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Relationship Between Ultrasonographic and Biochemical Markers of Tubal Ectopic Pregnancy and Success of Subsequent Management
Relationship Between Ultrasonographic and Biochemical Markers of Tubal Ectopic Pregnancy and Success of Subsequent Management
- Source :
- Journal of Ultrasound in Medicine. 37:2899-2907
- Publication Year :
- 2018
- Publisher :
- Wiley, 2018.
-
Abstract
- Objectives To determine whether there is an association between morphologic types of tubal ectopic pregnancy (EP), 0-hour human chorionic gonadotropin (hCG) levels, and subsequent management success. Methods We conducted a prospective study (November 2006-December 2015). Women had a diagnosis of EP by transvaginal ultrasonography if they had an inhomogeneous mass adjacent to the ovary and moving separately from it ("blob" sign), a mass with a hyperechoic ring around the gestational sac ("bagel" sign), or a gestational sac with an embryonic pole with or without a yolk sac with or without cardiac activity. The morphologic type, EP size, and 0-hour hCG level were analyzed. A multivariate analysis determined any correlation between these variables and nonsurgical management success. Results A total of 7350 consecutive women underwent transvaginal ultrasonography, of whom 301 (4.2%) had a diagnosis of tubal EP; 181 (60.1%) had the blob sign; 90 (29.9%) had the bagel sign; and 23 (7.6%) were noted to have an embryo (14 viable and 9 nonviable). Eighty-three of 301(27.5%) women had expectant management; 67 of 301(22.2%) were given methotrexate; and 151 of 301 (50%) had surgery. Success rates for the groups were 77%, 75%, and 100%, respectively. No difference between the morphologic type and success rate of treatment was noted. Although there was a significant correlation between the EP mass size and 0-hour hCG level, the mass size itself was not correlated with the success rate of either medical or expectant management. Overall higher 0-hour hCG levels were associated with management failure. In the expectant group, median hCG level for failure was 589 IU/L versus 366 IU/L for success, whereas in the medical group, the median for failure was 1244 IU/L versus 7629 IU/L for success. Conclusions There is no significant correlation between the morphologic type and size of EP with a nonsurgical management outcome. A likely successful outcome is related to a lower level of serum hCG at presentation.
- Subjects :
- Adult
medicine.medical_specialty
Adolescent
Gestational sac
Ovary
Chorionic Gonadotropin
Ultrasonography, Prenatal
Human chorionic gonadotropin
Cohort Studies
Young Adult
03 medical and health sciences
0302 clinical medicine
Pregnancy
medicine
Humans
Radiology, Nuclear Medicine and imaging
Prospective Studies
030212 general & internal medicine
Yolk sac
Prospective cohort study
Biochemical markers
Gynecology
030219 obstetrics & reproductive medicine
Radiological and Ultrasound Technology
business.industry
Tubal ectopic pregnancy
Pregnancy, Ectopic
medicine.anatomical_structure
Female
Methotrexate
business
medicine.drug
Subjects
Details
- ISSN :
- 15509613 and 02784297
- Volume :
- 37
- Database :
- OpenAIRE
- Journal :
- Journal of Ultrasound in Medicine
- Accession number :
- edsair.doi.dedup.....7332a4f2ae911fe335034b011a792768
- Full Text :
- https://doi.org/10.1002/jum.14652