pregnancy with a view to suggest action to improve the prognosis. This was a prospective study carried out at NRS Medical College, Kolkata, among consecutive 180 patients of ectopic pregnancy admitted from January, 2002 to December, 2004. During this period the incidence of ectopic pregnancy was 1 in 161(0.6%). The peak age of incidence was 26-30 years; primi were the most sufferers. There were 65.0% patients was had identifiable risk factors. Tubectomy (14.4%), history of abortion (26.1%), infertility (12.2%), pelvic inflammatory diseases (12.8%) and history of previous surgery (11.1%) were the important risk factors. Amenorrhoea (76.1%), abdominal pain (86.1%) and vaginal bleeding (42.2%) were the frequent presenting complaints. There were 87.8% patients was had pallor, 9.4% were admitted with features of shock. Cervical motion tenderness (82.2%) was the most frequent sign. Urinary b-hCG was positive in 96.1% cases. Ultrasonography revealed diagnosis in rds cases among 129 patients. Culdocentesis evoked the diagnosis in 73.3% cases out of 135 patients. In 95.0% cases it was of tubal variety, 70.2% ruptured, 19.9% tubal abortion and 9.9% unruptured. Surgery by open method in the form of salpingectomy (81.9%), salpingo-oophorectomy (9.3%) and salpingostomy (5.3%) were the mainstay of management. Expectant management and medical therapy can be offered only in 1.2% and 1.75% respectively. There was no case fatality. By reducing and identifying the risk factors and 'catching' the patients at the earliest it is possible to improve the prognosis so far as morbidity, mortality and fertility are concerned. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | PREGNANCY, ECTOPIC | AGE DISTRIBUTION | PRIMIPARITY | RISK FACTORS | SIGNS AND SYMPTOMS | MANAGEMENT | SURGERY | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Age Factors | Parity | Fertility Measurements | Fertility | Population Dynamics | Biology | Organization and Administration | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 320193 |
| 25. Peer Reviewed Title: Ectopic pregnancy following emergency contraception with ethinyloestradiol-levonorgestrel: A case report. Author: Matsushita H; Takayanagi T; Ikarashi H Source: European Journal of Contraception and Reproductive Health Care. 2007 Jun;12(2):184-186. Abstract: Emergency contraception with ethinyloestradiol-levonorgestrel is effective, and ectopic pregnancy following its failure is rare. A 21-year-old nulligravid Japanese woman with regular menstrual periods took ethinyloestradiol-levonorgestrel pills for emergency contraception (EC) 36 and 48 hours after a coitus complicated by retention of the condom in the vagina. She started bleeding vaginally 24 days after that intercourse. As the bleeding continued for three weeks she consulted a gynaecologist. The pregnancy test was positive. Two weeks later she complained of lower abdominal pain, and transvaginal ultrasonography suggested a pelvic blood collection. At emergency surgery, she was found to have a left tubal pregnancy. Although ectopic pregnancy after failure of EC is rare, one should be alert to its possible occurrence. (author's) Language: English Keywords: JAPAN | RESEARCH REPORT | CASE STUDIES | WOMEN | FAMILY PLANNING ACCEPTORS | EMERGENCY CONTRACEPTION | PREGNANCY, ECTOPIC | ETHINYL ESTRADIOL | LEVONORGESTREL | SIGNS AND SYMPTOMS | ULTRASONICS | Developed Countries | Asia, Eastern | Asia | Studies | Research Methodology | Demographic Factors | Population | Family Planning Programs | Family Planning | Contraception | Pregnancy Complications | Diseases | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Progestin | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 317567 |
| 26. Title: [Audit of the severe obstetrical morbidity (near miss) in Gabon] Audit de la morbidite obstetricale grave (near miss) au Gabon. Author: Mayi-Tsonga S; Meye JF; Tagne A; Ndombi I; Diallo T Source: Cahiers Sante. 2007 Apr-Jun;17(2):111-115. Abstract: Objective: To examine "near-miss" cases to identify the weak points of our department. Material and methods: This prospective study took place at the Libreville Hospital Maternity Center for six months, from 1 June to 31 December 2006. It included all pregnant women with a severe obstetrical complication (uterine haemorrhage with signs of shock, eclampsia, severe infection) or whose condition required a major intervention to prevent death. The quality of these patients' management was studied from their arrival in the department to their discharge. Results: The prevalence of near-misses was of 3.15%, that is, 137 cases among 4350 deliveries. Ruptured ectopic pregnancies, haemorrhage following clandestine elective abortions, and post-partum haemorrhages (third stage of delivery) were the three primary causes for near misses. Almost 40% of these women waited more than 45 minutes before seeing any qualified personnel. Once the patient was seen, clinical examinations were impossible for 22% because of the lack of the appropriate material. The average time to surgery was 5 hours and 15 minutes. The lack of sterilized surgical linens was one of the major causes of delay in surgical management. Conclusion: The number of patients seeking care in our department, relative to the staff resources, makes it difficult to optimise the quality of emergency obstetric care. Language: French Keywords: GABON | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREGNANCY COMPLICATIONS | PREVALENCE | BLEEDING | CHILDBIRTH | PREGNANCY, ECTOPIC | ABORTION | POSTPARTUM | OBSTETRICAL SURGERY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Diseases | Measurement | Signs and Symptoms | Pregnancy Outcomes | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Puerperium | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 324565 Notification |
| 27. Title: A study of serological evidence of prior chlamydia trachomatis infection in patients with ectopic pregnancy in Ilorin, Nigeria. Author: Moses AO; Munir'deen AI; Adegboyega FA; Abdulgafar JA Source: European Journal of Scientific Research. 2007;16(2):461-466. Abstract: Ectopic pregnancy is one of the most serious sequelae to acute salpingitis. Chlamydia trachomatis has been reported to be the most common etiological agent of acute salpingitis. However, little is known about the role of Chlamydia trachomatis in the etiology of ectopic pregnancy in Nigeria. The objective was to determine the prevalence of antibodies to Chlamydia trachomatis in women presenting with ectopic pregnancy in Ilorin, with a specific objective of establishing an aetiological role for Chlamydia trachomatis infection as a risk factor for ectopic pregnancy in Nigerian women. A case-control study conducted in eight health facilities within Ilorin metropolis. The study population was made up of 48 women with ectopic pregnancy and 48 women with early intrauterine pregnancy as control. Pre tested questionnaire were interviewer administered to the women and their serum levels of IgG antibody to Chlamydia trachomatis were determined. The prevalence of serum antichlamydia antibody in women with ectopic pregnancy (70.8%) was significantly higher compared with women with normal intrauterine pregnancy (37.5%). The prevalence was higher in women with ectopic pregnancy who were below age 30 years (82.6%) when compared with the prevalence in women with ectopic pregnancy who were 30 years and above (60%), and also higher in women who had no other readily identifiable risk factors for ectopic pregnancy (73.8%) compared to women in whom other risk factors were present (50%). The study highly suggests that among women in Ilorin, prior Chlamydial trachomatis infection is associated with an increased risk of ectopic pregnancy. We suggest that an effective way of reducing the ectopic pregnancy rate is by prevention of Chlamydial infection. (author's) Language: English Keywords: NIGERIA | RESEARCH REPORT | CASE CONTROL STUDIES | PREGNANT WOMEN | PREGNANCY, ECTOPIC | CHLAMYDIA | TRACHOMA | ANTIBODIES | PREVALENCE | SEROCONVERSION | RISK FACTORS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Bacterial and Fungal Diseases | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Measurement Document Number: 317549 |
| 28. Peer Reviewed Title: Laparoscopic management of atypical presentation of ectopic pregnancy. Author: Nahar S; Begum S; Islam MS Source: Pakistan Journal of Medical Sciences. 2007 Apr-Jun;23(2):198-201. Abstract: The objective was as analysis of management in 22 ectopic pregnancies clinically presented as an atypical form. Twenty two patients with suspected ectopic pregnancy were successfully managed laparoscopically during three years period at Victory Nursing and infertility management centre, Khulna, Bangladesh. All patients had dull ache pain in lower abdomen or any one of the iliac fossa. All cases were hemodynamically stable and ambulatory. Ultrasonography findings were complex Heterogeneous mass without any free fluid in 8 cases, definitive gestational sac in 6, and sac like structure in 8 cases. Urinary ß-hCG was positive in 40.9% and negative in 59% cases. Pre-operative diagnoses were chronic ectopic pregnancy in 11, ruptured corpus luteum in six and chocolate cyst in five cases. Operating diagnosis were chronic ectopic pregnancy 14, unruptured tubal and cornual pregnancy 5, ovarian ectopic in three cases. Surgical procedures were salpingostomy, salpingectomy, salpingo-ophrectomy, partial ovarian resection and only sac removal with peritoneal toileting. Operating time was 30-120 minutes. The average postoperative stay was 24-48 hours without any complications. Unruptured early ectopic may present with minimal symptomotology. Hence in all women of child bearing age the provisional diagnosis of ectopic pregnancy may be kept in mind while examining and investigating a patient. (author's) Language: English Keywords: BANGLADESH | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | PREGNANCY, ECTOPIC | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | ULTRASONICS | LAPAROSCOPY | OBSTETRICAL SURGERY | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Physical Examinations and Diagnoses | Surgery | Treatment Document Number: 315623 |
| 29. Title: The impact of cesarean birth on subsequent fertility. Author: Oral E; Elter K Source: Current Opinion in Obstetrics and Gynecology. 2007 Jun;19(3):238-243. Abstract: Recently, the rate of cesarean delivery has increased to 25-30% of all births, the highest rate ever reported in the USA. Primary cesarean deliveries, especially elective procedures, mainly contribute to this increase. Currently, controversy concerning elective cesarean delivery is an area of growing debate. Women should be well informed about the benefits and risks of on-demand cesarean delivery. This may be problematic, however, due to the limited current scientific data on the benefits and risks. One of the issues causing debate is the association between cesarean section and subsequent infertility. In the present review, we aim to analyze the evidence for the impact of cesarean delivery on subsequent fertility. Cesarean section has been reported to be associated with decreased subsequent fertility. Recent studies, which have tried to explain this association, suggest that this is most probably voluntary or due to some other biases, or possible confounding factors, which are due to organic or psychosocial effects of an emergency cesarean section or labor preceding the cesarean delivery. Elective cesarean section does not appear to cause infertility. What we need now, however, are more qualitative studies to determine the contribution of cesarean section per se on fecundity. (author's) Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | PREGNANT WOMEN | CHILDBIRTH | CESAREAN SECTION | PREVALENCE | IMPACT | FERTILITY | RISK FACTORS | INFERTILITY | PREGNANCY, ECTOPIC | North America | Americas | Developed Countries | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Research Methodology | Communication | Population Dynamics | Biology | Pregnancy Complications | Diseases Document Number: 313497 |
| 30. Title: Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a viable cesarean scar ectopic pregnancy. Author: Ozkan S; Caliskan E; Ozeren S; Corakci A; Cakiroglu Y Source: Journal of Obstetrics and Gynaecology Research. 2007 Dec;33(6):873-877. Abstract: Implantation of conception material within a cesarean section scar is an extremely rare form of ectopic pregnancy with devastating complications, such as uterine rupture and intractable bleeding. Both 2-D and 3-D transvaginal ultrasonographic devices are used adequately for precise diagnosis, but there is still a lack of consensus concerning management strategies. No therapeutic modality is suggested to be entirely efficacious and safe for preserving uterine integrity. We present here a 29-year-old woman with vaginal bleeding and a gestational sac with a viable embryo of 6 weeks of age that was implanted in a cesarean section scar. Serum beta-hCG levels were 16 792 mIU/mL. Following an unsuccessful treatment course of systemic methotrexate, the patient underwent operative hysteroscopy. Minimally invasive hysteroscopic resection of the ectopic gestational mass without major complication appears to be an alternative therapeutic approach with minimal morbidity and preservation of future fertility. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | ULTRASONICS | HYSTEROSCOPY | CESAREAN SECTION | PREGNANCY, ECTOPIC | PRODUCTS OF CONCEPTION, RETENTION | UTERUS | BLEEDING | SIGNS AND SYMPTOMS | PHYSICAL EXAMINATIONS AND DIAGNOSES | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Examinations and Diagnoses | Obstetrical Surgery | Surgery | Treatment | Pregnancy Complications | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 322694 |
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