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Objective: To evaluate the association between ectopic pregnancy (EP) and clinical and historical factors among women presenting with pain and/or bleeding in early pregnancy. Design: Nested case–control study. Setting: University medical center. Patient(s): Women with symptomatic early pregnancies of unknown location presenting for care between January 1, 1990 and July 31, 1999. Intervention(s): None. Main Outcome Measure(s): Clinical and historical risk factors were compared between women with EP and women with ongoing intrauterine pregnancies or spontaneous abortions. Result(s): The following factors were associated with increased risk of EP: prior EP (odds ratio, 2.98 [95% confidence interval, 1.88–4.73] for one prior EP and 16.04 [5.39–47.72] for 2 or more), pelvic inflammatory disease history (1.5 [1.11–2.05]), pain at presentation (1.42 [1.06–1.92]), vaginal bleeding at presentation (1.42 [1.04–1.93]), and hCG of 501–2,000 mIU/mL (1.73 [1.24–2.42]). Age younger than 25 years (0.59 [0.41–0.85]) and a history of abortion were protective from EP (0.58 [0.38–0.90]). Prior nontubal pelvic surgery, past intrauterine device use, prior cesarean section, and current cervical infection demonstrated no association with EP. Conclusion(s): Evaluation of women with a symptomatic early pregnancy confirms and refutes some of the classical risk factors for EP. Prior EP is a strong risk factor, whereas pelvic inflammatory disease has an unexpected weak association. Previous abortion was found to have a negative association, whereas nontubal surgery, cesarean section, and a history of or concomitant cervical infection have no association. Knowledge of historical and clinical factors associated with EP may aid in early diagnosis. [Copyright &y& Elsevier]

Objective: To determine the association between endometrial stripe (ES) thickness and pregnancy outcome in women with a symptomatic first-trimester pregnancy and to determine how vaginal bleeding, pelvic pain and 1 human chorionic gonadotropin (hCG) level affect ES thickness., Study Design: Data on ES thickness, serum hCG, presence of pain, characterization of vaginal bleeding and ultimate clinical outcome were collected for 576 women presenting to the emergency room., Results: ES was thinner with increased vaginal bleeding and associated with hCG level and pregnancy outcome. The mean ES for ectopic pregnancies (EPs) was 9.56 +/- 4.87, for intrauterine pregnancies was 12.12 +/- 6.0 and for spontaneous abortion was 10.19 +/- 6.10. Ninety-nine percent of patients with EP had an ES <21 mm, and 100% had one < or =25 mm., Conclusion: There was considerable overlap in ES for the 3 pregnancy outcomes, making it a poor diagnostic test. Nevertheless, ES >21 mm in a woman with no evidence of a gestational sac excludes EP with 96% specificity. A patient with a stripe >25 mm may be expectantly managed.

Objective: To perform a phase IV, open-label study of OVULE (Personal Care Products, Skillman, New Jersey) using magnetic resonance imaging (MRI) to describe the release, vaginal distribution and retention of a suspension containing miconazole nitrate in healthy female volunteers., Study Design: Three parous and 3 nulligravid women were enrolled. Each subject self-inserted the OVULE on the MRI table and remained recumbent after insertion. MRI images were obtained every 15 minutes for 1 hour and then at predetermined intervals following suspension insertion until the suspension was no longer identified., Results: Placement of the OVULE was in the upper vagina in 4 subjects and in the lower vagina in 1 subject, and the Ovule was expelled in 1 subject. Average time to capsule shell dissolution was 36 minutes. Average time to maximum vaginal mucosal coverage by the suspension was 49 minutes. The average time at which the suspension was last seen in the vagina was 5 hours and 53 minutes., Conclusion: MRI can be used to noninvasively quantify the intravaginal spread of a therapeutic antifungal agent. Understanding the intravaginal spread of antifungal agents may lead to further optimization of antifungal preparations as well as to better patient instructions.