RESUMO

Introducción: Los datos clínicos y antecedentes epidemiológicos resultan de vital importancia en el diagnóstico oportuno del embarazo ectópico. Objetivo: Determinar las características clínico-epidemiológicas de pacientes operadas de embarazo ectópico. Métodos: Se diseñó y se realizó un estudio descriptivo, de corte transversal, tipo serie de casos en un universo de 130 pacientes operadas de embarazo ectópico en el Hospital Ginecobstétrico de Camagüey durante el período comprendido de enero a diciembre de 2020. Las variables estudiadas incluyeron: grupos de edades, color de la piel, municipio de procedencia, factores de riesgo, signos y síntomas, así como localización y estado hemodinámico. Resultados: Primaron las pacientes en el grupo de edad de 30-34 años (32,3 porciento), color de piel blanca (76,9 porciento), procedentes del municipio Camagüey (68,5 porciento). La tasa de incidencia provincial por cada 100 embarazos se ubicó en 2,2 porciento, superada por los municipios Camagüey (3,5 porciento) y Jimaguayú (3,0 porciento). El principal factor de riesgo identificado fue el tabaquismo (66,2 porciento), en tanto el dolor abdominal estuvo presente en el 100 porciento de los casos. Se reportó con mayor frecuencia la localización tubárica (91,0 porciento), y el 59,1 porciento se clasificó como no accidentado. Conclusiones: Se determinaron ciertas características en la serie estudiada, de acuerdo con la preponderancia de la variable de los signos y síntomas según los grupos de edades, como elemento a tener en cuenta. La presencia mayoritaria de factores de riesgo modificables supone que sobre estos se debe intervenir desde la atención primaria de salud(AU)

Introduction: Clinical data and epidemiological background are of vital importance for the timely diagnosis of ectopic pregnancy. Objective: To determine the clinical-epidemiological characteristics of patients operated on for ectopic pregnancy. Methods: A descriptive, cross-sectional study of case series type was designed and carried out in a universe of 130 patients operated on for ectopic pregnancy at the gynecobstetric hospital of Camagüey during the period from January to December 2020. The studied variables included age groups, skin color, municipality of origin, risk factors, signs and symptoms, as well as localization and hemodynamic status. Results: There was a predominance of patients in the age group of 30-34 years (32.3 percent), white skin color (76.9 porciento), and from the municipality of Camagüey (68.5 ). The provincial incidence rate per 100 pregnancies was 2.2 porciento, surpassed by the municipalities of Camagüey (3.5 percent and Jimaguayú (3.0 percent). The main identified risk factor was smoking (66.2 percent), while abdominal pain was present in 100 percent of the cases. Tubal location was the most frequently reported (91.0 percent), and 59.1 percent were classified as unruptured. Conclusions: Certain characteristics were determined in the studied series, according to the preponderance of the variable of signs and symptoms by age groups, as an element to be taken into account. The majority presence of modifiable risk factors implies that these should be addressed by primary health care(AU)

Assuntos

RESUMO

OBJECTIVE: To evaluate the use of different treatment options for ectopic pregnancy and the frequency of severe complications in a university hospital. METHODS: Observational study with women with ectopic pregnancy admitted at UNICAMP Womens Hospital, Brazil, between 01/01/2000 and 12/31/2017. The outcome variables were the type of treatment (first choice) and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran-Armitage test, chi-square test, Mann-Whitney test and multiple Cox regression. RESULTS: In total 673 women were included in the study. The mean age was 29.0 years (± 6.1) and the mean gestational age was 7.7 (± 2.5). The frequency of surgical treatment decreased significantly over time (z = -4.69; p < 0.001). Conversely, there was a significant increase in the frequency of methotrexate treatment (z = 4.73; p < 0.001). Seventy-one women (10.5%) developed some type of severe complication. In the final statistical model, the prevalence of severe complications was higher in women who were diagnosed with a ruptured ectopic pregnancy at admission (PR = 2.97; 95%CI: 1.61-5.46), did not present with vaginal bleeding (PR = 2.45; 95%CI: 1.41-4.25), had never undergone laparotomy/laparoscopy (PR = 6.69; 95%CI: 1.62-27.53), had a non-tubal ectopic pregnancy (PR = 4.61; 95%CI: 1.98-10.74), and do not smoke (PR = 2.41; 95%CI: 1.08-5.36). CONCLUSION: there was a change in the first treatment option for cases of ectopic pregnancy in the hospital during the period of analysis. Factors inherent to a disease that is more difficult to treat are related to a higher frequency of severe complications.

OBJETIVO: Avaliar as diferentes opções de tratamento para gravidez ectópica e a frequencia de complicações graves em um hospital universitário. MéTODOS: Estudo observacional com mulheres com gravidez ectópica admitidas no Hospital da Mulher da UNICAMP, no Brasill, entre 01/01/2000 e 31/12/2017. As variáveis de desfecho foram o tipo de tratamento (primeira escolha) e a presença de complicações graves. As variáveis independents foram dados clínicos e sociodemográficos. A análise estatística foi realizada pelo teste de Cochran­Armitage, teste de qui-quadrado, teste de Mann­Whitney e Regressão de Cox Múltipla. RESULADOS: No total, 673 mulheres foram incluídas no estudo. A idade médica foi de 29.0 anos (± 6.1) e a idade gestacional media foi de 7.7 (± 2.5). A frequencia de tratamento cirúrgico diminuiu significativamente ao longo dos anos(z = -4.69; p < 0.001). Simultaneamente, houve um aumento da frequencia do tratamento clínico(z = 4.73; p < 0.001). Setenta e uma mulheres (10.5%) desenvolveram algum tipo de complicação grave. No modelo estatístico final, a prevalência de complicações graves foi maior nas mulheres que tiveram diagnóstico de gestação ectópica rota à admissão (PR = 2.97; 95%CI: 1.61­5.46), que não apresentaram sangramento vaginal (PR = 2.45; 95%CI: 1.41­4.25), sem antecedentes de laparotomia/laparoscopia (PR = 6.69; 95%CI: 1.62­27.53), com gravidez ectópica não-tubária (PR = 4.61; 95%CI: 1.98­10.74), e não tabagistas (PR = 2.41; 95%CI: 1.08­5.36). CONCLUSãO: Houve uma mudança na escolha do primeiro tratamento indicado nos casos de gravidez ectópica durante o período analisado. Os fatores inerentes a doença relacionados a maior dificuldade de tratamento foram associados a maior frequencia de complicações graves.

Assuntos

RESUMO

OBJECTIVE: To verify the accuracy of an online algorithm using Bayes' theorem for diagnosing ectopic pregnancy (EP) using human chorionic gonadotropin (hCG), ultrasound, and clinical data in a real cohort. DESIGN: A retrospective cohort study. SETTING: Gynecologic emergency unit in a tertiary teaching hospital. PATIENT(S): First-trimester pregnant women who attended the gynecologic emergency unit for any reason. Those who had <13 weeks of pregnancy confirmed by a recent positive pregnancy test; a digital image or electronic report of transvaginal ultrasound (TVUS) obtained from hospital database; and a follow-up with a pathology report or a clinical resolution of a confirmed pregnancy were included in the study. Clinical signs and symptoms, the presence of risk factors for EP, the TVUS findings in each consultation, and the hCG levels were independent variables obtained from the electronic medical records. From these data, the pretest probability, based on the clinical presentation and risk factors, and the likelihood ratio for each variable were calculated for their use in the algorithm, yielding a posttest probability. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE(S): The accuracy of the online algorithm to identify cases of EP using clinical signs and symptoms, the presence of risk factors for EP, the TVUS findings in each consultation, and the hCG levels. The main outcome was EP, confirmed either by pathology report or by the presence of fetal heartbeat or gestational sac outside the uterine cavity. RESULT(S): Between January 1, 2009 and December 27, 2016, 2,495 women were analyzed, and the algorithm was applied to 2,185 of them. The incidence of EP was 8.5% (212/2,495); 310 women were excluded because they were submitted to surgery with decision thresholds <95%. The algorithm was applied to 2,185 women. Just one case remained inconclusive after 3 consultations, and it was considered as an error in prediction. The sensitivity, specificity, and accuracy values (95% confidence interval) of the algorithm were 98.9% (96.1%-99.8%), 98.9% (98.3%-99.2%), and 98.9% (98.3%-99.2%), respectively. CONCLUSION(S): The accuracy of the Bayesian algorithm to confirm or rule out EP is excellent. Online Nomogram https://docs.google.com/spreadsheets/d/1jStXlMBjbPyDf6_W0deKGKQLZHU5EFAe8rLhNVPuJuY/edit?usp=sharing.

Assuntos

RESUMO

OBJECTIVE: Ectopic pregnancy is a well-known complication following in vitro fertilization with embryo transfer; studies have questioned, however, whether there are risk factors that could be identified before the procedure. The objective of this study was to investigate the possible risk factors involved in ectopic pregnancy following in vitro fertilization. METHODS: Retrospective case-control study performed at an assisted reproduction clinic in Brazil. To select the control group, we used a 1:4 ratio. The study included 499 patients submitted to in vitro fertilization with clinical pregnancy. We collected the data from electronic records, between 2000-2019 and divided into: Group 1, ectopic pregnancy (n=90) and Group 2, intrauterine pregnancies (n=409). RESULTS: When comparing groups, the results observed were: Tubal factor infertility (35.6% vs. 21.1%, p=.005) (OR 2.0 [1.2-3.4], p=.004); Previous miscarriage history (15.1% vs. 7.1%, p<.05) (OR 2.0 [1.02-4.29], p=.044); Number of cleavage-stage embryo transfers (69.2% vs. 54.0 p=.028) (OR 1.9 [1.08-3.33], p=.025); Two or more embryos transferred (OR 2.5 [1.12-5.70], p=.025), all associated with greater ectopic pregnancy risk. Oocyte recipient patients were excluded from this analysis, but when included a difference was found when comparing the groups (9.4% (10/106) vs. 3.0% (13/434), p=.007), (OR 3.3 [1.41-7.98] p=.005); this result should be interpreted with caution because of the sample size. CONCLUSIONS: In high-risk patients, a single blastocyst transfer seems to be a reasonable approach to decrease the ectopic pregnancy risk.

Assuntos

Assuntos

Assuntos

RESUMO

OBJECTIVE: In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. METHODS: In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. RESULTS: Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (ß-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose ß-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose ß-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. CONCLUSION: The fertility status of the patients, the clinical and laboratory findings, and the levels of ß-hCG are the factors that must be considered in planning the appropriate treatment.

Assuntos

RESUMO

Abstract Objective In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. Methods In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. Results Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. Conclusion The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.

Assuntos

Assuntos

RESUMO

Introducción: durante los últimos 20 años la incidencia del embarazo ectópico se ha duplicado o triplicado, principalmente en los países desarrollados. Este incremento se comporta de forma diferente en países, regiones o áreas poblacionales. Objetivo: caracterizar el comportamiento del embarazo ectópico en el Hospital General Docente de Guantánamo Dr. Agostinho Neto durante el año 2006. Método: el universo estuvo constituido por 763 pacientes con embarazo ectópico en el período 2002-2006. La muestra fue de 175, todas del año 2006. Las variables estudiadas fueron: grupo de edades, síntomas al ingreso, medios diagnósticos, formas clínicas y operaciones realizadas. Resultados: se obtuvo discreto crecimiento en el número de embarazos ectópicos durante los años de estudio. El grupo de edades de 20-24 obtuvo el 31,4 por ciento en frecuencia y el de 25-29 el 34,9 por ciento. El 85,7 por ciento de las pacientes acudió con los síntomas de dolor bajo vientre y sangramiento vaginal anormal, seguidas por las que presentaron dolor bajo vientre y amenorrea (78,3 por ciento). En 73 pacientes fue diagnosticado por la clínica más culdocentesis en el 41,8 por ciento de los casos y solo en 9 por clínica más laparoscopia. Conclusiones: hubo incremento de los embarazos ectópicos. El año de mayor frecuencia fue 2006. Predominó el grupo de edades de 25 a 29 años y las pacientes primíparas. El síntoma al ingreso predominante fue el dolor bajo vientre y el sangramiento vaginal anormal. El diagnóstico con más frecuencia fue la clínica más culdocentesis. El embarazo ectópico complicado inestable, el sitio de implantación tubárica y la localización ampular con salpingectomía total como operación fueron las más frecuentes(AU)

Introduction: during the last 20 years the incidence of ectopic pregnancy has doubled or tripled, mainly in developed countries. This increase behaves differently in countries, regions or population areas. Objective: to characterize the behavior of ectopic pregnancy in the Guantánamo General Teaching Hospital Dr. Agostinho Neto during the year 2006. Method: the universe consisted of 763 patients with ectopic pregnancy in the period 2002-2006. The sample was 175, all of the year 2006. The variables studied were: age group, symptoms on admission, means of diagnosis, clinical forms and operations performed. Results: discrete growth was obtained in the number of ectopic pregnancies during the years of study. The age group of 20-24 obtained 31.4 percent in frequency and that of 25-29 and 34.9 percent. 85.7 percent of the patients presented with symptoms of abdominal pain and abnormal vaginal bleeding, followed by those with lower abdominal pain and amenorrhea (78.3 percent). In 73 patients it was diagnosed by the clinic plus culdocentesis in 41.8 percent of the cases and only in 9 by clinical plus laparoscopy. Conclusions: there was an increase in ectopic pregnancies. The year of greatest frequency was 2006. The age group of 25 to 29 years and the primiparous patients predominated. The predominant symptom of admission was lower abdominal pain and abnormal vaginal bleeding. The diagnosis with more frequency was the clinic plus culdocentesis. The complicated unstable ectopic pregnancy, the tubal implantation site and the ampullary location with total salpingectomy as the operation were the most frequent(AU)

Introdução: nos últimos 20 anos, a incidência de gravidez ectópica dobrou ou triplicou, principalmente nos países desenvolvidos. Esse aumento se comporta de maneira diferente em países, regiões ou áreas de população. Objetivo: caracterizar o comportamento da gravidez ectópica no Hospital Geral de Ensino de Guantánamo Dr. Agostinho Neto durante o ano de 2006. Método: o universo consistiu em 763 pacientes com gravidez ectópica no período 2002-2006. A amostra foi de 175, durante todo o ano de 2006. As variáveis estudadas foram: faixa etária, sintomas na admissão, meios de diagnóstico, formas clínicas e operações realizadas. Resultados: crescimento discreto foi obtido no número de gestações ectópicas durante os anos de estudo. A faixa etária de 20 a 24 anos obteve 31,4 por cento de frequência e a de 25 a 29 e 34,9 por cento. 85,7 por cento dos pacientes apresentavam sintomas de dor abdominal e sangramento vaginal anormal, seguidos por dor abdominal baixa e amenorreia (78,3 por cento). Em 73 pacientes foi diagnosticada pela clínica mais culdocentese em 41,8 por cento dos casos e somente em 9 pela clínica mais laparoscopia. Conclusões: houve aumento de gravidez ectópica. O ano de maior frequência foi 2006. A faixa etária de 25 a 29 anos e as primíparas predominaram. O sintoma predominante da admissão foi dor no baixo ventre e sangramento vaginal anormal. O diagnóstico com maior frequência foi a clínica e culdocentese. A gestação ectópica complicada e instável, o local de implantação das trompas e a localização ampular com salpingectomia total como operação foram os mais frequentes(AU)

Assuntos