Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA.
Published: October 2019
AI Article Synopsis
Article Abstract
Introduction: Ectopic pregnancy (EP) is a potentially life-threatening condition and early diagnosis still remains a challenge, causing a delay in management leading to tubal rupture.
Objectives: To identify putative plasma biomarkers for the detection of tubal EP and elucidate altered biochemical pathways in EP compared to intrauterine pregnancies.
Methods: This case-control study included prospective recruitment of 39 tubal EP cases and 89 early intrauterine pregnancy controls. Plasma samples were biochemically profiled using proton nuclear magnetic resonance spectroscopy (H NMR). To avoid over-fitting, datasets were randomly divided into a discovery group (26 cases vs 60 controls) and a test group (13 cases and 29 controls). Logistic regression models were developed in the discovery group and validated in the independent test group. Area under the receiver operating characteristics curve (AUC), 95% confidence interval (CI), sensitivity, and specificity values were calculated.
Results: In total 13 of 43 (30.3%) metabolite concentrations were significantly altered in EP plasma (p < 0.05). Metabolomic profiling yielded significant separation between EP and controls (p < 0.05). Independent validation of a two-metabolite model consisting of lactate and acetate, achieved an AUC (95% CI) = 0.935 (0.843-1.000) with a sensitivity of 92.3% and specificity of 96.6%. The second metabolite model (D-glucose, pyruvate, acetoacetate) performed well with an AUC (95% CI) = 0.822 (0.657-0.988) and a sensitivity of 84.6% and specificity of 86.2%.
Conclusion: We report novel metabolomic biomarkers with a high accuracy for the detection of EP. Accurate biomarkers could potentially result in improved early diagnosis of tubal EP cases.
Background: Abdominal pregnancy is a rare but, serious obstetric condition that has continued to pose difficulties in its diagnosis and management. The clinical presentation takes various forms, mostly nonspecific, leading to the delay in diagnosis and management. With a high degree of suspicion, the diagnosis can be made by an abdominal ultrasound particularly in the early trimesters.
Purpose: Ectopic pregnancy (EP) constitutes 1-2% of all pregnancies. Methotrexate (MTX) is commonly used in treating EP, but it has some limitations and potential side effects. Clinical studies have shown that letrozole, an aromatase inhibitor, may potentially be used in conjunction with MTX therapy.
Ectopic pregnancies are uncommon among women presenting for abortion. However, where suspected, rapid referral for definitive diagnosis is essential to prevent harm. We assessed whether implementation of a standardised decision-making tool, an algorithmic representation of the clinical decisions and associated actions defined in policy, in a British abortion service was associated with a reduction in missed opportunities to escalate care where indicated.
Background: To evaluate the risk factors associated with WOI (window of implantation) displacement based on ERT (endometrial receptivity test), and to confirm the association of ectopic pregnancy with WOI displacement.
Methods: This is a retrospective study at the Reproductive Medicine Center of Xiangya Hospital from January 2020 to April 2024, consisting of 934 patients who performed ERT. The patients underwent 3771 assisted reproductive technology (ART) cycles and 2629 embryo transfer (ET) cycles, with each patient experiencing at least one implantation failure.
