Explore the vast range of titles available.

Purpose The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality. Methods This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, β-human chorionic gonadotropin (β-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA). Results The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10 − 5 ) that was diagnosed in the 7th gestational week. The only association found was between the β-HCG level and LOS, with a linear regression β coefficient of 0.01 and a P -value of 0.04. Conclusion EP is a relatively common condition affecting approximately 1% of all pregnancies. β-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.

Tubal ectopic pregnancies can cause substantial morbidity or even death. Current treatment is with methotrexate or surgery. Methotrexate treatment fails in approximately 30% of women who subsequently require rescue surgery. Gefitinib, an epidermal growth factor receptor inhibitor, might improve the effects of methotrexate. We assessed the efficacy of oral gefitinib with methotrexate, versus methotrexate alone, to treat tubal ectopic pregnancy. We performed a multicentre, randomised, double-blind, placebo-controlled trial across 50 UK hospitals. Participants diagnosed with tubal ectopic pregnancy were administered a single dose of intramuscular methotrexate (50 mg/m2) and randomised (1:1 ratio) to 7 days of additional oral gefitinib (250 mg daily) or placebo. The primary outcome, analysed by intention to treat, was surgical intervention to resolve the ectopic pregnancy. Secondary outcomes included time to resolution of ectopic pregnancy and serious adverse events. This trial is registered at the ISRCTN registry, ISCRTN 67795930. Between Nov 2, 2016, and Oct 6, 2021, 328 participants were allocated to methotrexate and gefitinib (n=165) or methotrexate and placebo (n=163). Three participants in the placebo group withdrew. Surgical intervention occurred in 50 (30%) of 165 participants in the gefitinib group and in 47 (29%) of 160 participants in the placebo group (adjusted risk ratio 1·15, 95% CI 0·85 to 1·58; adjusted risk difference –0·01, 95% CI –0·10 to 0·09; p=0·37). Without surgical intervention, median time to resolution was 28·0 days in the gefitinib group and 28·0 days in the placebo group (subdistribution hazard ratio 1·03, 95% CI 0·75 to 1·40). Serious adverse events occurred in five (3%) of 165 participants in the gefitinib group and in six (4%) of 162 participants in the placebo group. Diarrhoea and rash were more common in the gefitinib group. In women with a tubal ectopic pregnancy, adding oral gefitinib to parenteral methotrexate does not offer clinical benefit over methotrexate and increases minor adverse reactions. National Institute of Health Research.

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. In our study, we explored the efficacy of adding letrozole to MTX in managing EP. Methods Between June 2021 and September 2022, a total of 60 patients diagnosed with EP at the Faculty of Medicine, Yüzüncü Yıl University, were randomly divided into two groups. Group 1 received MTX alone, while Group 2 received a combination of MTX and letrozole. The primary outcome measure was the change in serum β-hCG levels. Secondary outcomes included the need for surgical intervention and the occurrence of side effects. Results Both groups demonstrated similar success rates in treatment, and there was no significant difference between the MTX and MTX + letrozole groups regarding the need for surgical intervention. Although β-hCG levels declined more rapidly in the MTX + letrozole group, these decreases were not statistically significant. The combination of MTX and letrozole in the treatment of ectopic pregnancy has shown similar efficacy to single-dose MTX. Conclusion Letrozole may offer a potential contribution to MTX therapy by providing a more pronounced reduction in β-hCG levels, but further research with larger sample sizes and longer follow-up periods is needed to confirm these findings.

Background The incidence of caesarean scar pregnancy (CSP) has significantly increased due to the increasing prevalence of caesarean deliveries and advances in diagnostic imaging. However, no consensus has yet been reached on the optimal therapeutic approach. Type II CSP leads to disease heterogeneity, characterized by multiple treatment options and the absence of a unified therapeutic approach. Hysteroscopic treatment for CSP has demonstrated a notable success rate, particularly in cases of type I CSP. High-intensity focused ultrasound (HIFU) ablation has emerged as a novel, non-invasive treatment option that minimizes intraoperative blood loss. However, its use may be excessive in low-risk cases. Here, we report a protocol for a randomized clinical trial designed to evaluate the necessity of performing HIFU in CSP treatment when combined with suction curettage under hysteroscopic guidance. Methods We aim to propose a randomized clinical trial that will enroll 140 participants. All participants will undergo surgical suction curettage guided by hysteroscopy, randomized into groups with or without HIFU pretreatment. Data on demographic characteristics, disease characteristics, ultrasound findings, and laboratory test results will be collected before the intervention. The primary outcome will be the intraoperative blood loss. Secondary outcomes will include the incidence of near haemorrhage, therapeutic success rates, and subsequent pregnancy outcomes within a 2-year follow-up period. Discussion Hysteroscopy has exhibited favourable therapeutic outcomes in the management of CSP, though it remains associated with a risk of intraoperative haemorrhage. HIFU has shown promise as a preoperative adjuvant modality. However, the comparative clinical advantages of standalone hysteroscopic intervention versus HIFU-assisted protocols are insufficiently explored in prospective clinical studies. This investigation seeks to assess both the standalone efficacy of hysteroscopic resection and the efficacy of combined therapy incorporating HIFU pretreatment for type II CSP. Trial registration Registration number: ChiCTR2000034332. Registration date: 2nd July 2020.

This retrospective study investigates the association between maternal serum electrolyte and hormone levels and the success of methotrexate (MTX) treatment in ectopic pregnancies, aiming to identify predictive factors and improve clinical outcomes. A total of 372 patients treated with single-dose MTX between 2012 and 2023 were included, divided into two groups: those who successfully responded to MTX and those requiring surgical intervention. Significant differences were observed in beta-hCG levels, with a mean of 1376 in the MTX-successful group and 2358 in the surgical group. Electrolyte analysis showed that patients who responded successfully to MTX had higher potassium and albumin levels, whereas magnesium levels were lower compared to the surgical group. Haematological parameters also varied, with higher hemoglobin and hematocrit levels observed in the MTX-successful group. The findings suggest that serum potassium, magnesium, and albumin levels may be predictive markers for MTX efficacy. Higher potassium and albumin levels, along with lower magnesium levels, may contribute to improved treatment outcomes. These results support the potential role of dietary interventions—such as increasing potassium and albumin intake and moderating magnesium levels—in enhancing MTX success rates. This study underscores the importance of maternal biochemical profiles in guiding treatment strategies for ectopic pregnancy and highlights the value of individualized approaches to optimize outcomes and minimize the need for surgical intervention. Future research should aim to elucidate the biological mechanisms underlying these associations and validate the findings in larger and more diverse patient populations.

Background We aimed to establish a predictive nomogram to evaluate the incidence of residual tissue in patients with endogenic cesarean scar ectopic pregnancy after negative pressure aspiration. Methods This retrospective study included patients treated in the gynecology department of our institution from May 2017 to August 2023 who underwent negative pressure suction treatment, ultrasound examinations before and after treatment, and received telephone follow-up for at least 6 months. A total of 899 patients met the inclusion criteria and were divided into a training cohort (629 patients, 70%) and a validation cohort (270 patients, 30%). Independent predictive factors were established using multivariate logistic regression. The resulting nomogram was validated using 1,000 bootstrap resampling, and calibration curves were plotted. Receiver operating characteristic (ROC) analysis was performed to calculate the area under the curve, sensitivity, specificity, and other metrics to assess its discriminative performance. Clinical decision curves were constructed to evaluate clinical applicability and quantify the net benefit within a range of threshold probabilities. The model was externally validated in the validation cohort. Results Predictive factors included in the nomogram included age (hazard ratio [HR]: 1.220, 95% confidence interval [CI]: 1.135—1.316), BMI (HR: 0.890, 95% CI: 0.796—0.986), intraoperative major hemorrhage (HR: 4.457, 95% CI: 1.610—12.292), maximum diameter of the gestational sac (HR: 1.572, 95% CI: 1.295, 1.914), and thickness of the remaining muscle layer of the lower uterine segment (HR: 1.572, 95% CI: 0.014, 0.430). The ROC curve of the resulting nomogram showed similar area under the curve values for the training (0.809, 95% CI: 0.751—0.867) and validation cohorts (0.814, 95% CI: 0.739, 0.888). The Hosmer–Lemeshow test indicated good model fit ( P  = 0.861), and the calibration curve was close to the ideal diagonal line. Decision curve analysis demonstrated good net benefit, and external validation confirmed its reliability. Conclusions The model may aid in individual clinical decision-making, allowing clinicians to perform immediate postoperative assessments for patients with endogenous ectopic pregnancy in cesarean section scars treated with negative pressure suction, identify high-risk subpopulations, and select appropriate supplementary treatment in advance, making it particularly suitable for low-income areas and resource-limited primary hospitals.

Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester. Using an untargeted metabolomic approach, we sought to identify putative plasma biomarkers using tandem liquid chromatography–mass spectrometry for the detection of tubal EP. This case-control study included the prospective recruitment of 50 tubal EP cases and 50 early intrauterine pregnancy controls. To avoid over-fitting, logistic regression models were developed in a randomly selected discovery group (30 cases vs. 30 controls) and validated in the test group (20 cases vs. 20 controls). In total, 585 mass spectral features were detected, of which 221 molecular features were significantly altered in EP plasma (p < 0.05). Molecular networking and metabolite identification was employed using the Global Natural Products Social Molecular Networking (GNPS) database, which identified 97 metabolites at a high confidence level. Top significant metabolites include subclasses of sphingolipids, carnitines, glycerophosphocholines, and tryptophan metabolism. The top regression model, consisting of D-erythro-sphingosine and oleoyl-carnitine, was validated in a test group and achieved an area under receiving operating curve (AUC) (95% CI) = 0.962 (0.910–1) with a sensitivity of 100% and specificity of 95.9%. Metabolite alterations indicate alterations related to inflammation and abnormal placentation in EP. The validation of these metabolite biomarkers in the future could potentially result in improved early diagnosis.

Intramural pregnancy (IMP) is a rare and potentially life‐threatening uterine ectopic pregnancy implanted within the myometrium. Despite its recognition as a distinct clinical entity, diagnostic challenges and a lack of standardized management protocols persist. IMP occurs when a gestational sac implants into the myometrium beyond the endometrial‐myometrial junction, often following uterine trauma. Diagnosis is hindered by non‐specific symptoms and frequent misclassification. While ultrasound is the primary diagnostic tool, magnetic resonance imaging (MRI) may be needed in unclear cases. Treatment options range from expectant management to surgical intervention, but no consensus exists on the optimal approach. To enhance understanding and improve clinical outcomes, we propose an international IMP registry to collect data on diagnosis, treatment, and fertility outcomes. This collaborative effort aims to inform evidence‐based guidelines, facilitating accurate early diagnosis and optimized patient care.

Background Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment. Methods The scientific literature was searched for studies investigating EP/HP during IVF-ET. Publications in English and within the past 6 years were mostly selected. Results A history of tubal infertility, pelvic inflammatory disease and specific aspects of embryo transfer technique are the most significant risk factors for later EP. Early measurement of serum hCG and performance of TVS by an expert operator as early as gestational week 5 can identify cases of possible EP. These women should be closely monitored with repeated ultrasound and hCG measurement until a diagnosis is reached. Treatment must be customised to the clinical condition and future fertility requirements of the patient. In cases of HP, the viable IUP can be preserved in the majority of cases but requires early detection of HP. No apparent negative impact of the different treatment approaches for EP/HP on subsequent IVF-ET, except for risk of recurrence. Conclusions EP/HP are tragic events in a couple’s reproductive life, and the earlier the diagnosis the better the prognosis. Due to the increase incidence following IVF-ET, there is a compelling need to develop a diagnostic biomarker/algorithm that can predict pregnancy outcome with high sensitivity and specificity before IVF-ET to prevent and/or properly manage those who are at higher risk of EP/HP.

Background Conservative treatment remains a viable option for selected patients with ectopic pregnancy (EP), but failure may lead to rupture and serious complications. Currently, serum β -hCG is the main predictor for treatment outcomes, yet its accuracy is limited. This study aimed to develop and validate a predictive model that integrates radiomic features derived from super-resolution (SR) ultrasound images with clinical biomarkers to improve risk stratification. Methods A total of 228 patients with EP receiving conservative treatment were retrospectively included, with 169 classified as treatment success and 59 as failure. SR images were generated using a deep learning-based generative adversarial network (GAN). Radiomic features were extracted from both normal-resolution (NR) and SR ultrasound images. Features with intraclass correlation coefficient (ICC) ≥ 0.75 were retained after intra- and inter-observer evaluation. Feature selection involved statistical testing and Least Absolute Shrinkage and Selection Operator (LASSO) regression. Random forest algorithms were used to construct NR and SR models. A clinical model based on serum β -hCG was also developed. The Clin-SR model was constructed by fusing SR radiomics with β -hCG values. Model performance was evaluated using area under the curve (AUC), calibration, and decision curve analysis (DCA). An independent temporal validation cohort ( n  = 40; 20 failures, 20 successes) was used to validation of the nomogram derived from the Clin-SR model. Results The SR model significantly outperformed the NR model in the test cohort (AUC: 0.791 ± 0.015 vs. 0.629 ± 0.083). In a representative iteration, the Clin-SR fusion model achieved an AUC of 0.870 ± 0.015, with good calibration and net clinical benefit, suggesting reliable performance in predicting conservative treatment failure. In the independent validation cohort, the nomogram demonstrated good generalizability with an AUC of 0.808 and consistent calibration across risk thresholds. Key contributing radiomic features included Gray Level Variance and Voxel Volume, reflecting lesion heterogeneity and size. Conclusions The Clin-SR model, which integrates deep learning-enhanced SR ultrasound radiomics with serum β -hCG, offers a robust and non-invasive tool for predicting conservative treatment failure in ectopic pregnancy. This multimodal approach enhances early risk stratification and supports personalized clinical decision-making, potentially reducing overtreatment and emergency interventions.