ECTOPIC PREGNANCY – MODERN DIAGNOSIS AND MANAGEMENT Edited by Michael Kamrava Ectopic Pregnancy – Modern Diagnosis and Management Edited by Michael Kamrava Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Used under license from Shutterstock.com First published October, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Ectopic Pregnancy – Modern Diagnosis and Management, Edited by Michael Kamrava p. cm. ISBN 978-953-307-648-5 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Epidemiology, Morbidity and Mortality 1 Chapter 1 Differential Diagnosis of Ectopic Pregnancy - Morbidity and Mortality 3 Panagiotis Tsikouras, Marina Dimitraki, Alexandros Ammari, Sofia Bouchlariotou, Stefanos Zervoudis, Panagiotis Oikonomidis, Constantinos Zakas, Theodoros Mylonas, Anastasios Liberis, Vasileios Liberis and Georgios Maroulis Part 2 Causes of Ectopic Pregnancy 11 Chapter 2 Tubal Damage, Infertility and Tubal Ectopic Pregnancy: Chlamydia trachomatis and Other Microbial Aetiologies 13 Louise M. Hafner and Elise S. Pelzer Chapter 3 Ectopic Pregnancy and Assisted Reproductive Technologies: A Systematic Review 45 Anastasia Velalopoulou, Dimitrios Peschos, Mynbaev Ospan, Eliseeva Marina, Ioannis Verginadis, Yannis Simos, Tsirkas Panagiotis, Spyridon Karkabounas, Vicky Kalfakakou, Angelos Evangelou and Ioannis P. Kosmas Chapter 4 Hysteroscopic Endometrial Embryo Delivery (HEED) 79 M.M. Kamrava, L. Tran and J.L. Hall Chapter 5 Ectopic Pregnancy Following Reconstructive, Organ-Preserving Microsurgery in Tubal Infertility 87 Cordula Schippert, Philipp Soergel and Guillermo-José Garcia-Rocha Chapter 6 Persistent Ectopic Pregnancy After Laparoscopic Linear Salpingostomy for Tubal Pregnancy: Prevention and Early Detection 97 Shigeo Akira, Takashi Abe and Toshiyuki Takeshita VI Contents Part 3 Diagnosis of Ectopic Pregnancy 107 Chapter 7 Management and Outcome of Ectopic Pregnancy in Developing Countries 109 Buowari Yvonne Dabota Chapter 8 Clinical Application of One-Step Diagnosis for Ectopic Pregnancy by HCG Ratio: Hemoperitoneum Versus Venous Serum 137 Yu-dong Wang, Wei-wei Cheng and Xiao-ping Wan Chapter 9 Inhibins and Activins as Possible Marker of Ectopic Pregnancy 151 Blazej Meczekalski and Agnieszka Podfigurna-Stopa Chapter 10 Term Extra-Uterine Pregnancy 163 Ismail A. Al-Badawi, Osama Al Omar and Togas Tulandi Part 4 Management of Ectopic Pregnancy 175 Chapter 11 Clinical Treatment of Unruptured Ectopic Pregnancy 177 Julio Elito Junior Chapter 12 MTX Could Be First-Line Therapy Even in Cases Where hCG Level is Greater than 5,000 IU/ml 209 Yoshiki Yamashita, Sousuke Katoh, Yoko Yoshida, Satoe Fujiwara, Sachiko Kawabe, Mika Hayashi, Atsushi Hayashi, Yoshito Terai and Masahide Ohmichi Chapter 13 The Treatment of Ectopic Pregnancy with Laparoscopy-Assisted Local Injection of Chemotherapeutic Agents 217 Ching-Hui Chen, Peng-Hui Wang, Li-Hsuan Chiu and Wei-Min Liu Chapter 14 Fertility-Preserving Surgery for Cervical Ectopic Pregnancy, from Past to Present 225 Seiryu Kamoi, Nao Iwasaki and Toshiyuki Takeshita Chapter 15 Modern Management of Cornual Ectopic Pregnancy 237 Maged Shendy and Rami Atalla Preface The objective in compiling this book has been to bring more worldwide awareness of this important cause of maternal morbidity and mortality. In addition to the sexually transmitted diseases, as advanced reproductive technologies have become available everywhere, occurrence of ectopic pregnancies has also increased more than before. With better understanding of the causes of this condition, earlier diagnosis and earlier treatment of sexually transmitted diseases, along with employing improved reproductive technologies, has led to more non-invasive treatment options and improved outcome in the management of these, potentially life-threatening, situations. This book is dedicated to all our patients from all over the world who have given us the impetus for giving them hope for having a family. Also, I would like to thank my wife, Soheila, and our children Mitchell and Michelle for their patience, understanding and encouragement in taking on this task. Michael Kamrava, MD West Coast IVF Clinic, Inc. LA Center for Embryo Implantation (SEED/ HEED) USA [...]... mycoplasmas and cases of PID (Moller et al., 1985 )and mycoplasma, PID and ectopic pregnancy (Jurstrand et al., 2007) A prospective study of 212 infertile couples was undertaken to investigate the presence of 26 Ectopic Pregnancy – Modern Diagnosis and Management M.genitalium in women with tubal factor infertility and it was found that antibodies to M.genitalium were shown to be independently and significantly... bowel colitis ,inguinal or crural hernia and muscular pain should be included in the differential diagnosis of abdominal pain in lower quadrants Ectopic pregnancy is responsible for a significant proportion of maternal mortality and morbidity According to the WHO, ectopic pregnancy accounts for 0.1 to 4.9% of the total 8 Ectopic Pregnancy – Modern Diagnosis and Management maternal deaths worldwide [27]... differentiation of the gestational sac of early intrauterine pregnancy from the pseudogestational sac of ectopic pregnancy Radiology Mar 1983;146(3):755-9 10 Ectopic Pregnancy – Modern Diagnosis and Management [24] Dart RG, Dart L, Mitchell P, Berty C The predictive value of endometrial stripe thickness in patients with suspected ectopic pregnancy who have an empty uterus at ultrasonography Acad Emerg... ruptured ectopic pregnancy Obstet Gynecol 1982;60:13-14 Differential Diagnosis of Ectopic Pregnancy - Morbidity and Mortality 9 [7] Mol BW, Lijmer JG, Ankum WM, van der Veen F, Bossuyt PM The accuracy of single serum progesterone measurement in the diagnosis of ectopic pregnancy: a metaanalysis Hum Reprod Nov 1998;13(11):3220-7 [8] Lipscomb GH, Stovall TG, Ling FW Non surgical treatment of ectopic pregnancy. .. has an 80% risk of pregnancy loss [11] An extrauterine sac containing a yolk sac or a fetal pole, with or without heart motion Fig 2: Although definitive for ectopic pregnancy, only 16-32% of ectopics have this finding on transvaginal sonogram [12] Fig 2 Vaginal Ultrasound showing gestational sac with yolk sac in extra uterine location 6 Ectopic Pregnancy – Modern Diagnosis and Management Tubal ring... Ledger et al., 1994; Swenson et al., 1974) and the predominant anaerobic species originate from the Bacteroides genera Microorganisms and the immune response may result in scar tissue formation, alter the 16 Ectopic Pregnancy – Modern Diagnosis and Management activity of tubal cilia, result in the partial or complete destruction of cilia, and alter the composition and viscosity of the tubal secretions Within... Dimitraki1, Alexandros Ammari1, Sofia Bouchlariotou1, Stefanos Zervoudis2, Panagiotis Oikonomidis2, Constantinos Zakas2, Theodoros Mylonas1, Anastasios Liberis1, Vasileios Liberis1 and Georgios Maroulis1 1Department of Obstetrics and Gynecology , Democritus University of Thrace, Greece 2Department of Obstetrics and Gynecology, Rhea Hospital, Athens, Greece 4 Ectopic Pregnancy – Modern Diagnosis and Management. .. Causes of Ectopic Pregnancy 2 Tubal Damage, Infertility and Tubal Ectopic Pregnancy: Chlamydia trachomatis and Other Microbial Aetiologies Louise M Hafner and Elise S Pelzer Institute of Health and Biomedical Innovation, (IHBI), Queensland University of Technology (QUT) Australia 1 Introduction Infertility is a worldwide health problem with one in six couples suffering from this condition and with a... women who have either (1) damaged/occluded Fallopian tubes or (2) have history of salpingectomy Ectopic pregnancy is only relevant if the Fallopian tubes remain in situ Previous studies 14 Ectopic Pregnancy – Modern Diagnosis and Management have concluded that salpingitis can accompany early intrauterine pregnancy, often with significant foetal loss (Lara-Torre & Pinkerton 2002; Yip et al., 1993) but... in the sonographic diagnosis of ectopic pregnancy AJR Am J Roentgenol Nov 1999;173(5):1301-2 [16] Frates MC, Brown DL, Doubilet PM, Hornstein MD Tubal rupture in patients with ectopic pregnancy: diagnosis with transvaginal US Radiology Jun 1994;191(3):76972 [17] Blaivas M Color doppler in the diagnosis of ectopic pregnancy in the emergency department: is there anything beyond a mass and fluid? J Emerg . ECTOPIC PREGNANCY – MODERN DIAGNOSIS AND MANAGEMENT Edited by Michael Kamrava Ectopic Pregnancy – Modern Diagnosis and Management Edited by. Ectopic Pregnancy – Modern Diagnosis and Management 6 Tubal ring is a thick-walled cystic structure in the adnexa, independent of the ovary and uterus, and is highly predictive of ectopic. proportion of maternal mortality and morbidity. According to the WHO, ectopic pregnancy accounts for 0.1 to 4.9% of the total Ectopic Pregnancy – Modern Diagnosis and Management 8 maternal deaths