Hard Cases for Critics of Abortion
Christopher Kaczor in The Ethics of Abortion, 2023
In an ectopic pregnancy, the human embryo does not implant in the uterus but rather elsewhere in the woman's body, usually in the fallopian tube. The frequency of ectopic pregnancy has increased some 600% in the last two decades (Diamond 1999, p. 5). When the human embryo implants in the fallopian tube (or even more rarely, elsewhere), the pathology can lead to profuse bleeding and loss of both maternal and embryonic human life. Ectopic pregnancy may be treated in different ways, including salpingectomy (removal of the tube with embryo), salpingostomy (removal of embryo alone), and by use of methotrexate. Although there is an ongoing discussion of treatment options, especially the use of methotrexate, each of these options has been defended as permissible in accord with double-effect reasoning by scholars who accept that every human being is a person.
Abdominal Ectopic Pregnancy
Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy in Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
The symptoms range from amenorrhea, abdominal pain, and vaginal bleeding to hemorrhagic shock. The most common clinical presentation of ectopic pregnancy is early trimester vaginal bleeding and/or abdominal pain [8]. The hidden nature of ectopic pregnancy lesions may lead to clinical emergencies. Acute clinical manifestations include acute pelvic, right or left upper abdominal, or diffuse abdominal pain. Abdominal tenderness, sickness, and hypovolemic shock occur during the phases of amenorrhea. Nonspecific symptoms, such as epigastric pain, dyspepsia, or irregular vaginal bleeding, sometimes anticipate the acute clinical evolution [6]. Rupture and hemoperitoneum must be considered in case of hypotension, tachycardia, abdominal tenderness with abdominal guarding, and low-grade fever [1].
Gynaecology
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
An ectopic pregnancy refers to a pregnancy that grows outside of the uterine cavity, most commonly within the Fallopian tube, with rarer sites including the ovary, cervix, broad ligament and abdominal cavity. As the ectopic pregnancy grows, the placental tissue can infiltrate the blood vessels surrounding the Fallopian tube, leading to bleeding within the tube and into the peritoneal cavity. Further growth of the ectopic pregnancy can rupture the Fallopian tube, causing significant intraperitoneal blood loss. This constitutes a gynaecological emergency. An ectopic pregnancy occurs in 11 per 1000 pregnancies, and a maternal mortality rate of 0.2 per 1000 estimated ectopic pregnancies. The major risk factors for an ectopic pregnancy are shown in Summary box 81.2.
A systematic review and meta-analysis of the prevalence and association between levonorgestrel and ectopic pregnancy
Published in Expert Opinion on Drug Safety, 2023
Bannawich Sapapsap, Nattawut Leelakanok, Kansak Boonpattharatthiti, Tippawan Siritientong, Janthima Methaneethorn
Ectopic pregnancy or extrauterine pregnancy is a pregnancy in which the embryo implantation occurs outside the uterus and is a life-threatening pregnancy complication [1]. The incidence rate of ectopic pregnancy ranges from 0.3% to 2% [2–4] while the case-fatality rate ranges from 0.94% to 1.40% [5,6]. In addition, life-threatening complications from ectopic pregnancy include excessive hemorrhage, shock, and renal failure [7]. Patients with a history of ectopic pregnancy may have a compromised conception ability [8] and adverse pregnancy outcomes [9] in the future. Therefore, decreasing the risk of ectopic pregnancy is essential. Evidence has identified multiple risk factors that are associated with ectopic pregnancy including multiple sexual partners, nulliparity, previous genital infections (including pelvic inflammatory disease, chlamydia, gonorrhea), previous diagnosis of infertility, previous history of ectopic pregnancy, sexual debut at the age of lower than 15 years, smoking, usage of intrauterine devices, medical procedures e.g. cervical excision, elective abortions, prior dilation and curettage, and salpingotomy [10–16].
Serum kisspeptin, to discriminate between ectopic pregnancy, miscarriage and first trimester pregnancy
Published in Journal of Obstetrics and Gynaecology, 2022
Semra Yuksel, Fatma Ketenci Gencer
Ectopic pregnancy affects 2% of all clinical pregnancies and seen mostly in women aged between 35 and 44 years (Cagnacci et al. 1999; Marion and Meeks 2012). The symptoms mostly occur at early weeks of gestation (6–8 weeks). Patients with ectopic pregnancy mainly complain about vaginal bleeding and abdominal pain especially when the location of pregnancy presents at the tuba. Uterine bleeding in patients with ectopic pregnancy usually occurs as miscarriage or abortus imminens of early gestation. In case of hCG levels below 1500–2000 IU/mL, it is hard to make differential diagnosis in a short time period between ectopic pregnancy and miscarriage or early pregnancy. Consecutive serum hCG measurements after transvaginal ultrasound (TVUS) are often required for confirming the diagnosis. Slower doubling times of hCG may both occur in miscarriage and ectopic pregnancy. Hence, the patients usually wait for definite diagnosis at a certain time when the gestational week is early (4–6 weeks) in routine gynaecologic practice.
Combined analysis of human chorionic gonadotrophin concentrations at different time points after frozen-thawed blastocyst transfer can improve our ability to predict the pregnancy outcomes of single gestations
Published in Journal of Obstetrics and Gynaecology, 2022
Yun Ren, Hongzhen Li, Qiao Jie, Zhen Xiaoying, Rong Li, Hai-Yan Wang
This was a retrospective study conducted in a single university-affiliated IVF centre. The inclusion criteria for patients were as follows: women aged ≤44 years, non-donor cycles with one or two frozen-thawed blastocysts transferred in natural or hormone replacement (HRT) cycles, with only one gestational sac inside the uterus confirmed by ultrasound examination undertaken 30 days after ET. Initial HCG levels were determined on days 12 or 14 after ET. Secondary HCG levels were determined on days 19 or 21 after ET. All HCG measurements were performed at the laboratory based in our centre. Patients who underwent biochemical pregnancy loss, ectopic pregnancies, multiple gestations (including vanish twin syndrome), and pregnancies achieved by preimplantation genetic diagnosis, were excluded from analysis. Women with a history of recurrent spontaneous abortion were also excluded. Pregnancy was defined as a rise in HCG above 30 IU/L. Biochemical pregnancy loss was diagnosed if no sign of pregnancy was evident on ultrasound examination. Ectopic pregnancy was diagnosed by transvaginal ultrasound and/or laparoscopy. Early miscarriage was defined as pregnancy loss after ultrasonic demonstration of a foetal gestational sac and abortion prior to 12 weeks of gestation. Ongoing pregnancy was defined as one that proceeded beyond 12 weeks of gestation. All study parameters were extracted from a computerised database held by the IVF centre in our hospital, and from patients’ files. We acquired a range of data, including baseline patient demographics and characteristics, serum HCG levels, ultrasound findings, and pregnancy outcomes.
Related Knowledge Centers
- Abdominal Pain
- Fetus
- Pelvic Inflammatory Disease
- Syncope
- Tachycardia
- Uterus
- Complications of Pregnancy
- Vaginal Bleeding
- Shock
- Chlamydia