1
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Dereli ML, Savran Üçok B, Özkan S, Sucu S, Topkara S, Fıratlıgil FB, Ercan EE, Uğur M, Akdaş Reis Y, Engin Üstün Y. The importance of blood-count-derived inflammatory markers in predicting methotrexate success in patients with tubal ectopic pregnancy. Int J Gynaecol Obstet 2024. [PMID: 38773760 DOI: 10.1002/ijgo.15696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/11/2024] [Accepted: 05/11/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVE To investigate the systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) in predicting a successful methotrexate response in tubal ectopic pregnancy (TEP). METHODS Women treated for TEP at a tertiary hospital between 2017 and 2021 were retrospectively reviewed. A total of 502 (100%) eligible patients who received methotrexate were included and divided into two groups based on whether or not they were successfully treated with methotrexate alone. Inflammatory parameters derived from the patients' hemograms at hospital admission were compared. RESULTS In total, 434 (86.4%) patients were successfully treated with methotrexate alone (Group 1), while 68 (13.6%) patients underwent surgery after methotrexate failure (Group 2). Median neutrophil count, NLR, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, SII, largest ectopic mass diameter, and β-human chorionic gonadotropin (β-hCG) were significantly lower, whereas median lymphocyte and platelet counts were significantly higher in Group 1. According to the receiver operating characteristic analysis performed for the discriminatory power of NLR, β-hCG, and SII for methotrexate response, the area under the curve values were 0.742, 0.730, and 0.699, respectively. CONCLUSION Low NLR and SII are associated with methotrexate success and could be used to refine decision making regarding β-hCG for predicting successful response to methotrexate in patients with TEP.
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Affiliation(s)
- Murat Levent Dereli
- Department of Obstetrics and Gynecology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Belgin Savran Üçok
- Department of Obstetrics and Gynecology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Sadullah Özkan
- Department of Obstetrics and Gynecology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Sadun Sucu
- Department of Obstetrics and Gynecology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Serap Topkara
- Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Fahri Burçin Fıratlıgil
- Department of Obstetrics and Gynecology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Emel Ebru Ercan
- Department of Obstetrics and Gynecology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Merve Uğur
- Department of Obstetrics and Gynecology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Yıldız Akdaş Reis
- Department of Obstetrics and Gynecology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
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2
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Yang Q, Carvalho KC, Shirazi R, Falahati A. Editorial: Emerging researchers in frontiers in pharmacology: obstetric and pediatric pharmacology 2022. Front Pharmacol 2023; 14:1215954. [PMID: 37305541 PMCID: PMC10248523 DOI: 10.3389/fphar.2023.1215954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | | | - Reza Shirazi
- Department of Anatomy, School of Medical Sciences, Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Ali Falahati
- Department of Biology, Yazd University, Yazd, Iran
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3
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Zhao X, Yan L, Ji S, Zhang Y, Ha L, He C, Tian Y, Chen L, Zhu Q, Li M, Zhang J. Colnoy-stimulating factor 1 positive (CSF1 + ) secretory epithelial cells induce excessive trophoblast invasion in tubal pregnancy rupture. Cell Prolif 2023:e13408. [PMID: 36721079 DOI: 10.1111/cpr.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 02/02/2023] Open
Abstract
Tubal ectopic pregnancy (TEP) occurs when an embryo aberrantly implants in the fallopian tube, leading to abortive or ruptured tubal ectopic pregnancy (AEP or REP). Poor outcomes of REP include maternal infertility or mortality. Current studies on the prevention and treatment of ruptured tubal ectopic pregnancy (REP) are unfortunately hampered by a lack of the cell spectrum and cell-cell communications in the maternal-foetal interface. Here, we investigate the mechanisms of tubal rupture through single-cell transcriptome profiling of the fallopian tube-trophoblast interface in REP, AEP and intrauterine pregnancy patients. In REP, extravillous trophoblast (EVTs) cells form a dominant cell population, displaying aggressive invasion and proliferation, with robust differentiation into three subsets. Cell communication analysis identified colony-stimulating factor 1 (CSF1), overexpressed by fallopian tube secretory epithelial cells in REP, with CSF1R on EVTs and macrophages, as a ligand/receptor pair that stimulates EVT invasion and macrophage accumulation. CSF1+ secretory epithelial cells stimulate EVTs migration and invasion, leading to a tubal rupture in REP. These results provide a mechanistic context and cellular milieu leading to tubal rupture, facilitating further study and development of therapeutics for REP in early pregnancy.
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Affiliation(s)
- Xiaoya Zhao
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Li Yan
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Sifan Ji
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yiqin Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Lisai Ha
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Chuqing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yuan Tian
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Luting Chen
- Shanghai Municipal Key Clinical Specialty, Shanghai, China.,Department of Assisted Reproduction, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qian Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Mingqing Li
- Hospital and Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
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4
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Yan L, Li J, Wang Y, Zhu Q, Zhao X, He C, Zhu C, Ji S, Zhang Y, MuDanLiFu H, Zhang J. Trophoblastic infiltration of tubal pregnancy may have an association with chronic inflammation of the fallopian tube. Int J Gynaecol Obstet 2023. [PMID: 36607245 DOI: 10.1002/ijgo.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/28/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To explore the factors associated with trophoblastic infiltration in ampullary pregnancy from the perspective of clinical and pathologic characteristics. METHODS A single-center, retrospective, clinicopathologic cohort study was conducted in women who were diagnosed with tubal pregnancy and underwent salpingectomy in the International Peace Maternal and Child Health Care Hospital from January 2018 to June 2021. RESULTS A total of 333 eligible women diagnosed with ampullary pregnancy were included in the analysis. Multivariate logistic analysis showed that preoperative β-human chorionic gonadotropin greater than 3000 IU/L (adjusted odds ratio [aOR] 3.77, 95% confidence interval [CI] 2.02-7.03), and vascular remodeling phenomenon (aOR 4.34, 95% CI 2.41-7.83) were positively correlated with the infiltration of extravillous trophoblasts into serosa, while presence of chronic inflammation of the fallopian tube was a negatively corellated factor (aOR 0.49, 95% CI 0.29-0.85). CONCLUSION The depth of trophoblastic infiltration in tubal pregnancy may be related to the presence of chronic inflammation in the fallopian tube. A tubal pregnancy in a tube with chronic salpingitis is more likely to develop into an abortive ectopic pregnancy; whereas in a fallopian tube without chronic inflammation, the risk of it developing into a ruptured ectopic pregnancy increases. Hence, early identification is needed to properly address this dangerous pregnancy situation.
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Affiliation(s)
- Li Yan
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Juan Li
- Department of Pathology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yang Wang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Qian Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Xiaoya Zhao
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Chuqing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Chenfeng Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Sifan Ji
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Yiqin Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - HaLiSai MuDanLiFu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
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5
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Teshima DRK, Pereira PP, Francisco RPV, De Oliveira MA, Schulz R, Antonângelo L, Cabar FR. Tissue concentration of vascular endothelial growth factor is not related to the depth of trophoblastic invasion in ampullary pregnancies—A pilot study. Front Pharmacol 2022; 13:989031. [PMID: 36339590 PMCID: PMC9630585 DOI: 10.3389/fphar.2022.989031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/05/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: The factors that modulate trophoblastic invasion into the tubal wall remain uncertain. Moreover, it is known that the concentration of vascular endothelial growth factor (VEGF) is increased in cases of deeper trophoblastic invasion in the fallopian tubes. Objective: This study aimed to assess if there is a correlation between VEGF tissue expression and the depth of trophoblastic infiltration into the tubal wall in patients with ampullary pregnancy. Methods: A cross-sectional study was conducted in patients with a diagnosis of tubal pregnancy in the ampullary region who underwent salpingectomy. Inclusion criteria were spontaneously conceived singleton pregnancies, diagnosis of tubal pregnancy in the ampullary region, and radical surgical treatment. A lack of agreement regarding the location of the tubal pregnancy and impossibility of either anatomopathological or tissue VEGF analysis were the exclusion criteria. Histologically, trophoblastic invasion into the tubal wall was classified as grade I when limited to the tubal mucosa, grade II when it reached the muscle layer, and grade III when it comprised the full thickness of the tubal wall. A total of 42 patients fulfilled the inclusion criteria and were selected to participate in the study. Eight patients were excluded. After surgery, tissue VEGF expression was measured by immunohistochemistry and the point counting technique. Results: Histological analysis revealed that eight patients had stage I tubal infiltration, seven had stage II, and 19 had stage III. The difference between the percentage of VEGF expression in the trophoblastic tissue was not significant in relation to the degree of trophoblastic invasion (p = 0.621) (ANOVA). Trophoblastic tissue VEGF showed no statistical difference for prediction of both degrees of trophoblastic invasion (univariate multinomial regression). Conclusion: The depth of trophoblastic penetration into the tubal wall in ampullary pregnancies is not associated with tissue VEGF expression.
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Affiliation(s)
| | - Pedro Paulo Pereira
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Matheus Abelo De Oliveira
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Regina Schulz
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Leila Antonângelo
- Department of Clinical Pathology, Department of Pathology and Medical Research, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fábio Roberto Cabar
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- *Correspondence: Fábio Roberto Cabar,
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6
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Cabar FR, Pereira PP, de Oliveira MA, Francisco RPV. Serum vascular endothelial growth factor as a marker for tubal pregnancy. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:860-865. [PMID: 35766702 PMCID: PMC9575910 DOI: 10.1590/1806-9282.20220224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/27/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate whether a single measurement of vascular endothelial growth factor could distinguish between intrauterine pregnancy and ectopic pregnancy and to correlate the levels of vascular endothelial growth factor with serum levels of progesterone andβ-human chorionic gonadotropin in each subgroup. METHODS Ninety patients with a positive human chorionic gonadotropin test and either abdominal pain or vaginal bleeding were selected; pregnancies were singletons, spontaneously conceived, 42-56 days of gestational age. All patients had a transvaginal ultrasound examination and were divided into three subgroups: abnormal intrauterine pregnancy, tubal pregnancy, and normal intrauterine pregnancy. Tubal pregnancies were surgically treated and histologically confirmed. Blood samples were collected for the determination of β-human chorionic gonadotropin, progesterone, and vascular endothelial growth factor and their concentrations were compared in each subgroup. Receiver operating characteristic curve was calculated by comparing the subgroup of tubal pregnancy to the other groups. A Fisher discriminant function analysis was performed. The level of significance was 5%. RESULTS One-way analysis of variance revealed a significant correlation between the different subgroups and β-human chorionic gonadotropin, progesterone, and vascular endothelial growth factor serum levels (p<0.001). Vascular endothelial growth factor concentration was significantly higher for patients with tubal pregnancy than for other subgroups (p<0.05). β-Human chorionic gonadotropin and progesterone levels were higher in the subgroup with normal intrauterine pregnancies compared with the subgroups with tubal and abnormal intrauterine pregnancies (p<0.05). Serum vascular endothelial growth factor level >188.7 ng/mL predicted tubal pregnancy with 96.7% sensitivity, 95.0% specificity, 90.6% positive predictive value, and 98.3% negative predictive value. CONCLUSIONS Serum vascular endothelial growth factor could be a marker in discriminating intrauterine pregnancy from tubal pregnancy; its levels are increased in women with ectopic pregnancy compared with women with normal and abnormal intrauterine pregnancies.
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Affiliation(s)
- Fábio Roberto Cabar
- Universidade de São Paulo, Faculdade de Medicina, Departamento
de Obstetrícia e Ginecologia – São Paulo(SP), Brazil
| | - Pedro Paulo Pereira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas – São Paulo(SP), Brazil
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7
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Ruptured ectopic pregnancies following methotrexate treatment: clinical course and predictors for improving patient counseling. Reprod Sci 2022; 29:1209-1214. [DOI: 10.1007/s43032-022-00881-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
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8
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Expression of matrix metalloproteinases and their inhibitors at the implantation site in ampullary ectopic pregnancies. J Gynecol Obstet Hum Reprod 2021; 50:102096. [PMID: 33592349 DOI: 10.1016/j.jogoh.2021.102096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/12/2021] [Accepted: 02/06/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study investigated the qualitative and semi-quantitative expression of metalloproteinases (MMP) and their tissue inhibitors (TIMP) in trophoblastic tissue during ampullary ectopic pregnancies and correlated that expression with the degree of tubal invasion. STUDY DESIGN It is a prospective study that included 34 patients diagnosed with ampullary tubal pregnancy who underwent salpingectomy. A histological evaluation of the depth of trophoblastic invasion in the tubes obtained was performed. Subsequently, the expression of the MMP-2, MMP-9, MMP-14, TIMP-1, TIMP-2 and TIMP-3 markers was qualitatively and semi-quantitatively evaluated by indirect immunohistochemistry. In addition, the degree of trophoblastic invasion was correlated with the expression of each marker and with the metalloproteinase/inhibitor ratios. RESULTS MMP-2 (11.2 %; 3.6-17.9) was the marker with greater expression at the implantation site, both in the qualitative and semi-quantitative assessment, while MMP-9 (2.23 %; 0.2-5.4) and TIMP-3 (2.53 %; 0.1-15.3) were only weakly expressed. CONCLUSION There was wide variation in expression among the markers and metalloproteinase/inhibitor ratios studied compared to the degrees of invasion.
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9
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Cohen A, Almog B, Cohen Y, Bibi G, Rimon E, Levin I. The role of HCG increment in the 48 h prior to methotrexate treatment as a predictor for treatment success. Eur J Obstet Gynecol Reprod Biol 2017; 211:103-107. [DOI: 10.1016/j.ejogrb.2017.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
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10
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Cabar FR, Kamio Teshima DR, Pereira PP, Antonangelo L, Schultz R, Francisco RP. Serum concentration of vascular endothelial growth factor and depth of trophoblastic invasion in ampullary ectopic pregnancy. Clinics (Sao Paulo) 2016; 71:699-702. [PMID: 28076513 PMCID: PMC5175296 DOI: 10.6061/clinics/2016(12)04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE: To evaluate the association between the depth of trophoblastic infiltration and serum vascular endothelial growth factorconcentration in patients with an ampullary pregnancy. METHODS: This prospective cross-sectionalstudy involved 34 patients with an ampullary ectopic pregnancy who underwent salpingectomy between 2012 and 2013. Maternal serum vascular endothelial growth factor concentrations were measured using Luminex technology. Trophoblastic invasion was classified histologically as follows: stage I, limited to the tubal mucosa; stage II, reaching the muscle layer; and stage III,involving the full thickness. The qualitative data were compared using Fisher's exact test. The nonparametric Kruskal-Wallis and Mann-Whitney tests were used to evaluate differences in serum vascular endothelial growth factor among the degrees of trophoblastic invasion. ROC curves were constructed to determine vascular endothelial growth factor cut-off values that predict the degree of tubal invasion based on the best sensitivity and specificity. RESULTS: Eight patients had stage I trophoblastic invasion, seven had stage II, and 19 had stage III. The median serum vascular endothelial growth factorconcentration was 69.88 pg/mL for stage I, 14.53 pg/mL for stage II and 9.08 pg/mL for stage III, with a significant difference between stages I and III. Based on the ROC curve, a serum vascular endothelial growth factor concentration of 25.9 pg/mL best differentiated stage I from stages II and III with asensitivity of 75.0%, specificity of 76.9%, and area under the curve of 0.798. CONCLUSIONS: The depth of trophoblastic penetration into the tubal wall isassociated with serum vascular endothelial growth factor concentration in ampullary pregnancies.
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Affiliation(s)
- Fábio Roberto Cabar
- Departamento de Obstetr�cia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
- E-mail:
| | - Décio Roberto Kamio Teshima
- Departamento de Obstetr�cia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Pedro Paulo Pereira
- Departamento de Obstetr�cia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Leila Antonangelo
- Departamento de Patologia e Pesquisa Médica, Laboratório 03, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Regina Schultz
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Rossana Pulcineli Francisco
- Departamento de Obstetr�cia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
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11
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Erol O, Suren D, Unal B, Ozel D, Kumru S, Sezer C. Significance of trophoblastic infiltration into the tubal wall in ampullary pregnancy. Int J Surg Pathol 2015; 23:271-6. [PMID: 25710937 DOI: 10.1177/1066896915572682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A total of 81 patients with an ampullary ectopic pregnancy undergoing salpingectomy were enrolled in the study. The ampullary pregnancies were classified according to the depth of trophoblastic infiltration into tubal wall as follows: Stage I, limited to mucosa; Stage II, extension to the tubal muscularis; Stage III, complete tubal wall infiltration up to the serosa. An association was observed between serum β-human chorionic gonadotropin (β-hCG) levels and the depth of trophoblastic infiltration. Significantly higher severe ischemic changes and rupture of tubal wall were observed in patients with stage III infiltration compared with the other groups. A significant association was found between the absolute depth of trophoblastic invasion and severe ischemic changes, and also rupture of serosa. In conclusion, serum β-hCG levels are associated with depth of trophoblastic invasion into the tubal wall, severe ischemic changes, and rupture of the tubal wall.
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Affiliation(s)
- Onur Erol
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Dinc Suren
- Antalya Training and Research Hospital, Antalya, Turkey
| | | | | | | | - Cem Sezer
- Antalya Training and Research Hospital, Antalya, Turkey
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12
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Cabar FR, Pereira PP, Schultz R, Francisco RP, Zugaib M. Association between ultrasound findings and serum levels of vascular endothelial growth factor in ampullary pregnancy. Fertil Steril 2015; 103:734-7. [PMID: 25577466 DOI: 10.1016/j.fertnstert.2014.12.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the association between ultrasound images and serum concentrations of vascular endothelial growth factor (VEGF) in ampullary pregnancies. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Fifty patients with ampullary pregnancy. INTERVENTION(S) Criteria for inclusion in the study were: singleton pregnancy from spontaneous conception; diagnosis of tubal pregnancy in the ampullary region; radical surgical treatment (salpingectomy); and measurement of serum VEGF, human chorionic gonadotropin, and progesterone on the day of surgery. An additional criterion was description of an ectopic mass by transvaginal ultrasound, as follows: [1] ectopic gestational sac containing an embryo with cardiac activity; and [2] tubal ring: a paraovarian formation similar to a gestational sac, not containing a viable embryo (an anechoic structure surrounded by a peripheral hyperechogenic halo); an empty ectopic gestational sac; a sac containing an embryo without cardiac activity; or a vitelline vesicle. MAIN OUTCOME MEASURE(S) Association between ultrasound images and serum concentrations of VEGF. RESULT(S) An association was found between ultrasonographic images and VEGF serum concentrations. Ectopic embryos with cardiac activity were associated with higher levels of serum VEGF. CONCLUSION(S) In ampullary pregnancy, higher serum levels of VEGF are associated with the finding of an embryo with cardiac activity on transvaginal ultrasound. Greater production of VEGF likely creates development conditions more conducive to ectopic embryos.
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Affiliation(s)
- Fábio Roberto Cabar
- Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, Brazil.
| | - Pedro Paulo Pereira
- Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, Brazil
| | - Regina Schultz
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, Brazil
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13
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Elito J, Ferreira DF, Araujo Júnior E, Stavale JN, Camano L. Values of beta-human chorionic gonadotrofin as a risk factor for tubal pregnancy rupture evaluated by histopathology. J Matern Fetal Neonatal Med 2013; 27:637-9. [PMID: 23844664 DOI: 10.3109/14767058.2013.823940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the depth of trophoblastic infiltration in tubal wall in ectopic pregnancy (EP) assessed by histopathology and their correlation with initial values of β-hCG. METHODS A prospective study including 27 patients with diagnosis of EP was realized. The tubal pregnancies were histologically classified according to the depth of infiltration of trophoblastic tissue on the wall of the tube (stage I: limited to mucosa; stage II: reaching the muscularis layer; stage III: complete infiltration of the tubal wall). The comparison between groups for numeric variables was performed by ANOVA. The receiver operating characteristic (ROC) curve was performed to obtain the cutoff value of β-hCG associated with the degree of trophoblast invasion into the wall of the tube evaluated by histology. RESULTS The mean β-hCG in patients evaluated by histopathology as stage I + II was 2868 mIU/ml and stage III was 11 202 mIU/ml (p = 0.017). β-hCG levels that best predicted for stage III was 2906 mIU/ml, with a sensitivity of 85.7% and a specificity of 69.2%. CONCLUSION There is a direct correlation between serum β-hCG and the depth of trophoblast infiltration of the tube wall at histopathology.
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Turgut EN, Celik E, Celik S, Arikan DC, Altuntas H, Leblebici C, Purisa S, Dansuk R. Could serum β-hCG levels and gestational age be the indicative factors for the prediction of the degree of trophoblastic invasion into tubal wall in unruptured ampullary pregnancies? Arch Gynecol Obstet 2012; 287:323-8. [PMID: 23011731 DOI: 10.1007/s00404-012-2566-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 09/10/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the predictive value of gestational age and maternal serum β-hCG concentration for the determination of the depth of trophoblastic invasion into the tubal wall. METHODS This is a retrospective trial conducted on women with a diagnosis of ampullary pregnancy (71) who were submitted to salpingectomy. Serum β-hCG measurements were obtained at the initial admission of hospital. Histological investigation was performed by a single well-experienced pathologist who was blind to the clinical and laboratory characteristics of the patients. Ampullary pregnancy was classified histologically according to the depth of trophoblastic infiltration into tubal wall: trophoblast limited to the tubal mucosa (stage I), extended to muscularis layer (stage II) and complete tubal wall infiltration up to serosal layer (stage III). RESULTS There was a significant difference in maternal serum β-hCG concentrations regarding the histological stages of trophoblastic invasion. The serum β-hCG concentrations that the best predicted for stage III trophoblastic invasion was 6,475 mIU/ml, with a sensitivity of 100 %, a specificity of 92 %. CONCLUSION The depth of trophoblastic tissue infiltration into tubal wall is correlated with serum β-hCG levels, but not with gestational age. These findings may explain the reason for conservative management failure of EP in women with high β-hCG concentrations.
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Affiliation(s)
- Emre Niyazi Turgut
- Department of Obstetrics and Gynecology, Istanbul Education and Research Hospital, Kasap Ilyas Mah. Org Abdurrah Nafiz Gurman Cd, 34098 Fatih, Istanbul, Turkey.
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Qi Y, Wang J, Wang Y, Ai Z, Teng Y. Peritoneal relative to venous serum biomarker concentrations for diagnosis of ectopic pregnancy. Arch Gynecol Obstet 2012; 285:1611-7. [PMID: 22215199 DOI: 10.1007/s00404-011-2202-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/22/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To retrospectively analyze the relationships of peritoneal serum relative to venous serum (R (p/v)) ratios for human chorionic gonadotropin, CA-125, and creatine kinase to the ectopic pregnancy (EP). METHODS Intra-abdominal fluid and venous blood samples of 118 subjects with suspected EP were obtained for biomarker measurements. R (p/v-hCG) >1 was considered indicative of EP, and final diagnosis was based on surgical finding of an ectopic chorionic villous or gynecological ultrasound finding of an intrauterine gestational sac. RESULTS R (p/v-hCG) and R (p/v-CA-125) were both significantly greater for abortive as compared to ruptured EP and for the absence as compared to presence of active bleeding. However, neither ratio differed significantly between ampullary and isthmic EP. R (p/v-hCG) and R (p/v-CA-125) correlated negatively with hemoperitoneum volume. R (p/v-hCG) exhibited only modest predictive value for rupture. However, with R (p/v-CA-125) as the diagnostic criterion for rupture, sensitivity and specificity were 66.7 and 100%, respectively; in patients initially diagnosed with EP, R (p/v-CA-125) values <22.43 effectively predicted rupture. R (p/v-CK) did not exhibit significant diagnostic value. CONCLUSIONS R (p/v-hCG) values >1 combined with positive culdocentesis test findings reliably indicate the presence of EP. In patients initially diagnosed with EP, R (p/v-CA-125) values <22.43 predict tubal rupture.
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Affiliation(s)
- Yanting Qi
- Department of Obstetrics and Gynecology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, China
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QIU XIAOYAN, XIE YI, CHEN LINGLING, GEMZELL-DANIELSSON KRISTINA. Expression of matrix metalloproteinases and their inhibitors at the feto-maternal interface in unruptured ectopic tubal pregnancy. Acta Obstet Gynecol Scand 2011; 90:966-71. [DOI: 10.1111/j.1600-0412.2011.01206.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Cabar FR, Pereira PP, Schultz R, Francisco RP, Zugaib M. Vascular endothelial growth factor and β-human chorionic gonadotropin are associated with trophoblastic invasion into the tubal wall in ectopic pregnancy. Fertil Steril 2010; 94:1595-600. [DOI: 10.1016/j.fertnstert.2009.10.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/15/2009] [Accepted: 10/17/2009] [Indexed: 11/26/2022]
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Pereira PP, Cabar FR, Schultz R, Zugaib M. Association between ultrasound findings and extent of trophoblastic invasion into the tubal wall in ampullary pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:472-476. [PMID: 19306476 DOI: 10.1002/uog.6333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Predictive factors of damage to the Fallopian tube may guide the treatment of patients with tubal pregnancy. The aim of the present study was to investigate the association between the depth of trophoblastic invasion into the tubal wall, assessed on postoperative histological examination, with the findings obtained on transvaginal sonography (TVS) in women with ampullary pregnancy. METHODS Women with ampullary pregnancy undergoing salpingectomy were enrolled into the study. Only women with a finding of either an embryo with cardiac activity or a tubal ring on TVS were included in the analysis, a total of 85 patients. Trophoblastic invasion was assessed postoperatively and was histologically classified as Stage I when limited to the tubal mucosa, Stage II when extending to the muscle layer and Stage III in the case of complete tubal wall infiltration. The association between findings on TVS and the stage of trophoblastic invasion was evaluated. RESULTS There was a significant association between the findings on TVS and the depth of trophoblastic invasion (P < 0.001). All patients in whom an embryo with cardiac activity had been identified were found to have Stage II (17.9%) or Stage III (82.1%) invasion, whereas in those patients who showed a tubal ring on TVS, Stage I invasion was the most frequent finding (41.3%). CONCLUSIONS In ampullary pregnancy, the finding on TVS of an embryo with cardiac activity is associated with deeper penetration of trophoblastic tissue into the tubal wall than is the finding of a tubal ring.
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Affiliation(s)
- P P Pereira
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Cabar FR, Pereira PP, Zugaib M. Intrauterine pregnancy after salpingectomy for tubal pregnancy due to emergency contraception: a case report. Clinics (Sao Paulo) 2007; 62:641-2. [PMID: 17952328 DOI: 10.1590/s1807-59322007000500018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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